Fukuda Tomohiro, Naganuma Makoto, Kanai Takanori
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.
Intest Res. 2019 Jan;17(1):36-44. doi: 10.5217/ir.2018.00126. Epub 2019 Jan 25.
Ulcerative colitis (UC) is a chronic inflammatory condition of the gastrointestinal tract. Although the cause of UC is postulated to be multifactorial in nature, including genetic predisposition, epithelial barrier defects, dysregulation of immune responses, and environmental factors, the specific pathogenesis of UC is still incompletely understood. In the treatment of UC so far, a method of suppressing immunity and treating it has been mainstream. Immunosuppressant drugs, including thiopurines (azathioprine or 6-mercaptopurine), anti-tumor necrosis factor-α (anti-TNF-α) antibody (infliximab and adalimumab), and calcineurin inhibitor, can be used in treat patients with corticosteroid-dependent and/or corticosteroid-refractory moderateto- severe UC. Recently, in addition to such a conventional therapeutic agent, golimumab, which is the first transgenic human monoclonal anti-TNF-α antibody to be fabricated, anti α-4/β-7 integrin antibody, and Janus kinase inhibitor have been reported to novel immunosuppressant therapy. Furthermore, other treatments with unique mechanisms different from immunosuppression, have also been suggested, including fecal microbiota transplantation and Indigo naturalis, which is a Chinese herbal medicine. We compared the features and efficacy of these new treatments. In this issue, the features and treatment options for these new treatments is reviewed.
溃疡性结肠炎（UC）是一种胃肠道的慢性炎症性疾病。尽管UC的病因被认为本质上是多因素的，包括遗传易感性、上皮屏障缺陷、免疫反应失调和环境因素，但UC的具体发病机制仍未完全了解。在迄今为止的UC治疗中，抑制免疫的治疗方法一直是主流。免疫抑制药物，包括硫嘌呤类药物（硫唑嘌呤或6-巯基嘌呤）、抗肿瘤坏死因子-α（抗TNF-α）抗体（英夫利昔单抗和阿达木单抗）以及钙调神经磷酸酶抑制剂，可用于治疗依赖糖皮质激素和/或对糖皮质激素难治的中度至重度UC患者。最近，除了这种传统治疗药物外，已报道首个制备的转基因人源单克隆抗TNF-α抗体戈利木单抗、抗α-4/β-7整合素抗体和Janus激酶抑制剂为新型免疫抑制疗法。此外，还提出了其他与免疫抑制机制不同的独特治疗方法，包括粪便微生物群移植和中药青黛。我们比较了这些新疗法的特点和疗效。在本期中，对这些新疗法的特点和治疗选择进行了综述。
