Ceribelli Angela, De Santis Maria, Selmi Carlo
Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy.
BIOMETRA Department, University of Milan, Italy.
Mediterr J Rheumatol. 2019 Sep 30;30(3):162-166. doi: 10.31138/mjr.30.3.162. eCollection 2019 Sep.
The ultimate goal of modern medicine is a personalized approach being tailored on the single patient, ie, tailored, based on a finely tuned definition of the immunogenetics, epigenetics, microbiome, and biomarkers, to maximize results and minimize risks particularly of new targeted treatments. Among individual factors around which to tailor the patient management are sex and age, with gender-medicine finally becoming central to the research agenda. Of note, we are not convinced that a whole personalized medicine approach in its current form will necessarily include gender medicine and thus this should remain central to the research agenda. To tackle this crucial issue, however, we should first be able to answer a question of paramount importance, that is, why does autoimmunity affect women more than men? The growing number of experimental works in this area militate against an easy answer to this question, but we will herein briefly discuss four major candidates (sex hormones, sex chromosomes, environmental factors, and the microbiome) to which some unsuspected others may be ancillary.
现代医学的最终目标是针对个体患者采取个性化方法，即基于对免疫遗传学、表观遗传学、微生物组和生物标志物的精确界定进行定制，以实现疗效最大化，尤其是新型靶向治疗的疗效最大化，并将风险降至最低。在围绕患者管理进行定制的个体因素中，性别和年龄是其中之一，性别医学最终成为研究议程的核心。值得注意的是，我们并不确信当前形式的整个个性化医疗方法必然会涵盖性别医学，因此性别医学仍应是研究议程的核心。然而，为解决这一关键问题，我们首先应能够回答一个至关重要的问题，即自身免疫为何对女性的影响大于男性？该领域越来越多的实验研究表明，这个问题并非能轻易作答，但我们将在此简要讨论四个主要因素（性激素、性染色体、环境因素和微生物组），可能还有一些未被怀疑的其他因素与之相关。
