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IL-23/IL-17 轴在系统性红斑狼疮和类风湿关节炎发病机制及治疗中的作用。

IL-23/IL-17 axis in the pathogenesis and treatment of systemic lupus erythematosus and rheumatoid arthritis.

机构信息

Universiti Sains Malaysia, School of Medical Sciences, Department of Immunology, 16150 Kubang Kerian, Kelantan, Malaysia.

出版信息

Malays J Pathol. 2020 Dec;42(3):333-347.

Abstract

Interleukin-23 (IL-23) and IL-17 are the gatekeepers of CD4+ T helper 17 (Th17) cells where IL-23 is required for the development and expansion of Th17 cells that subsequently produce IL-17 to promote inflammation. Owing to such pro-inflammatory properties, the IL-23/IL-17 axis has emerged as an important mechanism in the pathogenesis of autoimmune diseases including systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). In recent years, therapeutic antibodies targeting IL-23 (e.g. ustekinumab, tildrakizumab, guselkumab) or IL-17 (e.g. brodalumab, secukinumab, ixekizumab) have been approved for the treatment of various autoimmune diseases. In this review, we describe the pathogenic mechanisms of IL-23/IL-17 axis in SLE and RA, as well as summarising the findings from phase II and III clinical trials of anti-IL-23/IL-17 therapeutic antibodies in SLE and RA patients. In particular, phase II study has demonstrated that the anti-IL-23 antibody (ustekinumab) confers enhanced treatment outcomes in SLE patients, while anti-IL-17 antibodies (secukinumab and ixekizumab) have shown improved clinical benefits for RA patients in phase II/III studies. Our review highlights the emerging importance of targeting the IL-23/IL-17 axis in SLE and RA patients.

摘要

白细胞介素-23(IL-23)和白细胞介素-17(IL-17)是辅助性 T 细胞 17(Th17)细胞的“守门员”,其中 IL-23 是 Th17 细胞发育和扩增所必需的,而 Th17 细胞随后会产生 IL-17 以促进炎症。由于这种促炎特性,IL-23/IL-17 轴已成为包括系统性红斑狼疮(SLE)和类风湿关节炎(RA)在内的自身免疫性疾病发病机制中的重要机制。近年来,靶向 IL-23(如乌司奴单抗、替度鲁单抗、古塞库单抗)或 IL-17(如布罗达单抗、司库奇尤单抗、依奇珠单抗)的治疗性抗体已被批准用于治疗各种自身免疫性疾病。在这篇综述中,我们描述了 IL-23/IL-17 轴在 SLE 和 RA 中的发病机制,并总结了 SLE 和 RA 患者中抗 IL-23/IL-17 治疗性抗体的 II 期和 III 期临床试验结果。特别是,II 期研究表明,抗 IL-23 抗体(乌司奴单抗)可改善 SLE 患者的治疗效果,而抗 IL-17 抗体(司库奇尤单抗和依奇珠单抗)在 II/III 期研究中显示出改善 RA 患者的临床获益。我们的综述强调了靶向 SLE 和 RA 患者的 IL-23/IL-17 轴的重要性日益增加。

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