Universiti Sains Malaysia, School of Medical Sciences, Department of Immunology, 16150 Kubang Kerian, Kelantan, Malaysia.
Malays J Pathol. 2020 Dec;42(3):333-347.
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.
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。