Müller-Ladner Ulf, Frommer Klaus, Karrasch Thomas, Neumann Elena, Schäffler Andreas
Abteilung für Rheumatologie und Klinische Immunologie, Justus-Liebig-Universität Gießen, Campus Kerckhoff, Benekestr. 2-8, 61231, Bad Nauheim, Deutschland.
Klinik und Poliklinik für Innere Medizin III - Endokrinologie und Diabetologie, Justus-Liebig Universität Gießen, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland.
Z Rheumatol. 2021 May;80(4):353-361. doi: 10.1007/s00393-021-00987-4. Epub 2021 Mar 27.
One of the most recent scientific fields is the interaction between the immune system and metabolic processes. These interactions increasingly involve intracellular and extracellular signaling molecules and their receptors as well as molecular mechanisms that are used by both systems. The result of these intensive interactions is characterized by the term "metaflammation" and involves in particular, the ubiquitous adipose tissue present throughout the body. The links identified to date between the immune system and metabolism play a greater role in inflammatory rheumatic joint diseases than previously thought. In general, a markedly high body mass index (BMI) in particular, is associated with increased inflammatory activity and this is independent of the underlying disease entity. A higher BMI at the beginning of an immunomodulatory therapy also causes a more difficult response to the medication. Thus, the current scientific objective is to identify the individual "immuno-metabolic" pathways in order to apply the medications specifically to the site of action. Furthermore, all newer therapeutic agents, especially those specifically acting against individual immunological molecules, should be systematically analyzed with respect to their metabolic concomitant effects and their influence on metabolic comorbidities.
最新的科学领域之一是免疫系统与代谢过程之间的相互作用。这些相互作用越来越多地涉及细胞内和细胞外信号分子及其受体，以及两个系统都使用的分子机制。这些密集相互作用的结果以“代谢性炎症”一词为特征，尤其涉及遍布全身的普遍存在的脂肪组织。迄今为止，在免疫系统和新陈代谢之间发现的联系在炎症性风湿性关节疾病中所起的作用比以前认为的更大。一般来说，特别是明显较高的体重指数（BMI）与炎症活动增加有关，这与潜在的疾病实体无关。免疫调节治疗开始时较高的BMI也会导致对药物的反应更困难。因此，当前的科学目标是确定个体的“免疫代谢”途径，以便将药物特异性地应用于作用部位。此外，所有新型治疗药物，尤其是那些特异性作用于单个免疫分子的药物，都应就其代谢伴随效应及其对代谢合并症的影响进行系统分析。
