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宿主导向疗法:调节炎症以治疗结核病。

Host-Directed Therapies: Modulating Inflammation to Treat Tuberculosis.

机构信息

Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, United States.

出版信息

Front Immunol. 2021 Apr 19;12:660916. doi: 10.3389/fimmu.2021.660916. eCollection 2021.

Abstract

Following infection with , the causative agent of tuberculosis (TB), most human hosts are able to contain the infection and avoid progression to active TB disease through expression of a balanced, homeostatic immune response. Proinflammatory mechanisms aiming to kill, slow and sequester the pathogen are key to a successful host response. However, an excessive or inappropriate pro-inflammatory response may lead to granuloma enlargement and tissue damage, which may prolong the TB treatment duration and permanently diminish the lung function of TB survivors. The host also expresses certain anti-inflammatory mediators which may play either beneficial or detrimental roles depending on the timing of their deployment. The balance between the timing and expression levels of pro- and anti-inflammatory responses plays an important role in the fate of infection. Interestingly, appears to manipulate both sides of the human immune response to remodel the host environment for its own benefit. Consequently, therapies which modulate either end of this spectrum of immune responses at the appropriate time may have the potential to improve the treatment of TB or to reduce the formation of permanent lung damage after microbiological cure. Here, we highlight host-directed TB therapies targeting pro- or anti-inflammatory processes that have been evaluated in pre-clinical models. The repurposing of already available drugs known to modulate these responses may improve the future of TB therapy.

摘要

在感染结核分枝杆菌(TB)后,大多数宿主能够通过表达平衡、稳态的免疫反应来控制感染,避免发展为活动性结核病。旨在杀死、减缓和隔离病原体的促炎机制是宿主成功反应的关键。然而,过度或不适当的促炎反应可能导致肉芽肿增大和组织损伤,这可能延长结核病治疗时间并永久降低结核病幸存者的肺功能。宿主还表达某些抗炎介质,其根据其部署的时间可能发挥有益或有害的作用。促炎和抗炎反应的平衡在感染的命运中起着重要作用。有趣的是,似乎操纵了人类免疫反应的两面,为自身利益重塑宿主环境。因此,在适当的时间以调节免疫反应谱两端的疗法有可能改善结核病的治疗效果,或减少微生物学治愈后永久性肺损伤的形成。在这里,我们重点介绍了针对促炎或抗炎过程的宿主定向结核病治疗方法,这些方法已在临床前模型中进行了评估。重新利用已知能够调节这些反应的现有药物可能会改善结核病治疗的未来。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2f11/8089478/a801c41c1a80/fimmu-12-660916-g001.jpg

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