Nephrology and Kidney Transplantation Unit. Vall D'Hebron University Hospital, Barcelona. Spain.
University of Barcelona. Department of Clinical Sciences. Barcelona. Spain.
Best Pract Res Clin Gastroenterol. 2021 Oct-Dec;54-55:101757. doi: 10.1016/j.bpg.2021.101757. Epub 2021 Jun 16.
The innate and adaptive immune systems work as a complex interplay between different cell types, involving cytokines and chemokines mediating extracellular and paracrine effects. At the intracellular level, the inflammatory cascade is mediated by multifaceted processes that have been better described in the last 10 years. Immunosuppressive agents available in clinical practice act at different points of those cascades at the intracellular or extracellular level. Those drugs can mediate their effects on one or more cell types finally limiting inflammation and immune responses to antigens. Every immunosuppressive agent is characterized by intrinsic toxicity and side effects that may be due to the same therapeutic pathways or to off-target secondary effect of each molecule. We will here review the mechanisms of action of the most widely used immunosuppressive agents in the field of solid organ transplantation and autoimmune disorders, describing the mechanisms underlying both the therapeutic and secondary effects.
先天免疫系统和适应性免疫系统通过不同细胞类型之间的复杂相互作用发挥作用，其中细胞因子和趋化因子介导细胞外和旁分泌效应。在细胞内水平，炎症级联反应由多方面的过程介导，这些过程在过去 10 年中得到了更好的描述。临床实践中可用的免疫抑制剂作用于细胞内或细胞外水平的这些级联反应的不同点。这些药物可以通过一种或多种细胞类型来发挥作用，最终限制抗原引起的炎症和免疫反应。每种免疫抑制剂都有其内在的毒性和副作用，这些副作用可能是由于相同的治疗途径，也可能是由于每个分子的非靶向次要效应。我们将在这里回顾在实体器官移植和自身免疫性疾病领域中最广泛使用的免疫抑制剂的作用机制，描述治疗作用和次要作用的潜在机制。
