Straub Rainer H, Pongratz Georg, Buttgereit Frank, Gaber Timo
Labor für Experimentelle Rheumatologie und Neuroendokrin-Immunologie, Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland.
Abteilung für Rheumatologie, Klinik für Gastroenterologie, Krankenhaus Barmherzige Brüder Regensburg, 93049, Regensburg, Deutschland.
Z Rheumatol. 2023 Aug;82(6):479-490. doi: 10.1007/s00393-023-01389-4. Epub 2023 Jul 24.
Energy is the currency of life. The systemic and intracellular energy metabolism plays an essential role for the energy supply of the resting and activated immune system and this also applies to chronic inflammatory diseases.
This presentation examines both components of the systemic and cellular energy metabolism in health and chronic inflammation.
A literature search was conducted using PubMed, Embase and the Cochrane Library. The information is presented in the form of a narrative review.
A chronically activated immune system acquires large amounts of energy-rich substrates that are lost for other functions of the body. In particular, the immune system and the brain are in competition. The consequences of this competition are many known diseases, such as fatigue, anxiety, depression, anorexia, sleep problems, sarcopenia, osteoporosis, insulin resistance, hypertension and others. The permanent change in the brain causes long-term alterations that stimulate disease sequelae even after disease remission. In the intracellular energy supply, chronic inflammation typically involves a conversion to glycolysis (to lactate, which has its own regulatory functions) and the pentose phosphate pathway in disorders of mitochondrial function. The chronic changes in immune cells of patients with rheumatoid arthritis (RA) lead to a disruption of the citric acid cycle (Krebs cycle). The hypoxic situation in the inflamed tissue stimulates many alterations. A differentiation is made between effector functions and regulatory functions of immune cells.
Based on the energy changes mentioned, novel treatment suggestions can be made in addition to those already known in energy metabolism.
能量是生命的货币。全身和细胞内的能量代谢对于静息和激活状态下的免疫系统的能量供应起着至关重要的作用，这同样适用于慢性炎症性疾病。
本报告探讨了健康和慢性炎症状态下全身及细胞能量代谢的两个组成部分。
使用PubMed、Embase和Cochrane图书馆进行文献检索。信息以叙述性综述的形式呈现。
慢性激活的免疫系统获取大量富含能量的底物，而这些底物会从身体的其他功能中流失。特别是，免疫系统和大脑存在竞争关系。这种竞争的后果是许多已知疾病，如疲劳、焦虑、抑郁、厌食、睡眠问题、肌肉减少症、骨质疏松症、胰岛素抵抗、高血压等。大脑的长期变化会导致长期改变，即使在疾病缓解后也会刺激疾病后遗症。在细胞内能量供应方面，慢性炎症通常涉及在线粒体功能紊乱时向糖酵解（生成具有自身调节功能的乳酸）和磷酸戊糖途径的转变。类风湿性关节炎（RA）患者免疫细胞的慢性变化会导致柠檬酸循环（克雷布斯循环）的破坏。炎症组织中的缺氧情况会引发许多改变。免疫细胞的效应功能和调节功能有所不同。
基于上述能量变化，除了能量代谢中已有的已知治疗建议外，还可以提出新的治疗建议。
