靶向JAK/STAT通路治疗银屑病的潜力:聚焦酪氨酸激酶2抑制作用

Therapeutic Potential of Targeting the JAK/STAT Pathway in Psoriasis: Focus on TYK2 Inhibition.

作者信息

Dragotto Martina, D'Onghia Martina, Trovato Emanuele, Tognetti Linda, Rubegni Pietro, Calabrese Laura

机构信息

Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy.

Institute of Dermatology, Catholic University of the Sacred Heart, 00168 Rome, Italy.

出版信息

J Clin Med. 2024 May 24;13(11):3091. doi: 10.3390/jcm13113091.

Abstract

Psoriasis is an inflammatory skin disease with a chronic relapsing course and an often-detrimental impact on patients' quality of life. Thanks to incredible advances in research over the past few decades, the therapeutic armamentarium of psoriasis is now reasonably broad and structured, with several therapeutic agents that have demonstrated successful long-term control of this condition. However, there are still unfulfilled gaps resulting from the inherent limitations of existing therapies, which have paved the way for the identification of new therapeutic strategies or the improvement of existing ones. A great deal of attention has recently been paid to the JAK/STAT pathway, playing a crucial role in chronic inflammatory skin diseases, including psoriasis. Indeed, in a disease with such a complex pathogenesis, the possibility to antagonize multiple molecular pathways via JAK/STAT inhibition offers an undeniable therapeutic advantage. However, data from clinical trials evaluating the use of oral JAK inhibitors in immune-mediated disorders, such as RA, have arisen safety concerns, suggesting a potentially increased risk of class-specific AEs such as infections, venous thromboembolism, and malignancies. New molecules are currently under investigation for the treatment of psoriasis, such as deucravacitinib, an oral selective inhibitor that binds to the regulatory domain of TYK2, brepocitinib (PF-06700841) and PF-06826647 that bind to the active site in the catalytic domain. Due to the selective TYK2 blockade allowing the inhibition of key cytokine-mediated signals, such as those induced by IL-12 and IL-23, anti-TYK2 agents appear to be very promising as the safety profile seems to be superior compared with pan-JAK inhibitors. The aim of our review is to thoroughly explore the rationale behind the usage of JAK inhibitors in PsO, their efficacy and safety profiles, with a special focus on oral TYK2 inhibitors, as well as to provide a forward-looking update on novel therapeutic strategies targeting the TYK2 pathway in psoriasis.

摘要

银屑病是一种炎症性皮肤病,病程呈慢性复发性,常对患者的生活质量产生不利影响。得益于过去几十年研究取得的惊人进展,目前银屑病的治疗手段相当广泛且有条理,有多种治疗药物已证明能成功实现对该病的长期控制。然而,现有疗法的固有局限性仍导致一些未满足的差距,这为新治疗策略的识别或现有策略的改进铺平了道路。最近,JAK/STAT通路受到了极大关注,它在包括银屑病在内的慢性炎症性皮肤病中起关键作用。确实,在这样一种发病机制复杂的疾病中,通过JAK/STAT抑制拮抗多个分子通路的可能性提供了不可否认的治疗优势。然而,评估口服JAK抑制剂在类风湿关节炎等免疫介导疾病中应用的临床试验数据引发了安全担忧,提示存在特定类别不良事件(如感染、静脉血栓栓塞和恶性肿瘤)风险增加的可能性。目前正在研究用于治疗银屑病的新分子,如口服选择性抑制剂氘可来昔替尼,它与TYK2的调节域结合,还有巴瑞替尼(PF - 06700841)和PF - 06826647,它们与催化域的活性位点结合。由于选择性阻断TYK2可抑制关键细胞因子介导的信号,如由IL - 12和IL - 23诱导的信号,抗TYK2药物似乎非常有前景,因为其安全性似乎优于泛JAK抑制剂。我们综述的目的是深入探讨在银屑病中使用JAK抑制剂的原理、其疗效和安全性概况,特别关注口服TYK2抑制剂,并提供针对银屑病中TYK2通路的新型治疗策略的前瞻性更新。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4e66/11172692/c8f93c000c34/jcm-13-03091-g001.jpg

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