减轻炎症性肠病:灭火并防止病情隐匿发展
DAMP-ing IBD: Extinguish the Fire and Prevent Smoldering.
作者信息
Sandys Oliver, Stokkers Pieter C F, Te Velde Anje A
机构信息
Tytgat Institute for Liver and Intestinal Research, AmsterdamUMC, AGEM, University of Amsterdam, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, OLVG West, Amsterdam, The Netherlands.
出版信息
Dig Dis Sci. 2025 Jan;70(1):49-73. doi: 10.1007/s10620-024-08523-5. Epub 2024 Jul 4.
In inflammatory bowel diseases (IBD), the most promising therapies targeting cytokines or immune cell trafficking demonstrate around 40% efficacy. As IBD is a multifactorial inflammation of the intestinal tract, a single-target approach is unlikely to solve this problem, necessitating an alternative strategy that addresses its variability. One approach often overlooked by the pharmaceutically driven therapeutic options is to address the impact of environmental factors. This is somewhat surprising considering that IBD is increasingly viewed as a condition heavily influenced by such factors, including diet, stress, and environmental pollution-often referred to as the "Western lifestyle". In IBD, intestinal responses result from a complex interplay among the genetic background of the patient, molecules, cells, and the local inflammatory microenvironment where danger- and microbe-associated molecular patterns (D/MAMPs) provide an adjuvant-rich environment. Through activating DAMP receptors, this array of pro-inflammatory factors can stimulate, for example, the NLRP3 inflammasome-a major amplifier of the inflammatory response in IBD, and various immune cells via non-specific bystander activation of myeloid cells (e.g., macrophages) and lymphocytes (e.g., tissue-resident memory T cells). Current single-target biological treatment approaches can dampen the immune response, but without reducing exposure to environmental factors of IBD, e.g., by changing diet (reducing ultra-processed foods), the adjuvant-rich landscape is never resolved and continues to drive intestinal mucosal dysregulation. Thus, such treatment approaches are not enough to put out the inflammatory fire. The resultant smoldering, low-grade inflammation diminishes physiological resilience of the intestinal (micro)environment, perpetuating the state of chronic disease. Therefore, our hypothesis posits that successful interventions for IBD must address the complexity of the disease by simultaneously targeting all modifiable aspects: innate immunity cytokines and microbiota, adaptive immunity cells and cytokines, and factors that relate to the (micro)environment. Thus the disease can be comprehensively treated across the nano-, meso-, and microscales, rather than with a focus on single targets. A broader perspective on IBD treatment that also includes options to adapt the DAMPing (micro)environment is warranted.
在炎症性肠病(IBD)中,针对细胞因子或免疫细胞迁移的最有前景的疗法显示出约40%的疗效。由于IBD是肠道的多因素炎症,单一靶点方法不太可能解决这个问题,因此需要一种能应对其变异性的替代策略。药物驱动的治疗选择常常忽视的一种方法是解决环境因素的影响。考虑到IBD越来越被视为受此类因素严重影响的疾病,包括饮食、压力和环境污染——通常被称为“西方生活方式”,这有点令人惊讶。在IBD中,肠道反应是患者的遗传背景、分子、细胞以及局部炎症微环境之间复杂相互作用的结果,其中危险和微生物相关分子模式(D/MAMPs)提供了一个富含佐剂的环境。通过激活DAMP受体,这一系列促炎因子可刺激,例如,NLRP3炎性小体——IBD中炎症反应的主要放大器,以及通过髓样细胞(如巨噬细胞)和淋巴细胞(如组织驻留记忆T细胞)的非特异性旁观者激活作用刺激各种免疫细胞。当前的单靶点生物治疗方法可以抑制免疫反应,但如果不通过改变饮食(减少超加工食品)等方式减少IBD患者接触环境因素,富含佐剂的环境就永远无法解决,并继续驱动肠道黏膜失调。因此,此类治疗方法不足以扑灭炎症之火。由此产生的闷烧、低度炎症会削弱肠道(微)环境的生理恢复力,使慢性病状态持续存在。因此,我们的假设是,IBD的成功干预必须通过同时针对所有可改变的方面来应对疾病的复杂性:先天免疫细胞因子和微生物群、适应性免疫细胞和细胞因子,以及与(微)环境相关的因素。这样,疾病就可以在纳米、中观和微观尺度上得到全面治疗,而不是专注于单一靶点。对IBD治疗需要有更广泛的视角,其中也应包括调整DAMPing(微)环境的选择。