Institute of Clinical Chemistry, University Hospital Schleswig-Holstein Kiel and Lübeck, Germany; Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
Rev Neurol (Paris). 2024 Nov;180(9):888-894. doi: 10.1016/j.neurol.2024.08.005. Epub 2024 Sep 19.
There is a need to improve therapies in autoimmune neurologic conditions. Yet which strategic objectives are required, what are the barriers that stand before reaching them, and what are the options to address them? This article tries to summarize these objectives and their respective barriers. It discusses the difficulties in identifying molecular targets, biomarker-defined subgroups, the merits of upstream and downstream-targeted therapies, the need to develop autoreactivity-specific treatments in contrast to cell-type specific therapies, and the "evidence-bottleneck". Its focus is on autoantigen-specific autoimmunopathies in neurology. It also discusses the role of B- and T-cells in autoimmune neurology and how these can be exploited therapeutically. Finally, it argues for improved training of present and future neuroimmunologists.
在自身免疫性神经疾病中，需要改进治疗方法。然而，需要确定哪些战略目标，在实现这些目标之前存在哪些障碍，以及可以采取哪些措施来解决这些障碍？本文试图总结这些目标及其各自的障碍。它讨论了在确定分子靶点、生物标志物定义的亚组、上游和下游靶向治疗的优点、在针对细胞类型特异性治疗的基础上开发自身反应性特异性治疗的必要性，以及“证据瓶颈”等方面所面临的困难。它的重点是神经科自身抗原特异性自身免疫性疾病。它还讨论了 B 细胞和 T 细胞在自身免疫性神经病学中的作用以及如何从治疗角度利用这些细胞。最后，它呼吁加强对现有和未来神经免疫学家的培训。
