Yoshida Tsuneyasu, Nakashima Ran
Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Division of Clinical Immunology and Cancer Immunotherapy, Center for Cancer Immunotherapy and Immunobiology, Graduate School of Medicine, Kyoto University, 54 Shogoin-Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Curr Rheumatol Rep. 2025 May 5;27(1):23. doi: 10.1007/s11926-025-01188-7.
Anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive dermatomyositis (MDA5-DM) is a rare systemic autoimmune disease characterized by a clinically amyopathic presentation and a high-risk association with rapidly progressive interstitial lung disease. Although frequently fatal, the underlying mechanisms remain incompletely understood. This review provides a comprehensive summary of recent advances in research on MDA5-DM, aiming to deepen our understanding of its pathogenic mechanisms and to accelerate future basic research that will contribute to the development of novel therapeutic strategies.
Recent advancements have shed light on various aspects of this disease, including genetic and environmental factors contributing to disease susceptibility and the immunopathological processes and cytokine networks. Furthermore, significant progress has been made in understanding the pathogenicity, epitope recognition, and production mechanisms of anti-MDA5 antibodies, which have long been subjects of debate. On the therapeutic front, in addition to the conventional triple-combination regimen, emerging efficacy of JAK inhibitors and rituximab has been recognized. The development of biologics targeting lymphocytes offers additional hope for advancing therapeutic options. Advancing our understanding of the latest pathophysiological mechanisms of MDA5-DM is expected to pave the way for the development of safer and more effective therapeutic strategies.
抗黑色素瘤分化相关基因5(MDA5)抗体阳性皮肌炎(MDA5-DM)是一种罕见的系统性自身免疫性疾病,其特征为临床上无肌病表现且与快速进展性间质性肺病有高度风险关联。尽管该病常致命,但其潜在机制仍未完全明确。本综述全面总结了MDA5-DM研究的最新进展,旨在加深我们对其致病机制的理解,并加速未来有助于开发新治疗策略的基础研究。
近期进展揭示了该疾病的各个方面,包括导致疾病易感性的遗传和环境因素以及免疫病理过程和细胞因子网络。此外,在理解长期以来备受争议的抗MDA5抗体的致病性、表位识别和产生机制方面取得了重大进展。在治疗方面,除了传统的三联组合疗法外,JAK抑制剂和利妥昔单抗的新疗效已得到认可。靶向淋巴细胞的生物制剂的开发为推进治疗选择带来了更多希望。加深对MDA5-DM最新病理生理机制的理解有望为开发更安全、更有效的治疗策略铺平道路。