调节性T细胞和转谷氨酰胺酶2抑制剂在乳糜泻中的作用:一项系统评价。

Role of Regulatory T Cells and Transglutaminase 2 Inhibitors in Celiac Disease: A Systematic Review.

作者信息

Javed Ayesha, Saeed Amina, Akhtar Ayesha, Khalid Amna, Khan Amna Saleem, Rabba Waseem

机构信息

Pediatric Medicine, M. Islam Teaching Hospital, Gujranwala, PAK.

Obstetrics and Gynecology, Bhatti International Teaching Hospital, Kasur, PAK.

出版信息

Cureus. 2025 May 27;17(5):e84901. doi: 10.7759/cureus.84901. eCollection 2025 May.

Abstract

Celiac disease is an autoimmune disorder triggered by the ingestion of gluten in genetically predisposed individuals, leading to chronic intestinal inflammation and damage to the small intestinal lining (villus atrophy). While a strict gluten-free diet remains the primary treatment, emerging therapies targeting the immune response offer promising alternatives. This review focuses on the therapeutic potential of transglutaminase 2 (TG2) inhibitors, enzymes that, when overactive, contribute to immune system attacks on the gut, and regulatory T cells (Tregs), specialized immune cells that help calm down excessive immune reactions. This systematic review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Literature was searched across PubMed, Embase, and the Cochrane Library using both text terms and controlled vocabulary with Boolean operators ("AND," "OR"). We included full-text, open-access, English-language articles published between 2005 and 2025. The methodological quality of studies was assessed using the Mixed Methods Appraisal Tool. A total of 68 articles were initially identified. After screening and applying inclusion criteria, 14 studies were included in the final analysis. Among them, eight studies were rated as high quality (low risk of bias), while six were of moderate quality (uncertain risk of bias). TG2 inhibitors showed promising effects such as improved intestinal structure (villous architecture), reduced gastrointestinal symptoms, stabilized immune cell levels in the gut, and decreased activation of gluten-specific immune cells (CD4+ T cells). Treg therapies also demonstrated the ability to reduce inflammation by limiting the production of harmful immune signals such as interferon-gamma and interleukin-21. The findings highlight the therapeutic potential of TG2 inhibitors and Treg-based treatments in managing celiac disease by directly targeting the immune response. While preliminary results are promising, further clinical research is needed to confirm their effectiveness and safety for routine clinical use.

摘要

乳糜泻是一种自身免疫性疾病,在具有遗传易感性的个体中,摄入麸质会引发该病,导致慢性肠道炎症和小肠内壁损伤(绒毛萎缩)。虽然严格的无麸质饮食仍然是主要治疗方法,但针对免疫反应的新兴疗法提供了有前景的替代方案。本综述重点关注转谷氨酰胺酶2(TG2)抑制剂和调节性T细胞(Tregs)的治疗潜力,TG2是一种酶,过度活跃时会促使免疫系统攻击肠道,而Tregs是专门的免疫细胞,有助于平息过度的免疫反应。本系统综述遵循系统评价和Meta分析的首选报告项目指南。使用文本术语和带有布尔运算符(“AND”、“OR”)的控制词汇在PubMed、Embase和Cochrane图书馆中检索文献。我们纳入了2005年至2025年发表的全文、开放获取的英文文章。使用混合方法评估工具评估研究的方法学质量。最初共识别出68篇文章。经过筛选并应用纳入标准后,最终分析纳入了14项研究。其中,8项研究被评为高质量(低偏倚风险),6项为中等质量(偏倚风险不确定)。TG2抑制剂显示出有前景的效果,如改善肠道结构(绒毛结构)、减轻胃肠道症状、稳定肠道中的免疫细胞水平以及减少麸质特异性免疫细胞(CD4 + T细胞)的活化。Treg疗法也证明了通过限制干扰素-γ和白细胞介素-21等有害免疫信号的产生来减轻炎症的能力。这些发现突出了TG2抑制剂和基于Tregs的治疗方法通过直接针对免疫反应来管理乳糜泻的治疗潜力。虽然初步结果很有前景,但需要进一步的临床研究来证实它们在常规临床使用中的有效性和安全性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/92b5/12199851/bf025cc62a54/cureus-0017-00000084901-i01.jpg

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