Vischer T L
Division of Rheumatology, Hopital Cantonal Universitaire, Geneve, Switzerland.
Z Rheumatol. 1995 May-Jun;54(3):155-7.
Oral desensitization or oral tolerance is induced by giving antigenic peptides by the mucosal route. In man only the oral route has been used up to now. Experiments in animal models of human autoimmune diseases, have shown that it is not necessary to use the primary antigen responsible for disease induction. Antigens implicated in secondary immune phenomenon can act similarly by means of the so-called "bystander suppression". Thus for diseases such as multiple sclerosis (MS) and rheumatoid arthritis (RA) candidate antigens for desensitization are available. Many patients with MS have immunity to myelin basic protein (MBP). A recent controlled trial giving MBP to patients with MS is discussed (Weiner et al., Science 259, p. 1321, 1993). No clear-cut effect was obtained. Collagen II is used to induce experimental arthritis in rats; signs of immunity against it can be found in patients with RA. Collagen-induced arthritis has been successfully modified in animals by feeding of collagen II. In man one open uncontrolled trial and one other placebo controlled blind trial have been reported, and these are discussed (Trentham et al., Science 261, 1727, 1993). These trials suggest that oral desensitization might be useful and devoid of side effects. Subreum is a peptic E. coli extract containing heat shock protein 60. Its efficacy as a disease-controlling agent in RA has been documented (Clin. Exp. Rheum. 11, p. 121, 1993). It is given orally. Data suggesting that Subreum acts by oral desensitization are discussed. Considering the low incidence of side effects observed with oral desensitization, this therapeutic approach should also be tested in other forms of arthritis and other inflammatory diseases.
口服脱敏或口服耐受是通过黏膜途径给予抗原肽诱导产生的。到目前为止，在人类中仅采用了口服途径。在人类自身免疫性疾病的动物模型实验中，已表明无需使用引发疾病的主要抗原。与继发性免疫现象相关的抗原可通过所谓的“旁观者抑制”发挥类似作用。因此，对于诸如多发性硬化症（MS）和类风湿关节炎（RA）等疾病，有可用于脱敏的候选抗原。许多MS患者对髓鞘碱性蛋白（MBP）具有免疫力。讨论了一项近期针对MS患者给予MBP的对照试验（韦纳等人，《科学》259卷，第1321页，1993年）。未获得明确效果。胶原蛋白II用于诱导大鼠实验性关节炎；RA患者体内可发现针对它的免疫迹象。通过喂食胶原蛋白II，已成功在动物身上改变了胶原蛋白诱导的关节炎。在人类中，已报道了一项开放的非对照试验和另一项安慰剂对照的盲法试验，并对其进行了讨论（特伦瑟姆等人，《科学》261卷，第1727页，1993年）。这些试验表明口服脱敏可能有用且无副作用。Subreum是一种含有热休克蛋白60的消化性大肠杆菌提取物。其作为RA疾病控制剂的功效已有文献记载（《临床与实验风湿病学》11卷，第121页，1993年）。它通过口服给药。讨论了表明Subreum通过口服脱敏起作用的数据。鉴于口服脱敏观察到的副作用发生率较低，这种治疗方法也应在其他形式的关节炎和其他炎症性疾病中进行测试。
