Perspectives on Mycophenolate Mofetil in the Management of Autoimmunity.

IF 8.4 2区 医学 Q1 ALLERGY Clinical Reviews in Allergy & Immunology Pub Date : 2023-08-01 DOI:10.1007/s12016-023-08963-3
Rithika Bhat, Antonio Tonutti, Suraj Timilsina, Carlo Selmi, M Eric Gershwin
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引用次数: 1

Abstract

Before becoming a cornerstone in the treatment of numerous immune-mediated diseases, mycophenolate mofetil (MMF) was first introduced as an immunosuppressive agent in transplant immunology and later received the attention of rheumatologists and clinicians involved in the management of autoimmune diseases. MMF is now a widespread immunosuppressive drug for the treatment of several conditions, including lupus nephritis, interstitial lung disease associated with systemic sclerosis, and anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis while being efficacious also as rescue therapy in various orphan diseases, including dermatomyositis and IgA-associated nephropathy. Similarly, case reports or series support a possible use of MMF in other rare autoimmune diseases. Beyond modulating lymphocyte activation, MMF acts on other immune and non-immune cells and these effects may explain the therapeutic profile of this medication. The effects of MMF are broadly characterized by the impact on the immune system and the antiproliferative and antifibrotic changes induced. In this latter case, mechanistic data on fibroblasts may in the future allow to reevaluate the use of MMF in selected patients with inflammatory arthritis or systemic sclerosis. Attention must be paid towards the possible occurrence of adverse events, such as gastrointestinal complaints and teratogenicity, while the risk of infections and cancer related to MMF needs to be further investigated.

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霉酚酸酯在自身免疫管理中的应用前景。
在成为许多免疫介导疾病治疗的基石之前,霉酚酸酯(MMF)首先作为移植免疫学中的免疫抑制剂引入,后来受到风湿病学家和参与自身免疫性疾病管理的临床医生的关注。MMF现在是一种广泛的免疫抑制药物,用于治疗多种疾病,包括狼疮肾炎,与系统性硬化症相关的间质性肺疾病,以及抗中性粒细胞胞质抗体(ANCA)相关的血管炎,同时也有效地作为各种孤儿疾病的救援治疗,包括皮肌炎和iga相关肾病。同样,病例报告或系列报道支持MMF在其他罕见自身免疫性疾病中的可能应用。除了调节淋巴细胞活化外,MMF还作用于其他免疫和非免疫细胞,这些作用可以解释这种药物的治疗效果。MMF的作用主要表现在对免疫系统的影响以及诱导的抗增殖和抗纤维化变化。在后一种情况下,成纤维细胞的机制数据可能在未来允许重新评估MMF在炎性关节炎或系统性硬化症患者中的使用。必须注意可能发生的不良事件,如胃肠道不适和致畸,同时需要进一步调查与MMF相关的感染和癌症风险。
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来源期刊
CiteScore
22.30
自引率
1.10%
发文量
58
审稿时长
6-12 weeks
期刊介绍: Clinical Reviews in Allergy & Immunology is a scholarly journal that focuses on the advancement of clinical management in allergic and immunologic diseases. The journal publishes both scholarly reviews and experimental papers that address the current state of managing these diseases, placing new data into perspective. Each issue of the journal is dedicated to a specific theme of critical importance to allergists and immunologists, aiming to provide a comprehensive understanding of the subject matter for a wide readership. The journal is particularly helpful in explaining how novel data impacts clinical management, along with advancements such as standardized protocols for allergy skin testing and challenge procedures, as well as improved understanding of cell biology. Ultimately, the journal aims to contribute to the improvement of care and management for patients with immune-mediated diseases.
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