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Tailoring the treatment of inflammatory rheumatic diseases by a better stratification and characterization of the clinical patient heterogeneity. Findings from a systematic literature review and experts' consensus 通过对临床患者的异质性进行更好的分层和定性,对炎症性风湿病进行量身定制的治疗。系统文献综述和专家共识的结果。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103581
Piero Ruscitti , Yannick Allanore , Chiara Baldini , Giuseppe Barilaro , Elena Bartoloni Bocci , Pietro Bearzi , Elisa Bellis , Onorina Berardicurti , Alice Biaggi , Michele Bombardieri , Luca Cantarini , Francesco Paolo Cantatore , Roberto Caporali , Francesco Caso , Ricard Cervera , Francesco Ciccia , Paola Cipriani , Loukas Chatzis , Serena Colafrancesco , Fabrizio Conti , Roberto Giacomelli

Inflammatory rheumatic diseases are different pathologic conditions associated with a deregulated immune response, codified along a spectrum of disorders, with autoinflammatory and autoimmune diseases as two-end phenotypes of this continuum. Despite pathogenic differences, inflammatory rheumatic diseases are commonly managed with a limited number of immunosuppressive drugs, sometimes with partial evidence or transferring physicians' knowledge in different patients. In addition, several randomized clinical trials, enrolling these patients, did not meet the primary pre-established outcomes and these findings could be linked to the underlying molecular diversities along the spectrum of inflammatory rheumatic disorders. In fact, the resulting patient heterogeneity may be driven by differences in underlying molecular pathology also resulting in variable responses to immunosuppressive drugs. Thus, the identification of different clinical subsets may possibly overcome the major obstacles that limit the development more effective therapeutic strategies for these patients with inflammatory rheumatic diseases. This clinical heterogeneity could require a diverse therapeutic management to improve patient outcomes and increase the frequency of clinical remission. Therefore, the importance of better patient stratification and characterization is increasingly pointed out according to the precision medicine principles, also suggesting a new approach for disease treatment. In fact, based on a better proposed patient profiling, clinicians could more appropriately balance the therapeutic management. On these bases, we synthetized and discussed the available literature about the patient profiling in regard to therapy in the context of inflammatory rheumatic diseases, mainly focusing on randomized clinical trials. We provided an overview of the importance of a better stratification and characterization of the clinical heterogeneity of patients with inflammatory rheumatic diseases identifying this point as crucial in improving the management of these patients.

炎症性风湿病是与免疫反应失调有关的不同病理状态,按照疾病谱分类,自身炎症性疾病和自身免疫性疾病是这一连续统一体的两端表型。尽管致病原因不同,但炎症性风湿病通常使用数量有限的免疫抑制药物进行治疗,有时证据不足或医生对不同患者的认识存在差异。此外,有几项随机临床试验招募了这些患者,但并没有达到预设的主要结果,这些结果可能与炎症性风湿病的潜在分子多样性有关。事实上,患者的异质性可能是由潜在的分子病理学差异引起的,这也导致了对免疫抑制剂的不同反应。因此,确定不同的临床亚群可能会克服限制为这些炎症性风湿病患者制定更有效治疗策略的主要障碍。这种临床异质性可能需要多样化的治疗管理,以改善患者的预后,增加临床缓解的频率。因此,越来越多的人指出,根据精准医学原则对患者进行更好的分层和特征描述非常重要,这也为疾病治疗提出了一种新方法。事实上,基于更好的患者特征描述,临床医生可以更恰当地平衡治疗管理。在此基础上,我们综合并讨论了有关炎症性风湿病治疗中患者特征描述的现有文献,主要侧重于随机临床试验。我们概述了对炎症性风湿病患者的临床异质性进行更好的分层和特征描述的重要性,认为这一点对于改善这些患者的治疗至关重要。
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引用次数: 0
Gut-tropic T cells and extra-intestinal autoimmune diseases 肠道T细胞与肠道外自身免疫性疾病
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103544

Gut-tropic T cells primarily originate from gut-associated lymphoid tissue (GALT), and gut-tropic integrins mediate the trafficking of the T cells to the gastrointestinal tract, where their interplay with local hormones dictates the residence of the immune cells in both normal and compromised gastrointestinal tissues. Targeting gut-tropic integrins is an effective therapy for inflammatory bowel disease (IBD). Gut-tropic T cells are further capable of entering the peripheral circulatory system and relocating to multiple organs. There is mounting evidence indicating a correlation between gut-tropic T cells and extra-intestinal autoimmune disorders. This review aims to systematically discuss the origin, migration, and residence of gut-tropic T cells and their association with extra-intestinal autoimmune-related diseases. These discoveries are expected to offer new understandings into the development of a range of autoimmune disorders, as well as innovative approaches for preventing and treating the diseases.

肠道趋向性 T 细胞主要来源于肠道相关淋巴组织(GALT),肠道趋向性整合素介导 T 细胞向胃肠道的迁移,它们与当地激素的相互作用决定了免疫细胞在正常和受损胃肠组织中的驻留。以肠道趋向整合素为靶点是治疗炎症性肠病(IBD)的有效疗法。肠道趋向性 T 细胞还能进入外周循环系统并转移到多个器官。越来越多的证据表明,肠道T细胞与肠道外自身免疫性疾病之间存在关联。本综述旨在系统地讨论肠道T细胞的起源、迁移和驻留及其与肠道外自身免疫相关疾病的联系。这些发现有望为一系列自身免疫性疾病的发展提供新的认识,并为预防和治疗这些疾病提供创新方法。
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引用次数: 0
The pipeline of immunomodulatory therapies in polymyalgia rheumatica and giant cell arteritis: A systematic review of clinical trials 多发性风湿痛和巨细胞动脉炎的免疫调节疗法:临床试验系统回顾。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103590
Lou Kawka , Baptiste Chevet , Laurent Arnaud , Guillaume Becker , Guillermo Carvajal Alegria , Renaud Felten

Introduction

The objective of this systematic review was to provide an overview of current developments and potentially available therapeutic options for polymyalgia rheumatic (PMR) and giant cell arteritis (GCA), in the coming years.

Methods

We conducted a systematic review of 17 national and international clinical trial databases for all disease-modifying anti-rheumatic drugs (DMARDs) for PMR and GCA that are already marketed, in clinical development or withdrawn. The search was performed on January 2024, with the keywords “polymyalgia rheumatica” and “giant cell arteritis”. For each molecule, we only considered the study at the most advanced stage of clinical development.

Results

For PMR, a total of 15 DMARDs were identified: 2 conventional synthetic DMARDs (csDMARDs), 11 biologic DMARDs (bDMARDs) and 2 targeted synthetic DMARDs (tsDMARDs). For GCA, 18 DMARDs were identified: 2 csDMARDs, 14 bDMARDs and 2 tsDMARDs. Currently, there are only 2 approved corticosteroid-sparing therapies in these diseases, which both target the IL-6 signaling pathway, namely tocilizumab in GCA and sarilumab in PMR. Most of the molecules in current development are repurposed from from other conditions and clinical research in PMR/GCA seems to be mostly driven by the potential to repurpose existing treatments rather than by translational research.

Conclusion

This systematic review identified 23 DMARDs evaluated for PMR and GCA: 3 csDMARDs, 17 bDMARDs and 3 tsDMARDs. Several promising treatments are likely to be marketed in the coming years.

导言:本系统综述旨在概述多发性风湿痛(PMR)和巨细胞动脉炎(GCA)目前的发展情况以及未来几年可能的治疗方案:我们对17个国家和国际临床试验数据库中所有已上市、处于临床开发阶段或已撤出的治疗多发性风湿痛和巨细胞性动脉炎的疾病修饰抗风湿药(DMARDs)进行了系统性检索。搜索时间为 2024 年 1 月,关键词为 "多发性风湿痛 "和 "巨细胞动脉炎"。对于每种分子,我们只考虑处于临床开发最后期阶段的研究:结果:针对多发性风湿性关节炎,共发现了 15 种 DMARDs:结果:对于 PMR,共发现了 15 种 DMARDs:2 种传统合成 DMARDs(csDMARDs)、11 种生物 DMARDs(bDMARDs)和 2 种靶向合成 DMARDs(tsDMARDs)。对于 GCA,确定了 18 种 DMARDs:2种csDMARDs、14种bDMARDs和2种tsDMARDs。目前,在这些疾病中仅有两种获批的皮质类固醇保留疗法,这两种疗法都以 IL-6 信号通路为靶点,即治疗 GCA 的托西珠单抗和治疗 PMR 的沙利单抗。目前正在开发的大多数分子都是从其他疾病中转用而来,而PMR/GCA的临床研究似乎主要是由转用现有疗法的潜力而非转化研究驱动的:本系统综述确定了23种针对PMR和GCA的DMARDs:3种csDMARDs、17种bDMARDs和3种tsDMARDs。未来几年,一些有前景的治疗方法可能会上市。
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引用次数: 0
Are the new 2023 ACR/EULAR classification criteria suitable for advancing the knowledge of obstetric antiphospholipid syndrome? 2023 年 ACR/EULAR 新分类标准是否适用于增进对产科抗磷脂综合征的了解?
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103592
Víctor M. Martínez-Taboada , Ana Micieces Gómez , Ana Merino , Marcos López-Hoyos , Sara del Barrio-Longarela , Alejandra Comins-Boo , Rafael Galvez , José L. Hernández
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引用次数: 0
Polymyalgia rheumatica and giant cell arteritis induced by immune checkpoint inhibitors: A systematic literature review highlighting differences from the idiopathic forms 免疫检查点抑制剂诱发的多发性风湿痛和巨细胞动脉炎:系统性文献综述,强调与特发性的区别。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103589
Elvis Hysa , Andrea Casabella , Emanuele Gotelli , Rosanna Campitiello , Carlotta Schenone , Carlo Genova , Enrica Teresa Tanda , Alberto Sulli , Vanessa Smith , Marco Amedeo Cimmino , Sabrina Paolino , Maurizio Cutolo

Introduction

An altered immune tolerance disturbed by immune checkpoint inhibitors (ICIs) may contribute to new-onset polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). This systematic literature review (SLR) examines the characteristics of PMR and GCA-like syndromes following anticancer treatment with ICIs, summarizing their demographic, clinical and treatment-related features to provide insights whether they differ from the idiopathic forms.

Methods

The SLR was conducted in Medline and EMBASE databases from inception to July 2024, and in the EULAR/ACR abstract database (2021−2023). ICI-induced PMR and GCA syndromes were compared to the primary forms of the diseases using data from studies that included both groups as comparators. For manuscripts lacking direct comparisons, we summarized the main findings and discussed the differences using systematic reviews or large observational studies on the primary forms.

Results

From 1237 screened abstracts, 46 met the inclusion criteria, involving 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had an estimated pooled prevalence of 0.1% [95% CI: 0.07%, 0.14%] among ICI recipients and 15.9% [95% CI: 12.6%, 19.9%] among patients experiencing rheumatic immune-related adverse events.

Patients with ICI-PMR had a male-to-female ratio of 1.7:1 and a mean age of 71 ± 4 years. Most cases were associated with PD1/PDL1 blockers (87%). Clinical features included inflammatory pain in the girdles (100%), though pelvic girdle involvement was under-reported in some cases (3/28 studies). Peripheral arthritis was present in 35% of patients. Laboratory tests showed normal or slightly elevated inflammatory markers in 26% of cases. Glucocorticoids (GCs) led to symptom improvement in 84% of cases although 20% required immunosuppressive treatment and 14% experienced relapses.

ICI-GCA had a prevalence of 0.06% among ICI recipients, with equal gender distribution and a mean age of 71 ± 5 years. Most patients received anti-PD1/PDL1 blockers (57%). Clinical manifestations included cephalic symptoms (75%), permanent visual loss (23%) and symptoms related to large-vessel involvement (54%). High-dose GCs were effective, with 96% achieving remission, though 17% experienced relapses.

Conclusions

ICI-induced PMR and GCA may have distinct clinical profiles compared to idiopathic forms, with potentially milder symptoms and better treatment responses. Further studies are needed to confirm these findings and better understand the long-term outcomes and pathophysiology of these conditions.

导言:免疫检查点抑制剂(ICIs)扰乱的免疫耐受改变可能会导致新发多发性风湿痛(PMR)和巨细胞动脉炎(GCA)。本系统性文献综述(SLR)研究了使用 ICIs 抗癌治疗后的多发性风湿痛和巨细胞动脉炎样综合征的特征,总结了它们的人口统计学、临床和治疗相关特征,以深入了解它们是否有别于特发性综合征:方法:在 Medline 和 EMBASE 数据库(从开始到 2024 年 7 月)以及 EULAR/ACR 摘要数据库(2021-2023 年)中进行 SLR。将ICI诱发的PMR和GCA综合征与原发性疾病进行了比较,采用的数据来自将这两组疾病作为比较对象的研究。对于缺乏直接比较的稿件,我们总结了主要研究结果,并利用系统综述或有关原发性疾病的大型观察性研究讨论了两者之间的差异:从筛选出的 1237 篇摘要中,有 46 篇符合纳入标准,涉及 358 名患者(314 人使用 ICI-PMR,44 人使用 ICI-GCA)。据估计,ICI-PMR在ICI接受者中的总发病率为0.1% [95% CI:0.07%, 0.14%],在发生风湿免疫相关不良事件的患者中的总发病率为15.9% [95% CI:12.6%, 19.9%]。ICI-PMR 患者的男女比例为 1.7:1,平均年龄为 71 ± 4 岁。大多数病例与PD1/PDL1受体阻滞剂有关(87%)。临床特征包括腰部炎症性疼痛(100%),但某些病例的骨盆腰部受累情况报告不足(3/28 项研究)。35%的患者出现外周关节炎。实验室检查显示,26%的病例炎症指标正常或轻微升高。糖皮质激素(GCs)使84%的病例症状得到改善,但20%的病例需要接受免疫抑制治疗,14%的病例复发。ICI-GCA在ICI受者中的发病率为0.06%,男女比例相当,平均年龄为(71±5)岁。大多数患者接受了抗PD1/PDL1阻断剂治疗(57%)。临床表现包括头颅症状(75%)、永久性视力丧失(23%)和大血管受累相关症状(54%)。大剂量GCs疗效显著,96%的患者病情得到缓解,但也有17%的患者复发:ICI诱发的PMR和GCA与特发性PMR和GCA相比,可能具有不同的临床特征,症状可能较轻,治疗反应较好。需要进一步的研究来证实这些发现,并更好地了解这些病症的长期疗效和病理生理学。
{"title":"Polymyalgia rheumatica and giant cell arteritis induced by immune checkpoint inhibitors: A systematic literature review highlighting differences from the idiopathic forms","authors":"Elvis Hysa ,&nbsp;Andrea Casabella ,&nbsp;Emanuele Gotelli ,&nbsp;Rosanna Campitiello ,&nbsp;Carlotta Schenone ,&nbsp;Carlo Genova ,&nbsp;Enrica Teresa Tanda ,&nbsp;Alberto Sulli ,&nbsp;Vanessa Smith ,&nbsp;Marco Amedeo Cimmino ,&nbsp;Sabrina Paolino ,&nbsp;Maurizio Cutolo","doi":"10.1016/j.autrev.2024.103589","DOIUrl":"10.1016/j.autrev.2024.103589","url":null,"abstract":"<div><h3>Introduction</h3><p>An altered immune tolerance disturbed by immune checkpoint inhibitors (ICIs) may contribute to new-onset polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). This systematic literature review (SLR) examines the characteristics of PMR and GCA-like syndromes following anticancer treatment with ICIs, summarizing their demographic, clinical and treatment-related features to provide insights whether they differ from the idiopathic forms.</p></div><div><h3>Methods</h3><p>The SLR was conducted in Medline and EMBASE databases from inception to July 2024, and in the EULAR/ACR abstract database (2021−2023). ICI-induced PMR and GCA syndromes were compared to the primary forms of the diseases using data from studies that included both groups as comparators. For manuscripts lacking direct comparisons, we summarized the main findings and discussed the differences using systematic reviews or large observational studies on the primary forms.</p></div><div><h3>Results</h3><p>From 1237 screened abstracts, 46 met the inclusion criteria, involving 358 patients (314 with ICI-PMR and 44 with ICI-GCA). ICI-PMR had an estimated pooled prevalence of 0.1% [95% CI: 0.07%, 0.14%] among ICI recipients and 15.9% [95% CI: 12.6%, 19.9%] among patients experiencing rheumatic immune-related adverse events.</p><p>Patients with ICI-PMR had a male-to-female ratio of 1.7:1 and a mean age of 71 ± 4 years. Most cases were associated with PD1/PDL1 blockers (87%). Clinical features included inflammatory pain in the girdles (100%), though pelvic girdle involvement was under-reported in some cases (3/28 studies). Peripheral arthritis was present in 35% of patients. Laboratory tests showed normal or slightly elevated inflammatory markers in 26% of cases. Glucocorticoids (GCs) led to symptom improvement in 84% of cases although 20% required immunosuppressive treatment and 14% experienced relapses.</p><p>ICI-GCA had a prevalence of 0.06% among ICI recipients, with equal gender distribution and a mean age of 71 ± 5 years. Most patients received anti-PD1/PDL1 blockers (57%). Clinical manifestations included cephalic symptoms (75%), permanent visual loss (23%) and symptoms related to large-vessel involvement (54%). High-dose GCs were effective, with 96% achieving remission, though 17% experienced relapses.</p></div><div><h3>Conclusions</h3><p>ICI-induced PMR and GCA may have distinct clinical profiles compared to idiopathic forms, with potentially milder symptoms and better treatment responses. Further studies are needed to confirm these findings and better understand the long-term outcomes and pathophysiology of these conditions.</p></div>","PeriodicalId":8664,"journal":{"name":"Autoimmunity reviews","volume":"23 7","pages":"Article 103589"},"PeriodicalIF":9.2,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141905776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
B and T cells: (Still) the dominant orchestrators in autoimmune hepatitis B 细胞和 T 细胞:(仍然)是自身免疫性肝炎的主要协调者。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103591
Maria Serena Longhi , Lina Zhang , Giorgina Mieli-Vergani , Diego Vergani

Autoimmune hepatitis (AIH) is a severe hepatopathy characterized by hypergammaglobulinemia, presence of serum autoantibodies and histological appearance of interface hepatitis. Liver damage in AIH is initiated by the presentation of a liver autoantigen to uncommitted Th0 lymphocytes, followed by a cascade of effector immune responses culminating with the production of inflammatory cytokines, activation of cytotoxic cells and subsequent hepatocyte injury. B cells actively participate in AIH liver damage by presenting autoantigens to uncommitted T lymphocytes. B cells also undergo maturation into plasma cells that are responsible for production of immunoglobulin G and autoantibodies, which mediate antibody dependent cell cytotoxicity. Perpetuation of effector immunity with consequent progression of liver damage is permitted by impairment in regulatory T cells (Tregs), a lymphocyte subset central to the maintenance of immune homeostasis. Treg impairment in AIH is multifactorial, deriving from numerical decrease, reduced suppressive function, poor response to IL-2 and less stable phenotype. In this review, we discuss the role of B and T lymphocytes in the pathogenesis of AIH. Immunotherapeutic strategies that could limit inflammation and halt disease progression while reconstituting tolerance to liver autoantigens are also reviewed and discussed.

自身免疫性肝炎(AIH)是一种严重的肝病,以高丙种球蛋白血症、血清自身抗体和界面性肝炎组织学表现为特征。AIH 中的肝损伤是由肝脏自身抗原呈现给未就位的 Th0 淋巴细胞引起的,随后是一连串的效应免疫反应,最终产生炎症细胞因子、激活细胞毒性细胞并导致肝细胞损伤。B 细胞通过向未就位的 T 淋巴细胞展示自身抗原,积极参与 AIH 肝损伤。B 细胞还会成熟为浆细胞,负责产生免疫球蛋白 G 和自身抗体,从而介导抗体依赖性细胞毒性。调节性 T 细胞(Tregs)是维持免疫平衡的核心淋巴细胞亚群,其功能受损可导致效应免疫持续存在,进而加重肝损伤。AIH中Treg的损伤是多因素的,包括数量减少、抑制功能降低、对IL-2反应差和表型不稳定。在这篇综述中,我们将讨论 B 淋巴细胞和 T 淋巴细胞在 AIH 发病机制中的作用。我们还回顾并讨论了可限制炎症和阻止疾病进展,同时重建对肝脏自身抗原耐受性的免疫治疗策略。
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引用次数: 0
Research Progress in pathogenesis of connective tissue disease-associated interstitial lung disease from the perspective of pulmonary cells 从肺细胞角度看结缔组织病相关间质性肺病发病机制的研究进展。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103600
Shuyi Shen, Ming Hu, Yi Peng, Yi Zheng, Rong Zhang

The lungs are a principal factor in the increased morbidity and mortality observed in patients with Connective Tissue Disease (CTD), frequently presenting as CTD-associated Interstitial Lung Disease (ILD). Currently, there is a lack of comprehensive descriptions of the pulmonary cells implicated in the development of CTD-ILD. This review leverages the Human Lung Cell Atlas (HLCA) and spatial multi-omics atlases to discuss the advancements in research on the pathogenesis of CTD-ILD from a pulmonary cell perspective. This facilitates a more precise localization of disease sites and a more systematic consideration of disease progression, supporting further mechanistic studies and targeted therapies.

肺部是导致结缔组织病(CTD)患者发病率和死亡率增加的主要因素,经常表现为 CTD 相关性间质性肺病(ILD)。目前,还缺乏对与 CTD-ILD 发病有关的肺细胞的全面描述。本综述利用人类肺细胞图谱(HLCA)和空间多组学图谱,从肺细胞的角度探讨 CTD-ILD 发病机制研究的进展。这有助于更精确地定位疾病部位和更系统地考虑疾病进展,为进一步的机理研究和靶向治疗提供支持。
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引用次数: 0
Amphibole asbestos as an environmental trigger for systemic autoimmune diseases 闪石石棉是全身性自身免疫性疾病的环境诱因。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103603
Jean C. Pfau , Brett McLaurin , Brenda J. Buck , Frederick W. Miller

A growing body of evidence supports an association between systemic autoimmune disease and exposure to amphibole asbestos, a form of asbestos typically with straight, stiff, needle-like fibers that are easily inhaled. While the bulk of this evidence comes from the population exposed occupationally and environmentally to Libby Amphibole (LA) due to the mining of contaminated vermiculite in Montana, studies from Italy and Australia are broadening the evidence to other sites of amphibole exposures. What these investigations have done, that most historical studies have not, is to evaluate amphibole asbestos separately from chrysotile, the most common commercial asbestos in the United States. Here we review the current and historical evidence summarizing amphibole asbestos exposure as a risk factor for autoimmune disease. In both mice and humans, amphibole asbestos, but not chrysotile, drives production of both antinuclear autoantibodies (ANA) associated with lupus-like pathologies and pathogenic autoantibodies against mesothelial cells that appear to contribute to a severe and progressive pleural fibrosis. A growing public health concern has emerged with revelations that a) unregulated asbestos minerals can be just as pathogenic as commercial (regulated) asbestos, and b) bedrock and soil occurrences of asbestos are far more widespread than previously thought. While occupational exposures may be decreasing, environmental exposures are on the rise for many reasons, including those due to the creation of windborne asbestos-containing dusts from urban development and climate change, making this topic an urgent challenge for public and heath provider education, health screening and environmental regulations.

越来越多的证据表明,全身性自身免疫性疾病与暴露于闪石石棉之间存在关联,闪石石棉是一种典型的具有直、硬、针状纤维的石棉,很容易被吸入。虽然大部分证据来自于因在蒙大拿州开采受污染的蛭石而暴露于利比闪石(Libby Amphibole,LA)的职业和环境人群,但来自意大利和澳大利亚的研究正在将证据扩大到暴露于闪石的其他场所。与大多数历史研究不同的是,这些调查将闪石石棉与温石棉(美国最常见的商用石棉)分开进行评估。在此,我们回顾了当前和历史证据,总结了暴露于闪石石棉作为自身免疫性疾病风险因素的情况。在小鼠和人类中,闪石石棉(而非温石棉)会促使产生与狼疮样病症相关的抗核自身抗体(ANA),以及针对间皮细胞的致病性自身抗体,这些抗体似乎会导致严重的渐进性胸膜纤维化。随着人们发现:a)未受管制的石棉矿物与商业(受管制)石棉一样具有致病性;b)石棉在基岩和土壤中的分布比以前想象的要广泛得多,公共健康问题日益受到关注。虽然职业暴露可能在减少,但环境暴露却在增加,原因有很多,包括城市发展和气候变化产生的风媒含石棉粉尘,这使得公众和医疗机构的教育、健康检查和环境法规面临紧迫挑战。
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引用次数: 0
Early skeletal muscle manifestations in polyarteritis nodosa and ANCA-associated vasculitis 结节性多动脉炎和 ANCA 相关性血管炎的早期骨骼肌表现。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103602
Yasuhiro Shimojima, Shun Nomura, Satoru Ushiyama, Takanori Ichikawa, Ryota Takamatsu, Dai Kishida, Yoshiki Sekijima

Skeletal muscle involvement is common in patients with small- and medium-sized vasculitis, particularly polyarteritis nodosa (PAN) and antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Despite being not included in the standard classification criteria for PAN and AAV, skeletal muscle involvement is an important clinical indicator, particularly when vasculitic myopathy is the only pathological evidence in the absence of other organ involvement. Herein, we comprehensively reviewed and compared the clinical features of 71 and 135 patients with PAN and AAV, respectively, with skeletal muscle involvement at the time of disease onset. Most patients with PAN and AAV exhibited skeletal muscle involvement, often characterized by myalgia and occasional muscular weakness, predominantly in the lower extremities. Myalgia and weakness were observed more frequently in the distal lower extremities in patients with PAN than in those with AAV. In contrast, skeletal muscle involvement tended to exhibit a more dispersed distribution across all four extremities in those with AAV. Muscle magnetic resonance imaging T2-weighted and short-tau inversion recovery sequences can effectively identify hyperintense areas attributed to hypervascularity of affected muscle tissues and serve as a sensitive and useful modality for visually determining the suitable biopsy site. >90% of patients with PAN and AAV demonstrated perivascular inflammation in their affected muscle tissues, whereas fibrinoid necrosis of the vessel walls was reported in two-thirds of patients. Serum creatine kinase (CK) levels were within the normal range in approximately 80% of patients presenting with skeletal muscle involvement in PAN and AAV. Furthermore, muscle fiber damage was milder in patients with skeletal muscle involvement in PAN and AAV than those with idiopathic inflammatory myositis. Meanwhile, serum CK levels were elevated in 65–85% of patients with PAN and AAV who had myofiber necrosis and degeneration in the affected muscles. Most patients with PAN and AAV showed improvement in skeletal muscle involvement following glucocorticoids (GCs) administration; however, relapse was observed in some patients during the tapering of GCs. In summary, skeletal muscle involvement is a potential indicator for establishing PAN and AAV diagnoses during the early phases of the disease.

骨骼肌受累常见于中小型血管炎患者,尤其是结节性多动脉炎(PAN)和抗中性粒细胞胞浆抗体相关性血管炎(AAV)。尽管骨骼肌受累未被纳入 PAN 和 AAV 的标准分类标准,但骨骼肌受累是一项重要的临床指标,尤其是在没有其他器官受累的情况下,血管性肌病是唯一的病理证据。在此,我们分别对 71 例和 135 例 PAN 和 AAV 患者发病时骨骼肌受累的临床特征进行了全面回顾和比较。大多数 PAN 和 AAV 患者表现为骨骼肌受累,通常以肌痛和偶尔的肌无力为特征,主要表现在下肢。与 AAV 患者相比,PAN 患者下肢远端的肌痛和无力更为常见。与此相反,AAV 患者的骨骼肌受累往往更分散地分布在四肢。肌肉磁共振成像 T2 加权和短陶反转恢复序列可有效识别受累肌肉组织血管过多导致的高密度区,是一种敏感而有用的方法,可用于直观地确定合适的活检部位。>90%以上的 PAN 和 AAV 患者受累肌肉组织的血管周围出现炎症,三分之二的患者血管壁出现纤维素性坏死。约80%的PAN和AAV骨骼肌受累患者的血清肌酸激酶(CK)水平在正常范围内。此外,与特发性炎症性肌炎相比,PAN 和 AAV 骨骼肌受累患者的肌纤维损伤程度较轻。同时,65%-85%的 PAN 和 AAV 患者血清 CK 水平升高,这些患者受累肌肉的肌纤维坏死和变性。大多数 PAN 和 AAV 患者在服用糖皮质激素(GCs)后,骨骼肌受累的情况有所改善;但也有一些患者在减量服用 GCs 期间病情复发。总之,骨骼肌受累是在疾病早期阶段确定 PAN 和 AAV 诊断的一个潜在指标。
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引用次数: 0
Fecal microbiota transplantation in autoimmune diseases – An extensive paper on a pathogenetic therapy 粪便微生物群移植在自身免疫性疾病中的应用--一篇关于病理疗法的详尽论文。
IF 9.2 1区 医学 Q1 IMMUNOLOGY Pub Date : 2024-07-01 DOI: 10.1016/j.autrev.2024.103541

The role of infections in the pathogenesis of autoimmune diseases has long been recognized and reported. In addition to infectious agents, the internal composition of the “friendly” living bacteria, (microbiome) and its correlation to immune balance and dysregulation have drawn the attention of researchers for decades. Nevertheless, only recently, scientific papers regarding the potential role of transferring microbiome from healthy donor subjects to patients with autoimmune diseases has been proposed. Fecal microbiota transplantation or FMT, carries the logic of transferring microorganisms responsible for immune balance from healthy donors to individuals with immune dysregulation or more accurately for our paper, autoimmune diseases. Viewing the microbiome as a pathogenetic player allows us to consider FMT as a pathogenetic-based treatment. Promising results alongside improved outcomes have been demonstrated in patients with different autoimmune diseases following FMT. Therefore, in our current extensive review, we aimed to highlight the implication of FMT in various autoimmune diseases, such as inflammatory bowel disease, autoimmune thyroid and liver diseases, systemic lupus erythematosus, and type 1 diabetes mellitus, among others. Presenting all the aspects of FMT in more than 12 autoimmune diseases in one paper, to the best of our knowledge, is the first time presented in medical literature. Viewing FMT as such could contribute to better understanding and newer application of the model in the therapy of autoimmune diseases, indeed.

感染在自身免疫性疾病发病机制中的作用早已得到认可和报道。几十年来,除了感染病原体外,"友好 "活菌(微生物组)的内部组成及其与免疫平衡和失调的相关性也引起了研究人员的关注。然而,直到最近才有科学论文提出将健康捐献者的微生物组转移到自身免疫性疾病患者体内的潜在作用。粪便微生物群移植(FMT)的逻辑是将负责免疫平衡的微生物从健康捐献者体内转移到免疫失调患者体内,对于我们的论文来说,更准确地说,是自身免疫性疾病患者体内。将微生物组视为病原体,我们就可以将 FMT 视为一种基于病原体的治疗方法。不同自身免疫性疾病的患者在接受 FMT 治疗后,都取得了良好的疗效。因此,在我们目前的广泛综述中,我们旨在强调 FMT 对各种自身免疫性疾病的影响,如炎症性肠病、自身免疫性甲状腺和肝病、系统性红斑狼疮和 1 型糖尿病等。据我们所知,在一篇论文中介绍 FMT 治疗 12 种以上自身免疫性疾病的所有方面,在医学文献中尚属首次。如此看待 FMT,确实有助于更好地理解和更新该模型在自身免疫性疾病治疗中的应用。
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Autoimmunity reviews
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