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Neues zur Pathogenese der Myositiden

New aspects on the pathogenesis of myositis

  • Leitthema
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Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Idiopathische inflammatorische Myopathien (IIM) sind entzündliche Erkrankungen des Muskelapparates mit chronischem Verlauf und Muskelschwäche. Hierbei kommt es bei den 3 Haupterkrankungen, der Dermatomyositis, der Polymyositis und der Einschlusskörperchenmyositis, zu immunologischen Angriffsprozessen auf das Muskelgewebe durch das humorale antikörperbildende Immunsystem (B-Zellen), wie auch durch das zelluläre Immunsystem (dendritische Zellen, Monozyten/Makrophagen, CD4+- und CD8+-T-Zellen und natürliche Killerzellen). Letzteres wirkt dabei nicht nur autoaggressiv zytotoxisch, sondern unterhält auch die Entzündung. Über die Pathogenese der IIM ist bislang noch wenig bekannt. Dennoch scheinen genetische Prädispositionen und Umweltfaktoren eine unterstützende Rolle bei der Krankheitsinitiierung und im Verlauf zu spielen. Insbesondere scheinen auch Infektionen mit Pilzen, Bakterien und/oder Viren ätiologisch bedeutsam. Bis dato existieren nur wenige Merkmale zur Beurteilung der individuellen Prognose oder zur Abschätzung des therapiespezifischen Behandlungserfolgs. Konventionelle und neuere Behandlungsstrategien sind kritisch unter Berücksichtigung der Vergleichbarkeit der Studien zu bewerten. Zur Entwicklung neuer und zielgerichteter Therapien wird zunehmend die Einbeziehung von genomweiten Untersuchungsmethoden relevant, um molekulare Pathomechanismen systematisch zu erfassen und die Ätiopathogenese bei IIM besser zu verstehen. Diese Methoden wecken auch die Hoffnung, geeignete Biomarker für die Klassifikation, therapeutische Stratifizierung, Aktivitätsbestimmung, Prognose und die krankheitsspezifischen Subgruppen patientenspezifisch zu identifizieren.

Abstract

Idiopathic inflammatory myopathies (IIM) are chronic inflammatory diseases of muscle characterized by proximal muscle weakness. There are three main groups of diseases, dermatomyositis, polymyositis and inclusion body myositis. The muscle tissue is invaded by the humoral autoantibody producing immune system (B-cells) and by the cellular immune system with autoaggressive and inflammation modulating cells (e.g. dendritic cells, monocytes/macrophages, CD4 + and CD8 + T-cells and natural killer cells). The presence of specific or associated autoantibodies and inflammatory cellular infiltrates with cytotoxic and immune autoreactive properties are characteristic for IIM diseases. The pathogenesis is still unknown; nevertheless, there are several hints that exogenic factors might be involved in initiation and disease progression and bacterial, fungal and viral infections are thought to be possible initiators. Up to now information on prognostic markers to help with decision-making for individual treatment are limited. In addition, there has been only limited therapeutic success including conventional or novel drugs and biologicals and comparative validation studies are needed using similar outcome measurements. Moreover, to facilitate the use and development of novel therapies, elaboration of intracellular and cell-specific regulation could be useful to understand the etiopathogenesis and allow a better diagnosis, prognosis and possibly also a prediction for individualized subgroup treatment.

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Danksagung

Die Arbeit entstand im Rahmen des europäischen Förderprogramms (EuMyonet). Bei Herrn Prof. A. Engelhardt und Herrn Prof. W. Stenzel bedanken wir uns für die Bereitstellung der histologischen Bilder und für die Elektronenmikroskopaufnahme.

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  1. Medizinische Klinik mit Schwerpunkt Rheumatologie und klinische Immunologie, Charité Universitätsmedizin Berlin, Freie Universität und Humboldt Universität, Charitéplatz 1, 10117, Berlin, Deutschland

    B. Stuhlmüller, E. Feist, T. Häupl & G.-R. Burmester

  2. Rheumatologie, Innere Medizin, Azienda Ospedaliera ASMN, Institut für wissenschaftliche Forschung und Krankenpflege, Reggio Emilia, Italien

    N. Pipitone

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  1. B. Stuhlmüller
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  2. E. Feist
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  3. T. Häupl
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  4. G.-R. Burmester
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  5. N. Pipitone
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Correspondence to B. Stuhlmüller.

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Stuhlmüller, B., Feist, E., Häupl, T. et al. Neues zur Pathogenese der Myositiden. Z. Rheumatol. 72, 209–219 (2013). https://doi.org/10.1007/s00393-012-1078-5

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  • DOI: https://doi.org/10.1007/s00393-012-1078-5

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