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Energiemetabolismus des Immunsystems

Konsequenzen bei chronischen Entzündungen

Energy metabolism of the immune system

Consequences in chronic inflammation

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Energie ist die Währung des Lebens. Der systemische und zelluläre Energiestoffwechsel spielen eine wesentliche Rolle für die Energieversorgung des ruhenden und aktivierten Immunsystems, und das trifft auch bei chronisch entzündlichen Erkrankungen zu.

Ziel der Arbeit

In dieser Darstellung werden beide Komponenten des Energiestoffwechsels bei Gesundheit und Entzündung beleuchtet.

Material und Methoden

Es wurde eine Literaturrecherche mittels PubMed, Embase und der Cochrane Library durchgeführt. Die Information wird im Sinne einer narrativen Übersichtsarbeit vorgestellt.

Ergebnisse

Ein chronisch aktiviertes Immunsystem akquiriert große Mengen an energiereichen Substraten, die für andere Funktionen des Körpers verloren gehen. Dabei konkurrieren insbesondere das Immunsystem und das Gehirn. Folgeprobleme dieses Wettstreits sind viele bekannte Folgekrankheiten wie Müdigkeit, Angst, Depression, Anorexie, Schlafprobleme, Sarkopenie, Osteoporose, Insulinresistenz, Hypertension und andere. Die dauerhafte Veränderung im Gehirn bewirkt eine langfristige Aufrechterhaltung der Folgeprobleme auch in der Krankheitsremission. In der immunzellulären Energieversorgung findet bei chronischer Entzündung typischerweise eine Umstellung auf die Glykolyse (hin zu Laktat, das eigene Funktionen aufweist) und den Pentosephosphatweg bei Störungen der mitochondrialen Funktion statt. Die chronischen Veränderungen führen in Immunzellen von Patienten mit rheumatoider Arthritis (RA) zu einer Störung des Krebszyklus. Daran ist auch die hypoxische Situation im entzündeten Gewebe beteiligt. Es werden Effektorfunktionen von regulatorischen Funktionen unterschieden.

Diskussion

Auf dem Boden der genannten Energieveränderungen können neben bekannten auch neuartige Therapievorschläge gemacht werden.

Abstract

Background

Energy is the currency of life. The systemic and intracellular energy metabolism plays an essential role for the energy supply of the resting and activated immune system and this also applies to chronic inflammatory diseases.

Objective

This presentation examines both components of the systemic and cellular energy metabolism in health and chronic inflammation.

Material and methods

A literature search was conducted using PubMed, Embase and the Cochrane Library. The information is presented in the form of a narrative review.

Results

A chronically activated immune system acquires large amounts of energy-rich substrates that are lost for other functions of the body. In particular, the immune system and the brain are in competition. The consequences of this competition are many known diseases, such as fatigue, anxiety, depression, anorexia, sleep problems, sarcopenia, osteoporosis, insulin resistance, hypertension and others. The permanent change in the brain causes long-term alterations that stimulate disease sequelae even after disease remission. In the intracellular energy supply, chronic inflammation typically involves a conversion to glycolysis (to lactate, which has its own regulatory functions) and the pentose phosphate pathway in disorders of mitochondrial function. The chronic changes in immune cells of patients with rheumatoid arthritis (RA) lead to a disruption of the citric acid cycle (Krebs cycle). The hypoxic situation in the inflamed tissue stimulates many alterations. A differentiation is made between effector functions and regulatory functions of immune cells.

Conclusion

Based on the energy changes mentioned, novel treatment suggestions can be made in addition to those already known in energy metabolism.

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  1. Labor für Experimentelle Rheumatologie und Neuroendokrin-Immunologie, Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland

    Rainer H. Straub

  2. Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité – Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt-Universität zu Berlin, Berlin, Deutschland

    Frank Buttgereit & Timo Gaber

  3. Abteilung für Rheumatologie, Klinik für Gastroenterologie, Krankenhaus Barmherzige Brüder Regensburg, 93049, Regensburg, Deutschland

    Georg Pongratz

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  1. Rainer H. Straub
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Correspondence to Rainer H. Straub.

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Straub, R.H., Pongratz, G., Buttgereit, F. et al. Energiemetabolismus des Immunsystems. Z Rheumatol 82, 479–490 (2023). https://doi.org/10.1007/s00393-023-01389-4

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