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Pathogene Zellen der rheumatischen Entzündung als Ziele moderner Therapien

Pathogenic cells of rheumatic inflammation as the target of modern therapies

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Zusammenfassung

Das unzureichende Therapierepertoire für RA (rheumatoide Arthritis)-Patienten hat in den 80er-Jahren des letzten Jahrhunderts aufgrund zunehmender Erkenntnisse der der Krankheit zugrunde liegenden pathogenetischen Mechanismen zu der Entwicklung vielfacher neuer und biologischer Therapieverfahren geführt. Wie dargestellt, wurden in der Frühphase der Anwendung biologischer Medikationen zahlreiche zelluläre Strukturen für eine Intervention bei RA-Patienten getestet. Doch schaut man in der Übersicht der Therapieoptionen gerichtet gegen zelluläre Strukturen kritisch durch, so hat sich bei der T-Zell-gerichteten Therapie eine Blockade der Kostimulation durch Abatacept einen festen Platz im Therapierepertoire erworben. Gleiches gilt für B-Zell-gerichtete therapeutische Strategien. Auffallend ist, dass die in die Klinik eingeführten neuen Fusionsproteine sowie monoklonale Antikörper, auch die sog. „small molecules“, nicht bei allen Patienten mit einer RA zu dem gewünschten klinischen Erfolg führen, was es notwendig macht, weitere Therapieprinzipien zu entwickeln.

Abstract

In the 1970s and 1980s the course of rheumatoid arthritis (RA) could be defined as fateful despite the introduction of methotrexate as well as other immunosuppressive treatments. In most patients at this time RA was combined with an early disability due a progressive destruction of joints. In addition, comorbidity was known to be one of the major causes for a decreased life expectancy. These less than optimal options for treating RA patients led to intensive research in the pathogenesis with the aim to develop new treatment principles. Based on the increasing knowledge of pathogenically important mechanisms, so-called biologicals were developed targeting T and B cells and proinflammatory cytokines, such as tumor necrosis factor alpha. Over the past 10 years the repertoire of biologicals for treating RA has steadily and significantly increased, which was necessary especially for those patients classified as non-responders to available biological compounds. In the present overview cellular structures, T and B cells as well as cells of the monocyte/macrophage system are discussed as targets for immune interventions.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. J.R. Kalden gibt an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Abteilung für Molekulare Immunologie, Nikolaus-Fiebiger-Zentrum, Glückstr. 6, 91054, Erlangen, Deutschland

    J.R. Kalden

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Kalden, J. Pathogene Zellen der rheumatischen Entzündung als Ziele moderner Therapien. Z. Rheumatol. 74, 8–13 (2015). https://doi.org/10.1007/s00393-014-1437-5

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