MEDIX, God. 24 Br. 129  •  Sponzorirani članak  •  Neurologija HR ENG

Multipla skleroza: uloga pojedinih subpopulacija limfocita u imunopatogenezi bolesti i terapijske mogućnostiMultiple sclerosis: the role of certain lymphocyte subpopulations in disease immunopathogenesis and therapeutic opportunities

Barbara Barun

Multipla skleroza je imunopatogenetski heterogena bolest. Postoje dva klinička fenotipa bolesti: relapsno-remitirajući i progresivni. Oba klinička fenotipa karakterizirana su upalnim i degenerativnim patogenetskim mehanizmima, ali u kvantitativno i kvalitativno drugačijem omjeru. U imunopatogenezi multiple skleroze promijenjene su komponente i prirođene i stečene imunosti, a CD4+ T-limfociti ključne su regulatorne stanice koje su patološki promijenjene u toj bolesti. Prema imunopatogenetskom mehanizmu djelovanja, lijekovi koji su trenutno registrirani za liječenje relapsno-remitirajuće multiple skleroze dijele se u 3 skupine: imunomodulatorni lijekovi (interferon b, glatiramer-acetat, teriflunomid, dimetil-fumarat i daklizumab), antimigracijski lijekovi (fingolimod i natalizumab) te lijekovi s deplecijsko-rekonstitucijskim učinkom na imunološke stanice (alemtuzumab, kladribin i okrelizumab). Osim poznavanja imunopatogeneze bolesti i farmakološkoga profila lijekova, pri izboru liječenja potrebno je uzeti u obzir preferencije bolesnika te individualiziranim pristupom pravodobno odrediti odgovarajući lijek.

Ključne riječi:
B-limfociti; multipla skleroza; imunopatogeneza; liječenje; T-limfociti

Članak u cijelosti pročitajte u tiskanom izdanju MEDIX, God. 24 Br. 129

From the immunopathogenetic perspective, multiple sclerosis (MS) is a heterogeneous disease. There are two distinct clinical phenotypes of the disease: relapsing-remitting and progressive. Both are characterized by inflammation and neurodegeneration, yet in different quantitative and qualitative ratios. The immunopathogenesis of MS includes a disruption in components of both the inherited and adaptive immunity, with CD4+ T-lymphocytes as a key regulator of the immunological processes being altered in this disease. Regarding the immunopathogenetic mechanism of their action, the medication approved for the treatment of relapsing-remitting MS could be divided into three categories: immunodulatory medication (interferon beta, glatiramer-acetat, teriflunomid, dimethyl-fumarat and daclizumab), antimigrational medication (fingolimod and natalizumab) and medication with a depletion/reconstitution impact on immune cells (alemtuzmab, cladribin and ocrelizumab). In addition to mastering the immunopathogenesis of the disease and pharmacological profile of the medication, when choosing the therapy it is necessary to take into account each patient’s preferences, and by an individualized approach timely choose the appropriate medication. 

Key words:
B lymphocytes; immunopathogenesis; multiple sclerosis; therapy; T lymphocytes