类风湿关节炎的T细胞疫苗研究现状

类风湿关节炎是一种可导致关节畸形并丧失功能的慢性自身免疫性疾病。大量研究证实T细胞介导的免疫异常在类风湿关节炎的发病过程中发挥重要作用。经研究证实T细胞疫苗对类风湿关节炎有一定疗效,但受主要组织相容性抗原(MHC)限制,难以应用于临床。最近的T细胞疫苗研究另辟途径,证明在没有发现致病自身抗原的情况下T细胞疫苗依然有可能应用与类风湿关节炎的治疗,为研究类风湿关节炎的发病机制及治疗提供了有益的思路及资料。     

IL-6: TNF-α之后的类风湿关节炎治疗关键靶点

IL-6是一种重要的细胞因子,在类风湿关节炎发病过程中发挥重要作用。本文对已上市的IL-6受体单克隆抗体tocilizumab对类风湿关节炎的临床疗效和安全性进行了总结,并和TNF-α阻断药物进行了对比,证明tocilizumab在药物疗效和副作用方面与TNF-α阻断药物相比各有优劣。另外也对在研的IL-6通路阻断单抗的临床试验结果进行了总结。结合本中心近年的研究和总结,IL-6是继TNF-α之后的另一个重要的类风湿关节炎治疗关键靶点,该类药物的上市为以后类风湿关节炎的个性化治疗提供了更多的选择。     

类风湿关节炎药物治疗的规范化及临床实践探析

目的：在前人研究基础上进一步调查和研究类风湿关节炎（RA）患者药物治疗的规范化状况。方法：对湘潭市中心医院2012年3月至12月门诊就诊的120例风湿关节炎患者进行问卷调查。内容包括患者个人资料、就诊及确诊时间、科室,随诊时间间隔以及改善病情抗风湿药（DMARDs）的应用情况。结果：类风湿关节炎药物治疗不规范,甲氨蝶呤是患者应用最多的DMARDs,占60％,其次为来氟米特（30％）、柳氮磺吡啶（5％）及羟氯喹（5％）。结论：51％以上的RA病人DMARDs治疗不规范,尤其是在县级基层医院。类风湿性疾病的规范治疗需要从早期诊断治疗,优化联合用药,个性化治疗,定期跟踪疗效等方面来规范。     

双氯芬酸钠与塞来昔布治疗类风湿关节炎的疗效及对心血管的影响研究

目的：探讨双氯芬酸钠和塞来昔布治疗类风湿关节炎的临床疗效及用药安全性。方法：将我院2011 年1 月-2012 年1 月门诊收治的98 例类风湿性关节炎患者随机分为对照组和观察组,每组49 例。对照组给予双氯芬酸钠治疗,观察组给予塞来昔布治疗,观察两组临床治疗效果及心血管不良事件的发生情况。结果：观察组总有效率为91.84%显著高于对照组的75.51%,两组比较差异具有统计学意义（P〈0.05）;观察组ESR及CRP 分别为（110.65± 7.28）mm/h 和（10.42± 0.98）mg/L显著低于治疗前和对照组,比较差异具有统计学意义（P〈0.05）;观察组心血管不良事件发生率为8.16%显著低于对照组的20.41%,两组比较差异具有统计学意义（P〈0.05）。结论：塞来昔布治疗类风湿关节炎具有较好的临床疗效,可有效改善患者疼痛、僵硬或功能受限等症状,且心血管不良事件发生率低,值得临床进一步推广和应用。     

PEDF 在类风湿关节炎滑膜组织中的表达及临床意义

目的:研究类风湿关节炎患者滑膜组织中色素上皮衍生因子(Piment epithelial-derived factor,PEDF)的表达情况。方法:采用免疫组化法,检测30例类风湿关节炎活动期膝关节滑膜组织中PEDF蛋白表达,以16例退行性关节炎患者、16例正常人及该30例患者治疗后(稳定期)关节滑膜组织中PEDF蛋白作对照,进行对比分析。结果:PEDF在类风湿关节炎患者明显低于正常人、退行性关节炎患者滑膜组织中的表达,在活动期滑膜组织中的表达明显低于稳定期,组间比较,差异均有统计学意义(P均<0.05)。结论:PEDF与类风湿关节炎的疾病过程密切相关,针对色素上皮衍生因子的靶点治疗有望成为类风湿关节炎治疗的新的方向及策略。     

靶定IL-17 治疗类风湿关节炎研究进展

IL-17作为前炎症因子参与类风湿关节炎,系统性红斑狼疮等自身免疫性疾病的病理过程。它主要由CD4+T细胞的一个亚群--Th17细胞分泌释放。目前,IL-17在类风湿关节炎的病理过程中的作用引起了医学界广泛的关注,抗IL-17A抗体已经生产并进入临床实验,用于治疗类风湿关节炎、银屑病关节炎等疾病。但其在类风湿关节炎病理过程中的作用尚需进一步研究,其有效性亦尚需进一步探讨。本文主要针对IL-17家族的各个亚型的表达、调控、生物学作用及与类风湿关节炎发病的关系进行阐述,为类风湿关节炎的治疗提供新的思路。     

肠道菌群失调引起类风湿关节炎发病的研究进展

肠道菌群大多与宿主共生进化,菌群结构、数量恒定形成稳态,能有效预防有害病菌的入侵和炎性疾病的发生。目前多项研究结果显示,肠道菌群失调可能与多种疾病相关联,包括2型糖尿病、肥胖症、肝硬化、结直肠癌和类风湿关节炎。有研究表明,肠道菌群是影响类风湿关节炎(rheumatoid arthritis, RA)发病的环境因素,其中涉及的机制有肠道菌群-黏膜稳态的失衡,其不利于肠道适应性免疫的形成,使得免疫系统不能识别常驻菌与致病菌,引起黏膜紊乱;另一种机制是肠道菌群失调激活免疫因子,引起全身免疫反应。由此可见,肠道菌群参与类风湿关节炎的发生、发展,既有肠道黏膜与菌群的局部调节,也有全身性免疫因子的共同参与。本文主要对肠道菌群失调诱导类风湿关节炎发病的相关性研究予以综述,为进一步研究关节炎早期预防及病因治疗提供理论依据。     

类风湿关节炎免疫发病机制研究进展

类风湿关节炎(Rheumatoid Arthritis,RA)是以关节滑膜慢性炎症为主的自身免疫性疾病,其病因及发病机制尚未完全明确。本文从T细胞、树突状细胞、肥大细胞等免疫细胞及IL-1家族、结合含γc受体的细胞因子、IL-12家族、IL-17等细胞因子与类风湿关节炎发生发展的关系阐述类风湿关节炎免疫发病机制有关研究进展。     

雷公藤治疗类风湿关节炎

雷公藤有黄藤木、断肠草、蒸龙草、震龙根等别称,具有祛风除湿、活血通络、消肿止痛的作用。雷公藤作为治疗类风湿关节炎常用药的历史源远流长。类风湿关节炎(rheumatoid arthritis,RA)是一种自身免疫病,以侵蚀性关节炎为主要特征,其病理基础是滑膜炎,主要表现为关节肿胀和疼痛。本文先分别叙述雷公藤和类风湿,最后对近年来雷公藤治疗类风湿的临床研究和作用机制进行综述,以期为临床治疗RA的提供理论参考。     

T淋巴细胞亚群、血红蛋白及血小板在类风湿关节炎患者中的表达及临床意义分析

摘要 目的：探讨T淋巴细胞亚群、血红蛋白及血小板在类风湿关节炎患者中的表达及临床意义。方法：选取我院2020年1月到2023年1月收治的100例类风湿关节炎患者作为研究对象,依照患者病情活动性进行分组,将活动期类风湿关节炎的35例患者分为活动期组,将65例缓解期类风湿关节炎患者分为缓解期组,另选取同期体检的50名健康志愿者作为对照组,对比三组患者CD3⁺、CD4⁺、CD8⁺以及CD4⁺/CD8⁺比值,并对比三组受检者血红蛋白及血小板表达水平。应用Spearman相关分析分析T淋巴细胞亚群、血红蛋白及血小板与类风湿关节炎活动程度的相关性,并应用logistic回归分析分析T淋巴细胞亚群、血红蛋白及血小板对类风湿关节炎活动期的独立预测价值。结果：三组受检者T淋巴细胞亚群表达水平对比有差异,且活动期组CD3⁺、CD4⁺、CD4⁺/CD8⁺水平较缓解期组和对照组低,CD8⁺水平较高（P＜0.05）;三组受检者血红蛋白及血小板表达水平对比差异显著,且活动期组血红蛋白水平较缓解期组和对照组低,血小板水平较高（P＜0.05）;Spearman相关分析结果显示：CD3⁺、CD4⁺、CD4⁺/CD8⁺、血红蛋白与类风湿关节炎病情活动程度呈负相关,CD8⁺、血小板与类风湿关节炎病情活动程度呈正相关（P＜0.05）;logistic回归分析结果表明：CD4⁺/CD8⁺升高、血红蛋白升高及血小板降低为类风湿关节炎活动期的独立影响因素（P＜0.05）。结论：类风湿关节炎患者在疾病活动期T淋巴细胞亚群相关细胞比例、血红蛋白及血小板表达水平会出现明显变化,且与其活动程度具有明显相关性。以CD4⁺/CD8⁺升高、血红蛋白升高及血小板降低情况可独立判定类风湿关节炎活动期,因此临床上对于上述指标升高的类风湿关节炎患者需及时改善治疗措施,改善患者预后水平。     

Retinoic acid, local cell-cell interactions, and pattern formation in vertebrate limbs.

Retinoic acid (RA), a derivative of vitamin A, has remarkable effects on developing and regenerating limbs. These effects include teratogenesis, arising from RA's ability to inhibit growth and pattern formation. They also include pattern duplication, arising as a result of the stimulation of additional growth and pattern formation. In this review we present evidence that the diverse effects of RA are consistent with a singular, underlying explanation. We propose that in all cases exogenously applied RA causes the positional information of pattern formation-competent cells to be reset to a value that is posterior-ventral-proximal with respect to the limb. The diversity of outcomes can be seen as a product of the mode of application of exogenous RA (global versus local) coupled with the unifying concept that growth and pattern formation in both limb development and limb regeneration are controlled by local cell-cell interactions, as formulated in the polar coordinate model. We explore the possibility that the major role of endogenous RA in limb development is in the establishment of the limb field rather than as a diffusible morphogen that specifies graded positional information across the limb as previously proposed. Finally, we interpret the results of the recent finding that RA can turn tail regenerates into limbs, as evidence that intercalary interactions may also be involved in the formation of the primary body axis.     

Kinetics and mechanisms of oxidation of some antioxidants with photochemically generated tert-butoxyl radicals

Dietary antioxidants play an important role in the prevention of several chronic diseases including cardiovascular diseases, cancer, ageing and diabetes. In order to understand the mechanism of oxidation of antioxidants viz., gallic acid (GA), caffeic acid (CA), rosmarinic acid (RA) and chlorogenic acid (CGA), a systematic kinetic study of these antioxidants with photochemically generated tertiary butoxyl (t-BuO) radicals was carried out. The oxidation of antioxidants by t-BuO radicals was followed spectrophotometrically by measuring the absorbance of GA (266 nm), CA (310 nm), RA (324 nm) and CGA (328 nm) at their respective lambda(max). The initial rates of oxidation of antioxidants were calculated from the plot of absorbance vs time and were found to increase with increase in [antioxidant], [t-BuOOH] and light intensity in all the cases. The quantum yields (phi) were calculated from the initial rates of oxidation of antioxidant and the measured light intensity at 254 nm, the wavelength at which the tert-butyl hydroperoxide (t-BuOOH) was activated to radicals. The quantum yields were found to depend on [antioxidant] and [t-BuOOH], and were independent of light intensity. The order with respect to [antioxidant], [t-BuOOH] were found to be fractional whereas order with respect to intensity was one. The order of reactivity was found to be: CA > CGA > RA > GA. The products were identified by mass spectral data. On the basis of kinetic results and product analysis, probable mechanisms were suggested.     

Plasma lipid peroxidation and antioxidant levels in patients with rheumatoid arthritis

In recent years, a great number of studies have investigated the possible role of reactive oxygen species in the aetiology and pathogenesis of rheumatoid arthritis (RA). The aim of this study was to investigate plasma concentrations of vitamin E, beta-carotene, activities of glutathione peroxidase (GSH-Px) and catalase, levels of lipid peroxidation (MDA) and reduced glutathione (GSH) in 36 patients with rheumatoid arthritis (RA) and 22 healthy age-matched controls. The plasma activity of GSH-Px and catalase (p < 0.001), levels of GSH (p < 0.01), concentration of beta-carotene (p < 0.05) and vitamin E (p < 0.001), haemoglobin and hematocrit (p < 0.05) were significantly lower in patients with RA than in controls. The MDA levels (p < 0.01), C reactive protein, rheumatoid factor, anti-streptolysin-o values (p < 0.001), platelet count (p < 0.05) and erythrocyte sedimentation rate (p < 0.001) were higher in the patient group than in the control group. These results provide some evidence for a potential role of increased lipid peroxidation and decreased enzymic and non-enzymic antioxidants in RA by its inflammatory character. These results suggested that oxidant stress plays a very important role in the pathogenesis of RA.     

Retinoic acid inhibits growth in agarose of early chick embryonic cells and may be involved in regulation of axis formation

The mechanisms involved in the generation of axial structures in the chick are well documented, yet, little is known about the actual factors that generate such a complex pattern. The recent demonstrations that all-trans-retinoic acid (RA) acts as a morphogen during limb development (Thaller and Eichele, 1987) lead us to examine whether during axis formation in the developing chick, RA could be one of the factors involved. We now show that retinoic acid can block a very unusual property of normal early chick embryonic cells, mainly their capacity to grow in semisolid medium. We also present experiments that suggest that RA may play a direct role during axis formation in the developing chick.     

Circadian rhythms in rheumatology - a glucocorticoid perspective

The hypothalamic-pituitary-adrenal (HPA) axis plays an important role in regulating and controlling immune responses. Dysfunction of the HPA axis has been implicated in the pathogenesis of rheumatoid arthritis (RA) and other rheumatic diseases. The impact of glucocorticoid (GC) therapy on HPA axis function also remains a matter of concern, particularly for longer treatment duration. Knowledge of circadian rhythms and the influence of GC in rheumatology is important: on the one hand we aim for optimal treatment of the daily undulating inflammatory symptoms, for example morning stiffness and swelling; on the other, we wish to disturb the HPA axis as little as possible. This review describes circadian rhythms in RA and other chronic inflammatory diseases, dysfunction of the HPA axis in RA and other rheumatic diseases and the recent concept of the hepato-hypothalamic-pituitary-adrenal-renal axis, the problem of adrenal suppression by GC therapy and how it can be avoided, and evidence that chronotherapy with modified release prednisone effective at 02:00 a.m. can inhibit proinflammatory sequelae of nocturnal inflammation better compared with GC administration in the morning but does not increase the risk of HPA axis insufficiency in RA.     

Restorative and synergistic efficacy of Kalpaamruthaa, a modified Siddha preparation, on an altered antioxidant status in adjuvant induced arthritic rat model

BACKGROUND: Rheumatoid arthritis (RA) is a prevalent and debilitating disease that affects the joints. Infiltration of blood-derived cells in the affected joints upon activation generate reactive oxygen/nitrogen species, resulting in an oxidative stress. One approach to counteract this oxidative stress is the use of antioxidants as therapeutic agents. OBJECTIVES: Kalpaamruthaa (KA), a modified indigenous Siddha preparation constituting Semecarpus anacardium nut milk extract (SA), Emblica officinalis (EO) and honey was evaluated for its synergistic antioxidant potential in adjuvant induced arthritic rats than sole SA treatment. MATERIALS AND METHODS: Levels/activities of reactive oxygen species (ROS)/reactive nitrogen species (RNS), myeloperoxidase, lipid peroxide and enzymic and non-enzymic antioxidants were determined in control, arthritis induced, SA and KA treated (150 mg/kg b.wt.) animals. RESULTS AND CONCLUSION: The levels/activities of ROS/RNS, myeloperoxidase and lipid peroxide were increased significantly (p<0.05) and the activities of enzymic and non-enzymic antioxidants were in turn decreased in arthritic rats, whereas these changes were reverted to near normal levels upon SA and KA treatment. KA showed an enhanced antioxidant potential than sole treatment of SA in adjuvant induced arthritic rats. KA via enhancing the antioxidant status in adjuvant induced arthritic rats than sole SA treatment proves to be an important therapeutic modality in the management of RA and thereby instituting the role of oxidative stress in the clinical manifestation of the disease RA. The profound antioxidant efficacy of KA than SA alone might be due to the synergistic action of the polyphenols such as flavonoids, tannins and other compounds such as vitamin C and hydroxycinnamates present in KA.     

The outcome of 5-ALA-mediated photodynamic treatment in melanoma cells is influenced by vitamin C and heme oxygenase-1

Photodynamic therapy (PDT) is an important clinical approach for cancer treatment. It involves the administration of a photosensitizer, followed by its activation with light and induction of cell death. The underlying mechanism is an increased production of reactive oxygen species (ROS) leading to oxidative stress, which is followed by cell death. However, effectiveness of PDT is limited due to an initiation of endogenous rescue response systems like heme oxygenase-1 (HO-1) in tumor cells. In recent years, consuming of antioxidant supplements has become widespread, but the effect of exogenously applied antioxidants on cancer therapy outcome remains unclear. Thus, this study was aimed to investigate if exogenous antioxidants might decrease ROS-induced cytotoxicity in photodynamic treatment. Lycopene, β-carotene, vitamin C, N-acetylcysteine, trolox, and N-tert-butyl-α-phenylnitrone in different doses were administered to human melanoma cells prior exposure to photodynamic treatment. Supplementation with vitamin C resulted in a significant decrease of the cell death rate, whereas the other tested antioxidants had no effect on cell viability and oxidative stress markers. The simultaneous application of vitamin C with the HO-1 activity inhibitor zinc protoporphyrine IX (ZnPPIX) caused a considerable decrease of photodynamic treatment-induced cytotoxicity compared to ZnPPIX alone. It can be summarized that exogenously applied antioxidants do not have a leading role in the protective response against photodynamic treatment. However, further studies are necessary to investigate more antioxidants and other substances, which might affect the outcome of photodynamic treatment in cancer therapy.     

Regulation of retinoic acid distribution is required for proximodistal patterning and outgrowth of the developing mouse limb

Exogenous retinoic acid (RA) induces marked effects on limb patterning, but the precise role of endogenous RA in this process has remained unknown. We have studied the role of RA in mouse limb development by focusing on CYP26B1, a cytochrome P450 enzyme that inactivates RA. Cyp26b1 was shown to be expressed in the distal region of the developing limb bud, and mice that lack CYP26B1 exhibited severe limb malformation (meromelia). The lack of CYP26B1 resulted in spreading of the RA signal toward the distal end of the developing limb and induced proximodistal patterning defects characterized by expansion of proximal identity and restriction of distal identity. CYP26B1 deficiency also induced pronounced apoptosis in the developing limb and delayed chondrocyte maturation. Wild-type embryos exposed to excess RA phenocopied the limb defects of Cyp26b1(-/-) mice. These observations suggest that RA acts as a morphogen to determine proximodistal identity, and that CYP26B1 prevents apoptosis and promotes chondrocyte maturation, in the developing limb.     

Controversy of free radical hypothesis: reactive oxygen species--cause or consequence of tissue injury?

For a decade or two, the hypothesis of causality of various disorders by reactive oxygen species (ROS), due to their potentially harmful effect towards cellular constituents, is one of the most frequently cited in biomedical sciences. In fact, the ROS-mediated alterations of biomacromolecules are considered to be essential events in the etiopathogenesis of those diseases where involvement of ROS has been indicated. ROS easily react in vitro with most biological molecules, causing their degradation and destruction. This may implicitly suggest that, when excessively produced in vivo, ROS are deleterious to integral components of the cell and cause their dysfunctions. Some experimental data indicate that ROS-mediated lipid peroxidation, protein oxidation and oxidative alterations to nucleic acids are crucial events of unfavorable actions of ROS. Yet the most convincing evidence, i.e. unambiguous inhibition of tissue injury by pretreatment with antioxidants, has not been provided. On the contrary, there are quite a few papers reporting failure in applying antioxidants to heal those pathologies where the causal role of ROS was supposed. Other papers reported serious complications arising from antioxidant therapy, which is quite in contradiction to its expected effect. On the other hand, an increasing number of recent findings have provided evidence of a key role of ROS in both intracellular signaling and intercellular communication, processes involved in maintaining homeostasis. Hence, some investigators consider excessive production of ROS to be rather a "smoke after the fire" than "a deleterious fire" itself, suggesting the occurrence of overproduced ROS as being the consequence of some primary damage. The present paper aims at summarizing some pros and cons of various opinions with an attempt to help better understand the involvement of ROS in tissue injury.