Multisystem interactions in the pathogenesis of vasculitis
Multisystem interactions in the pathogenesis of vasculitis
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DOI：
10.1097/00002281-199701000-00002
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发表时间：
1997-01-01
影响因子：
5.1
通讯作者：
Goronzy, Jorg J.
中科院分区：
文献类型：
--
作者：
Weyand, Cornelia M.;Goronzy, Jorg J.
血管炎通常被认为是由对致病抗原的免疫反应引起的疾病。然而，引导炎症过程走向愈合和修复而不是破坏和疾病涉及多个决策点。本次审查重点关注有可能改变决策点但最近才开始引起关注的决定因素。血管炎疾病通常表现出严格的年龄偏好。对免疫衰老及其对免疫能力以及慢性炎症发展的影响的理解已取得进展。血管炎发病机制的第二个方面是独特的组织向性，涉及对确定尺寸和分布的血管的偏好。对巨细胞血管炎的研究已开始揭示受影响组织与炎症细胞之间的相互作用，并表明血管显微解剖结构决定了浸润的组织。一个重要的作用可能归因于外膜，它含有调节细胞，并可能为浸润细胞提供入口。最后，越来越多的数据表明宿主的免疫反应性在有益炎症和病理性炎症之间的决定中的重要性。巨细胞动脉炎的研究表明，部分通过细胞因子的作用实现的免疫调节环境的差异是导致疾病异质性和结果的原因。
The vasculitides are often considered diseases caused by an immune response to a causative antigen. However, multiple decision points are involved in guiding an inflammatory process toward healing and repair versus destruction and disease. This review focuses on determinants that have the potential to alter decision points but have only recently begun to attract attention. Vasculitic disorders often exhibit a strict age preference. Progress has been made in the understanding of immunosenescence and its implications for immunocompetence as well as for the development of chronic inflammation. A second aspect in the pathogenesis of vasculitis is the distinct tissue tropism, involving preference for vessels of defined sizes and distributions. Studies in giant cell vasculitis have begun to shed light on the interaction between the affected tissue and the inflammatory cells and suggest that the vascular microanatomy determines the organization of the infiltrate. An important role may be attributed to the tunica adventitia, which harbors regulatory cells and probably provides the port of entrance for infiltrating cells. Finally, data are accumulating on the importance of the host's immunoresponsiveness in the decision between a beneficial and a pathologic inflammation. Studies in giant cell arteritis have shown that differences in the immunomodulatory milieu that are partially accomplished through the action of cytokines are responsible for disease heterogeneity and outcome.