Synovial biopsies for molecular definition of rheumatoid arthritis and treatment response phenotyping: where can we improve?
Synovial biopsies for molecular definition of rheumatoid arthritis and treatment response phenotyping: where can we improve?
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DOI：
10.1080/14737159.2023.2284774
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发表时间：
2023-11-20
影响因子：
5.1
通讯作者：
Pitzalis，Costantino
中科院分区：
文献类型：
--
作者：
Iaquinta，Francesco Salvatore;Rivellese，Felice;Pitzalis，Costantino
前言类风湿性关节炎(RA)发病机制的细胞和分子机制方面的广泛知识促进了治疗的进展。然而，多达10%-20%的患者对被归类为多药耐药的多种治疗药物没有反应。未来的一个关键挑战将是在临床实践中实施滑膜活检，以促进从目前的反复试验策略向新形式的临床试验的转变。生物标记物驱动的试验有可能改善药物选择和患者分层，降低经济成本和不必要的药物相关毒性。这篇特别报告探讨了滑膜活检的临床和研究应用，类风湿关节炎分子病理生物学的进展，以更好地了解疾病的发病机制和治疗反应，以及所需范式转换的前进方向。专家意见在当前高度靶向的生物药物显著改变了类风湿关节炎患者的面貌的时代，滑膜活检的使用是一种有价值的实用工具，可以剖析疾病的发病机制和治疗反应。在不久的将来，人们希望技术的进步将加快滑膜分子分析的速度，并希望新的生物标记物驱动试验的设计将使患者能够获得更有效的治疗。
IntroductionThe extensive knowledge gained in the cellular and molecular mechanisms underlying Rheumatoid Arthritis (RA) pathogenesis has led to therapeutic advances. However, up to 10–20% of patients fail to respond to multiple therapeutic agents being classified as multi-drugresistant. A key challenge moving forward will be the implementation of synovial biopsies in clinical practice to facilitate the shift from the current trial-and-error strategy toward new forms of clinical trials. Biomarker-driven trials have the potential to improve drug selection and patient stratification, reduce economic costs and unnecessary drug-related toxicity.Areas coveredThis special report explores the clinical and research applications of synovial biopsy, the advancement in the molecular pathobiology of RA to better understand disease pathogenesis and treatment response, and the way forward for the paradigm shift needed.Expert opinionIn the current era of highly targeted biologic drugs which have dramatically transformed the outlook of RA patients, the use of synovial biopsy represents a valuable practical tool to dissect disease pathogenesis and, consequently, treatment response. In the near future, it is hoped that technological advances will allow for speeding up synovial molecular analysis and that the design of new biomarker-driven trials will enable the allocation of patients to more effective treatment.