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Иммунные механизмы атопического дерматита и новые подходы к таргетной биологической терапии

https://doi.org/10.21518/2079-701X-2022-16-3-130-136

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Аннотация

В настоящем обзоре представлены современные данные об иммунопатогенезе, роли цитокинов в воспалении при атопическом дерматите. Рассматриваются патогенетические фенотипы заболевания, связанные с различными нарушениями иммунных механизмов и дисфункцией эпидермального барьера. Показано, что воспалительные процессы при атопическом дерматите реализуются, главным образом, через Тh2-лимфоциты и продуцируемые ими IL-4 и IL-13, которые играют ключевую роль в каскаде аллергических реакций. Именно воздействием цитокинов IL-4 и IL-13 обусловлены основные патофизиологические механизмы, такие как уменьшение экспрессии белков эпидермального барьера и подавление терминальной дифференцировки кератиноцитов, нарушение микробиоты, ремоделирование тканей, переключение изотипа иммуноглобулинов B-лимфоцитами и синтез IgE, дегрануляция тучных клеток и базофилов, направленная миграция воспалительных клеток в ткани, зуд. Среднетяжелые и тяжелые формы атопического дерматита требуют назначения системной терапии, которая до недавнего времени была представлена неселективными иммуносупрессивными препаратами, обладающими умеренной эффективностью и выраженными побочными эффектами при их длительном применении. Современная таргетная терапия атопического дерматита предусматривает использование моноклональных антител как против провоспалительных цитокинов, так и их рецепторов. Прицельное воздействие на ключевые механизмы и мишени иммунного воспаления позволяет минимизировать возможные побочные эффекты иммуносупрессивной терапии. Описаны клинические исследования по изучению эффективности и безопасности ингибиторов IL-4 и IL-13 в терапии атопического дерматита.

Об авторах

Н. Н. Потекаев
Московский научно-практический центр дерматовенерологии и косметологии; Российский национальный исследовательский медицинский университет имени Н.И. Пирогова
Россия

д.м.н., профессор, директор; заведующий кафедрой кожных болезней и косметологии факультета дополнительного профессионального образования

119071, Москва, Ленинский проспект, д. 17;

117997, Москва, ул. Островитянова, д. 1



Г. П. Терещенко
Московский научно-практический центр дерматовенерологии и косметологии; Российский университет дружбы народов
Россия

к.м.н., заведующая консультативно-диагностического центром «Клиника аллергических болезней кожи» филиала «Юго-Западный»; доцент кафедры дерматовенерологии и аллергологии с курсом иммунологии Медицинского института

119071, Москва, Ленинский проспект, д. 17;

117198, Москва, ул. Миклухо-Маклая, д. 6



Р. А. Ханферьян
Российский университет дружбы народов
Россия

д.м.н., профессор Медицинского института

117198, Москва, ул. Миклухо-Маклая, д. 6



А. Л. Савастенко
Российский университет дружбы народов
Россия

заведующий учебной частью кафедры дерматовенерологии и аллергологии с курсом иммунологии Медицинского института

117198, Москва, ул. Миклухо-Маклая, д. 6



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Потекаев Н.Н., Терещенко Г.П., Ханферьян Р.А., Савастенко А.Л. Иммунные механизмы атопического дерматита и новые подходы к таргетной биологической терапии. Медицинский Совет. 2022;(3):130-136. https://doi.org/10.21518/2079-701X-2022-16-3-130-136

For citation:


Potekaev N.N., Tereshchenko G.P., Khanferyan R.A., Savastenko A.L. Immune mechanisms of atopic dermatitis and new approaches to targeted biological therapy. Meditsinskiy sovet = Medical Council. 2022;(3):130-136. (In Russ.) https://doi.org/10.21518/2079-701X-2022-16-3-130-136

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ISSN 2079-701X (Print)
ISSN 2658-5790 (Online)