Neurol. pro Praxi, 2002; 5: 236-243

Imunopatogeneze roztroušené sklerózy

doc. RNDr. Jan Krejsek CSc1, MUDr. Otakar Kopecký CSc1, MUDr. Radomír Taláb CSc2
1 Ústav klinické imunologie a alergologie, FN a LF UK Hradec Králové
2 Neurologická klinika FN, Hradec Králové

Keywords: roztroušená skleróza, imunopatogeneze, modulace.

Published: December 31, 2002  Show citation

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Krejsek J, Kopecký O, Taláb R. Imunopatogeneze roztroušené sklerózy. Neurol. praxi. 2002;3(5):236-243.

V patogenezi roztroušené sklerózy sehrává klíčovou úlohu autoimunitní imunopatologická reaktivita. V geneticky disponovaném jedinci vlivem neznámých vnějších faktorů, které velmi pravděpodobně zahrnují působení infekčních agens, dojde v CNS k uvolnění autoantigenů. Ty jsou po zpracování a vazbě na molekuly HLA prezentovány autoreaktivním T lymfocytům. Antigen prezentující buňky identifikují nebezpečné vzory, produkují pluripotentní prozánětové cytokiny (TNF) a poskytují nezbytné kostimulační signály T lymfocytům. Krevně-mozková bariéra se stává prostupnou pro lymfocyty a mononukleární fagocyty, které migrují do CNS vlivem C-C chemokinů. V poškozující zánětové reakci dominuje působení TH1 T lymfocytů a aktivovaných makrofágů. Hlavním terčem poškozujícího zánětu jsou imunodominantní epitopy strukturních molekul myelinové pochvy. Postupně dochází k intramolekulovému a intermolekulovému rozšiřování terčů autoimunitní imunopatologické reaktivity. Složky zánětu pozitivně regulují reparační procesy v CNS. Znalost patogeneze roztroušené sklerózy umožnila zavedení léků, které pozitivně modulují poškozující zánět. Jedná se o interferon a glatirameracetát. V preklinických testech jsou zkoušeny další nadějné preparáty.

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