Immunological Changes in Rosacea Patients
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Date
2022
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Rīgas Stradiņa universitāte
Rīga Stradiņš University
Rīga Stradiņš University
Abstract
Priekšvēsture: Rosacea ir hroniska ādas slimība, kas līdz šim nav pilnībā izprasta. Šīs slimības klīniskās pazīmes ir eritēma, telangiektāzijas, papulas un pustulas, un rinofīma. Cilvēki, kurus skārusi šī slimība, ļoti cieš no tās, jo klīniskās pazīmes var būt ļoti kropļojošas un arī stigmatizētas. Jau ir ārstēšanas metodes, kas var atvieglot rozācijas klīnisko gaitu, taču līdz šodienai pilnībā to izārstēt nav iespējams. Lai to panāktu, ir ļoti svarīgi izprast precīzu tās pamatā esošo etioloģiju un patofizioloģiju.
Šajā pārskatā ir apkopots zināšanu līmenis un apskatītas dažādas imunoloģiskās izmaiņas, kuras var novērot rozācijas gadījumā. Papildus tam visu izmaiņu kopsavilkums tiek parādīts shēmā, kas izskaidro šīs izmaiņas.
Metodes: PubMed tika veikta visaptveroša literatūras meklēšana, izmantojot atslēgvārdu “Rosacea”. Tika pārskatīti visi pēdējo 5 gadu raksti, kuriem ir brīva piekļuve un kuru saturs ietver imunoloģiskas izmaiņas rozācijas gadījumā. Tika izskatīti primārie un sekundārie raksti. Šajā pārskata darbā tika iekļauti tikai raksti, kas publicēti angļu valodā.
Rezultāti: Rozācijas patoģenēzē svarīga loma ir daudziem dažādiem imunoloģiskiem ceļiem. Imūnsistēmas šūnas ir būtiski iesaistītas šajā procesā, dominējot T palīgšūnām, īpaši Th1 un Th17 šūnām. Bez tām šeit var atrast arī tuklās šūnas, neitrofilus, makrofāgus, B šūnas un plazmocītus. Šīs šūnas izdala arī noteiktus citokīnus, kas veicina iekaisumu, proti, IL-1, IL-6, IL-8, IL-17, IL-18 un IL-33. Var identificēt arī dažādus receptorus. Tie ir PAR2, TLR2 un TRVP. Bez tiem tika konstatēta arī mikrobu aktivitāte saistībā ar rozāciju, kā arī D vitamīnu. Šķiet, ka vissvarīgākais slimības attīstības ceļš ir serīna proteāzes/katelicidīna mijiedarbība. Kallikreīns 5 un 7, kas ir serīna proteāze, aktivizē katelicidīnu LL37, un pēc tam peles modelī var redzēt rozācijas klīniskās pazīmes. No otras puses, kalikreīnus var deaktivizēt serīna proteāzes inhibitori, ko sauc par LEKTI/SPINK5. Aktivizējot kallikreīna/LL37 ceļu, tiek aktivizētas daudzas signālmolekulas. Tas ietver NF-kB ceļus un VEGF sekrēciju, kas veicina angioģenēzi. Visbeidzot, tika izveidota shēma, lai apkopotu visas imunoloģiskās izmaiņas, kuras esmu atklājis šī pētījuma ietvaros.
Secinājumi: Rozācijas gadījumā ir daudz imunoloģisku izmaiņu. Lai tās izpētītu, būs svarīgi uzzināt vairāk par tās etioloģiju, un visbeidzot izstrādāt efektīvas ārstēšanas metodes.
Background: Rosacea is a chronic skin disorder that is till today not entirely understood. Clinical features of this disease are erythema, telangiectasia, papules, and pustules and rhinophyma. People affected from this disease suffer immensely from it, as the clinical features can be very disfiguring and are also stigmatizing. There are already treatments that can alleviate the clinical course of rosacea, but a complete cure has not been found until today. Therefore, it is very important to understand the exact etiology and pathophysiology underlying it. The following review summarizes the state of knowledge and discusses the various immunological changes that can be seen in rosacea. In addition to that a summary of all the changes is displayed in a scheme explaining them. Methods: A comprehensive literature search was performed in PubMed, by using the keyword “Rosacea”. All articles of the last 5 years that have free access where then scanned for their content regarding the immunological changes in rosacea. Primary and secondary articles were considered. Only articles that are published in English were included in this review work. Results: A lot of different immunological pathways play an important role in rosacea. The cells of the immune system are substantially involved in this process with a dominant role of T helper cells, especially Th1 and Th17 cells. Besides those also mast cells, neutrophils, macrophages, B cells and plasma cells play a role. These cells also secrete certain cytokines that contribute to the inflammation, that are by name IL-1, IL-6, IL-8, IL-17, IL-18 and IL-33. A variety of receptors could also be identified. Those are PAR2, TLR2 and TRVP. Besides those also microbial activity was found in association with rosacea as well as vitamin D. The most important pathway for the development of the disease seems to be the serine protease/cathelicidin interaction. Kallikrein 5 and 7, which are serine proteases, are activating the cathelicidin LL37, where upon that the clinical features of rosacea can be seen in a mouse model. Kallikreins on the other hand can be deactivated by serine protease inhibitors called LEKTI/SPINK5. Upon activation of the Kallikrein/LL37 pathway a lot of signaling molecules get activated. This includes the NF-kB pathways and the secretion of VEGF, which promotes angiogenesis. Finally, a scheme was prepared to summarize all of the immunological changes that I have found in the recent research. Conclusions: There are a lot of immunological changes in rosacea. To investigate them will be important to find out more about its etiology and finally development efficient treatment methods.
Background: Rosacea is a chronic skin disorder that is till today not entirely understood. Clinical features of this disease are erythema, telangiectasia, papules, and pustules and rhinophyma. People affected from this disease suffer immensely from it, as the clinical features can be very disfiguring and are also stigmatizing. There are already treatments that can alleviate the clinical course of rosacea, but a complete cure has not been found until today. Therefore, it is very important to understand the exact etiology and pathophysiology underlying it. The following review summarizes the state of knowledge and discusses the various immunological changes that can be seen in rosacea. In addition to that a summary of all the changes is displayed in a scheme explaining them. Methods: A comprehensive literature search was performed in PubMed, by using the keyword “Rosacea”. All articles of the last 5 years that have free access where then scanned for their content regarding the immunological changes in rosacea. Primary and secondary articles were considered. Only articles that are published in English were included in this review work. Results: A lot of different immunological pathways play an important role in rosacea. The cells of the immune system are substantially involved in this process with a dominant role of T helper cells, especially Th1 and Th17 cells. Besides those also mast cells, neutrophils, macrophages, B cells and plasma cells play a role. These cells also secrete certain cytokines that contribute to the inflammation, that are by name IL-1, IL-6, IL-8, IL-17, IL-18 and IL-33. A variety of receptors could also be identified. Those are PAR2, TLR2 and TRVP. Besides those also microbial activity was found in association with rosacea as well as vitamin D. The most important pathway for the development of the disease seems to be the serine protease/cathelicidin interaction. Kallikrein 5 and 7, which are serine proteases, are activating the cathelicidin LL37, where upon that the clinical features of rosacea can be seen in a mouse model. Kallikreins on the other hand can be deactivated by serine protease inhibitors called LEKTI/SPINK5. Upon activation of the Kallikrein/LL37 pathway a lot of signaling molecules get activated. This includes the NF-kB pathways and the secretion of VEGF, which promotes angiogenesis. Finally, a scheme was prepared to summarize all of the immunological changes that I have found in the recent research. Conclusions: There are a lot of immunological changes in rosacea. To investigate them will be important to find out more about its etiology and finally development efficient treatment methods.
Description
Medicīna
Medicine
Veselības aprūpe
Health Care
Medicine
Veselības aprūpe
Health Care
Keywords
Rosacea, imunoloģiskās izmaiņas, katelicidīns LL-37, interleikīns, serīna proteāzes, nodevu līdzīgi receptoriem, mikrobu ietekme, Rosacea, immunological changes, cathelicidin LL-37, interleukins, serine proteases, toll like receptors, microbial impact