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Neuroendokrinimmunologie

Neue Aspekte zur Pathogenese und klinischen Anwendung

Neuroendocrine immunology

New pathogenetic aspects and clinical application

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Zusammenfassung

Nach einer 20-jährigen Phase der Verbesserung der antiinflammatorischen Therapie durch Biologika erkennen wir bei chronisch-entzündlichen Krankheiten (CEK) nach und nach langfristige Folgekrankheiten wie Fatigue, Anorexie/Mangelernährung, kachektische Fettsucht, Insulinresistenz, Dyslipidämie, Veränderungen der Steroidhormonachsen (z. B. Androgenverlust), erhöhter Sympathikustonus/erniedrigter Parasympathikustonus, entzündungsassoziierte Anämie und Osteopenie. In diesem Artikel wird eine neue Theorie zur Pathophysiologie dieser Folgekrankheiten erstmals in deutscher Sprache vorgestellt. Es werden dabei Elemente der Evolutionsmedizin und der neuroendokrinen Regulation des Energiehaushalts benutzt. Die Kernaussage ist folgende: Die Energiebereitstellung für ein aktiviertes Immunsystem wurde für vorübergehende entzündliche Episoden positiv selektioniert, wohingegen die Dauernutzung dieses adaptiven Programms bei CEK wegen der zu langen Beanspruchung der Systeme die o. g. Krankheitsfolgen induziert. Die Überlegungen können dazu ermutigen, bei CEK neben der Entzündungshemmung auch weitere typische systemische Krankheitsfolgen zu diagnostizieren und zu therapieren.

Abstract

After two decades of enormous improvements in anti-inflammatory therapy with biologics long-standing disease sequelae in chronic inflammatory diseases (CID) can be recognized, such as fatigue, anorexia/malnutrition, cachectic obesity, insulin resistance, dyslipidemia, changes of steroid hormone axes (e. g. loss of androgens), increased sympathetic nervous tone/decreased parasympathetic nervous tone, inflammation-related anemia and osteopenia. This article demonstrates for the first time in the German language a new theory to explain the pathophysiology of these disease sequelae. It includes concepts from evolutionary medicine and neuroendocrine regulation of energy allocation. The core statement is: the networks of energy regulation and energy allocation have been evolutionarily positively selected for transient inflammatory episodes (not for CIDs due to the negative selection pressure) but long-standing use of these adaptive programs for CID support systemic disease sequelae. These considerations might help to deviate focus from pure anti-inflammatory treatment to adequate diagnosis and therapy of systemic disease sequelae.

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Abbreviations

CEK:

Chronisch-entzündliche Erkrankungen

HDL-Cholesterin:

High-Density-Lipoprotein-Cholesterin

HLA:

„Human leukocyte antigene“

HPA-Achse:

Hypothalamus-Hypophysen-Nebennieren-Achse

IGF-1:

„Insulin-like growth factor“

RA:

Rheumatoide Arthritis

RANK:

„Receptor activator of NF-kappa-B“

RANKL:

„Receptor activator of NF-kappa-B ligand“

SNS:

Sympathisches Nervensystem

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  1. Labor für Experimentelle Rheumatologie und Neuroendokrinoimmunologie, Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland

    R.H. Straub

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Straub, R. Neuroendokrinimmunologie. Z. Rheumatol. 70, 767–774 (2011). https://doi.org/10.1007/s00393-011-0784-8

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  • DOI: https://doi.org/10.1007/s00393-011-0784-8

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