从间充质干细胞调控免疫平衡作用探讨中医扶正祛邪治疗银屑病
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摘要
银屑病是一种常见而顽固难治的慢性、炎症性皮肤病。近年来研究者普遍认为,银屑病的发病与免疫紊乱密切相关。银屑病涉及的炎症细胞与间充质干细胞所调控的细胞一致,间充质干细胞调节的辅助性T细胞17/调节性T细胞(Th17/Treg)免疫失衡可能是银屑病发病的关键环节。中医扶正祛邪理论与间充质干细胞调节免疫平衡有异曲同工之处,间充质干细胞能够促进抑炎淋巴细胞Treg增殖,而对促炎淋巴细胞Th17无明显效果,补肾类中药与间充质干细胞从来源及功能等方面具有相似性,因此,临床治疗银屑病时,在使用消风、清热、凉血、活血等祛邪法的同时更应注重补益类中药的使用,以提高临床疗效。
Psoriasis is a common and refractory chronic,inflammatory skin disease. In recent years,researchers generally believe that the incidence of psoriasis is closely related to immune disorders. The inflammatory cells involved in psoriasis are consistent with those regulated by mesenchymal stem cells. The immune imbalance of helper T cells17/regulatory T cells( Th17/Treg) regulated by mesenchymal stem cells may be a key link in the pathogenesis of psoriasis. The theory of Chinese medicine strengthening vital qi to eliminate pathogenic factor and the regulation of immune balance by mesenchymal stem cells have different approaches but equally satisfactory results. Mesenchymal stem cells can promote the proliferation of anti-inflammatory lymphocytes Treg,but have no obvious effects on pro-inflammatory lymphocytes Th17. Kidney-tonifying Chinese medicine and mesenchymal stem cells has similarities in terms of source and function. Therefore,in the clinical treatment of psoriasis,it is necessary to pay attention to the use of tonifying and replenishing Chinese medicines,while eliminating pathogenic factors,such as reliving wind,clearing heat,cooling blood,activating blood,so as to improve clinical efficacy.
Psoriasis is a common and refractory chronic,inflammatory skin disease. In recent years,researchers generally believe that the incidence of psoriasis is closely related to immune disorders. The inflammatory cells involved in psoriasis are consistent with those regulated by mesenchymal stem cells. The immune imbalance of helper T cells17/regulatory T cells( Th17/Treg) regulated by mesenchymal stem cells may be a key link in the pathogenesis of psoriasis. The theory of Chinese medicine strengthening vital qi to eliminate pathogenic factor and the regulation of immune balance by mesenchymal stem cells have different approaches but equally satisfactory results. Mesenchymal stem cells can promote the proliferation of anti-inflammatory lymphocytes Treg,but have no obvious effects on pro-inflammatory lymphocytes Th17. Kidney-tonifying Chinese medicine and mesenchymal stem cells has similarities in terms of source and function. Therefore,in the clinical treatment of psoriasis,it is necessary to pay attention to the use of tonifying and replenishing Chinese medicines,while eliminating pathogenic factors,such as reliving wind,clearing heat,cooling blood,activating blood,so as to improve clinical efficacy.
引文
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[4]MONTELEONE G,PALLONE F,MACDONALD TT,et al. Psoriasis:from pathogenesis to novel therapeutic approaches[J]. Clin Sci(Lond),2011,120(1):1-11.
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[6]GHARIBI T,AHMADI M,SEYFIZADEH N,et al.Immunomodulatory characteristics of mesenchymal stem cells and their role in the treatment of Multiple Sclerosis[J]. Cell Immunol,2015,293(2):113-121.
[7]GLENN JD, WHARTENBY KA. Mesenchymal stem cells:Emerging mechanisms of immunomodulation and therapy[J]. World J Stem Cells,2014,6(5):526-539.
[8]曹凯,章涛.间充质干细胞的免疫调节可塑性研究进展[J].医学综述,2018,24(1):34-39.
[9]HOU R,LIU R,NIU X,et al. Biological characteristics and gene expression pattern of bone marrow mesenchymal stem cells in patients with psoriasis[J]. Exp Dermatol,2014,23(7):521-523.
[10]LIU R,WANG Y,ZHAO X,et al. Lymphocyte inhibition is compromised in mesenchymal stem cells from psoriatic skin[J]. Eur J Dermatol,2014,24(5):560-567.
[11]ZHANG K,LIU R,YIN G,et al. Differential cytokine secretion of cultured bone marrow stromal cells from patients with psoriasis and healthy volunteers[J]. Eur J Dermatol,2010,20(1):49-53.
[12]LYNDE CW,POULIN Y,VENDER R,et al. Interleukin17A:toward a new understanding of psoriasis pathogenesis[J]. J Am Acad Dermatol,2014,71(1):141-150.
[13]NAKAJIMA K. Critical role of the interleukin-23/T-helper17 cell axis in the pathogenesis of psoriasis[J]. J Dermatol,2012,39(3):219-224.
[14]MATTOZZI C,SALVI M,D'EPIRO S,et al. Importance of regulatory T cells in the pathogenesis of psoriasis:review of the literature[J]. Dermatology,2013,227(2):134-145.
[15]JADALI Z,ESLAMI MB. T cell immune responses in psoriasis[J]. Iran J Allergy Asthma Immunol,2014,13(4):220-230.
[16]KARAMEHIC J,ZECEVIC L,RESIC H,et al. Immunophenotype lymphocyte of peripheral blood in patients with psoriasis[J]. Med Arch,2014,68(4):236-238.
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[20]姜群群,刘玲玲,康玲,等.银屑病中西医研究进展[J].中医临床研究,2017,9(25):144-148.
[21]KODE JA,MUKHERJEE S,JOGLEKAR MV,et al.Mesenchymal stem cells:immunobiology and role in immunomodulationand tissue regeneration[J]. Cytotherapy,2009,11(4):377-391.
[22]YAGI H,SOTO-GUTIERREZ A,PAREKKADAN B,et al. Mesenchymal stem cells:mechanisms of immunomodulation and homing[J]. Cell Transplant,2010,19(6):667-679.
[23]MATSUZAKI Y,SATO Y. Bone and stem cells. Isolation and immunomodulation of stem mesenchymal cells[J].Clin Calcium,2014,24(4):575-583.
[24]MELIEF SM,SCHRAMA E,BRUGMAN MH,et al.Multipotent stromal cells induce human regulatory T cells through a novel pathway involving skewing of monocytes toward anti-inflammatory macrophages[J]. Stem Cells,2013,31(9):1980-1991.
[25]尹秀平.从巴戟天多糖对银屑病AMSCs免疫调控的干预探讨“补肾培元”法治疗银屑病的作用机制[D].北京:中国中医科学院,2017.
[26]张爱娟,王汉裕,邝卫红.间充质干细胞的中医理论归属探讨[J].广州中医药大学学报,2016,33(2):258-261.
[27]杨明,张军峰,陈颖,等.基于中医现代认识进行干细胞与中医“精”的相似性探讨[J].辽宁中医药大学学报,2011,13(2):101-104.
[28]刘柏炎,蔡光先.试论中医学精气与干细胞生物学的关系[J].湖南中医学院学报,2003,23(6):29-30.
[29]吴小红,曾雪,郑晋云.许铣运用温阳化瘀复脉法治疗顽固性斑块型银屑病的体会[J].中国中西医结合皮肤性病学杂志,2017,16(3):271-273.
[30]周淑维,宋坪,刘瓦利.庄国康教授治疗银屑病经验[J].中国中西医结合皮肤性病学杂志,2004,3(1):37-38.
[31]许灿龙,蔡瑞康.蔡瑞康教授中西医结合治疗寻常型银屑病经验[J].中国中西医结合皮肤性病学杂志,2018(4):373-375.
[32]赵京霞,底婷婷,王燕,等.凉血活血中药对咪喹莫特诱导小鼠银屑病样皮损模型IL-23/IL-17炎症轴的作用[J].北京中医药大学学报,2015,38(2):89-94.
[33]娄卫海,张志礼,邓丙戌.凉血活血汤治疗进行期银屑病的临床及实验研究[J].中华皮肤科杂志,1999,32(2):80-81.
[34]宋坪,王晓旭,杨茂誉,等.开通玄府、通络解毒法治疗斑块状银屑病120例疗效观察[J].中医杂志,2013,54(17):1476-1479.
[2]丁晓岚,王婷琳,沈佚葳,等.中国六省市银屑病流行病学调查[J].中国皮肤性病学杂志,2010,24(7):598-601.
[3]LOWES MA,SUAREZ-FARINAS M,KRUEGER JG.Immunology of psoriasis[J]. Annu Rev Immunol,2014,32(1):227-255.
[4]MONTELEONE G,PALLONE F,MACDONALD TT,et al. Psoriasis:from pathogenesis to novel therapeutic approaches[J]. Clin Sci(Lond),2011,120(1):1-11.
[5]钟起诚.从中医药学与现代免疫学的联系探讨系统性红斑狼疮的发病机理及治疗[J].新中医,2004,36(2):3-6.
[6]GHARIBI T,AHMADI M,SEYFIZADEH N,et al.Immunomodulatory characteristics of mesenchymal stem cells and their role in the treatment of Multiple Sclerosis[J]. Cell Immunol,2015,293(2):113-121.
[7]GLENN JD, WHARTENBY KA. Mesenchymal stem cells:Emerging mechanisms of immunomodulation and therapy[J]. World J Stem Cells,2014,6(5):526-539.
[8]曹凯,章涛.间充质干细胞的免疫调节可塑性研究进展[J].医学综述,2018,24(1):34-39.
[9]HOU R,LIU R,NIU X,et al. Biological characteristics and gene expression pattern of bone marrow mesenchymal stem cells in patients with psoriasis[J]. Exp Dermatol,2014,23(7):521-523.
[10]LIU R,WANG Y,ZHAO X,et al. Lymphocyte inhibition is compromised in mesenchymal stem cells from psoriatic skin[J]. Eur J Dermatol,2014,24(5):560-567.
[11]ZHANG K,LIU R,YIN G,et al. Differential cytokine secretion of cultured bone marrow stromal cells from patients with psoriasis and healthy volunteers[J]. Eur J Dermatol,2010,20(1):49-53.
[12]LYNDE CW,POULIN Y,VENDER R,et al. Interleukin17A:toward a new understanding of psoriasis pathogenesis[J]. J Am Acad Dermatol,2014,71(1):141-150.
[13]NAKAJIMA K. Critical role of the interleukin-23/T-helper17 cell axis in the pathogenesis of psoriasis[J]. J Dermatol,2012,39(3):219-224.
[14]MATTOZZI C,SALVI M,D'EPIRO S,et al. Importance of regulatory T cells in the pathogenesis of psoriasis:review of the literature[J]. Dermatology,2013,227(2):134-145.
[15]JADALI Z,ESLAMI MB. T cell immune responses in psoriasis[J]. Iran J Allergy Asthma Immunol,2014,13(4):220-230.
[16]KARAMEHIC J,ZECEVIC L,RESIC H,et al. Immunophenotype lymphocyte of peripheral blood in patients with psoriasis[J]. Med Arch,2014,68(4):236-238.
[17]巢元方.诸病源候论[M].南京中医学院,校释.北京:人民卫生出版社,1982:962.
[18]祁坤.外科大成[M].上海:上海卫生出版社,1957:337.
[19]尚俊良,徐佳,王莒生,等.银屑病中医研究概述[J].中医杂志,2017,58(22):1971-1974.
[20]姜群群,刘玲玲,康玲,等.银屑病中西医研究进展[J].中医临床研究,2017,9(25):144-148.
[21]KODE JA,MUKHERJEE S,JOGLEKAR MV,et al.Mesenchymal stem cells:immunobiology and role in immunomodulationand tissue regeneration[J]. Cytotherapy,2009,11(4):377-391.
[22]YAGI H,SOTO-GUTIERREZ A,PAREKKADAN B,et al. Mesenchymal stem cells:mechanisms of immunomodulation and homing[J]. Cell Transplant,2010,19(6):667-679.
[23]MATSUZAKI Y,SATO Y. Bone and stem cells. Isolation and immunomodulation of stem mesenchymal cells[J].Clin Calcium,2014,24(4):575-583.
[24]MELIEF SM,SCHRAMA E,BRUGMAN MH,et al.Multipotent stromal cells induce human regulatory T cells through a novel pathway involving skewing of monocytes toward anti-inflammatory macrophages[J]. Stem Cells,2013,31(9):1980-1991.
[25]尹秀平.从巴戟天多糖对银屑病AMSCs免疫调控的干预探讨“补肾培元”法治疗银屑病的作用机制[D].北京:中国中医科学院,2017.
[26]张爱娟,王汉裕,邝卫红.间充质干细胞的中医理论归属探讨[J].广州中医药大学学报,2016,33(2):258-261.
[27]杨明,张军峰,陈颖,等.基于中医现代认识进行干细胞与中医“精”的相似性探讨[J].辽宁中医药大学学报,2011,13(2):101-104.
[28]刘柏炎,蔡光先.试论中医学精气与干细胞生物学的关系[J].湖南中医学院学报,2003,23(6):29-30.
[29]吴小红,曾雪,郑晋云.许铣运用温阳化瘀复脉法治疗顽固性斑块型银屑病的体会[J].中国中西医结合皮肤性病学杂志,2017,16(3):271-273.
[30]周淑维,宋坪,刘瓦利.庄国康教授治疗银屑病经验[J].中国中西医结合皮肤性病学杂志,2004,3(1):37-38.
[31]许灿龙,蔡瑞康.蔡瑞康教授中西医结合治疗寻常型银屑病经验[J].中国中西医结合皮肤性病学杂志,2018(4):373-375.
[32]赵京霞,底婷婷,王燕,等.凉血活血中药对咪喹莫特诱导小鼠银屑病样皮损模型IL-23/IL-17炎症轴的作用[J].北京中医药大学学报,2015,38(2):89-94.
[33]娄卫海,张志礼,邓丙戌.凉血活血汤治疗进行期银屑病的临床及实验研究[J].中华皮肤科杂志,1999,32(2):80-81.
[34]宋坪,王晓旭,杨茂誉,等.开通玄府、通络解毒法治疗斑块状银屑病120例疗效观察[J].中医杂志,2013,54(17):1476-1479.