Maksim OV, Salukhov VV, Romashevskiy BV. Prospects for targeted therapy of Graves' disease: A review. Consilium Medicum. 2024;26(4):238–245. DOI:10.26442/20751753.2024.4.202764
Перспективы таргетной терапии болезни Грейвса
Максим О.В., Салухов В.В., Ромашевский Б.В. Перспективы таргетной терапии болезни Грейвса. Consilium Medicum. 2024;26(4):238–245. DOI:10.26442/20751753.2024.4.202764
Maksim OV, Salukhov VV, Romashevskiy BV. Prospects for targeted therapy of Graves' disease: A review. Consilium Medicum. 2024;26(4):238–245. DOI:10.26442/20751753.2024.4.202764
Высокая распространенность аутоиммунных заболеваний щитовидной железы и низкая эффективность лечения являются одними из причин длительной нетрудоспособности и высокой инвалидизации пациентов. В настоящее время достигнут существенный прогресс в изучении иммунологических механизмов развития аутоиммунной патологии щитовидной железы, что позволяет разработать новые направления в ее лечении. Болезнь Грейвса (БГ) является классическим аутоиммунным заболеванием, характеризующимся образованием стимулирующих антител к рецептору тиреотропного гормона и проявляющимся клиникой тиреотоксикоза. Основные методы лечения БГ не менялись на протяжении последних 70 лет и представлены консервативной тиреостатической терапией, радиойодтерапией и тиреоидэктомией. В то же время каждый из приведенных методов имеет свои противопоказания и нежелательные побочные явления, что требует поиска новых подходов в терапии указанных заболеваний. Лечение с использованием современных биологических препаратов дает возможность избирательно воздействовать на основные механизмы аутоиммунного повреждения при БГ с минимальным системным влиянием на организм. В статье рассмотрены основные патогенетические механизмы развития БГ и эндокринной офтальмопатии, а также освещены вопросы коррекции данных нарушений с использованием таргетной терапии.
The high prevalence of autoimmune thyroid diseases and the low effectiveness of treatment are the great of the reasons for long-term disability and high disability of patients. Significant progress in the study of immunological mechanisms of the development of autoimmune thyroid pathology has been achieved. These findings evidences provide new directions in the treatment of these diseases. Graves' disease is a classic autoimmune disease characterized by the formation of stimulating antibodies to the thyroid-stimulating hormone receptor and manifested by the thyrotoxicosis clinic. The main methods of treating Graves' disease are the conservative thyrostatic therapy, radioiodotherapy and thyroidectomy during past 70 years. At the same time, each of these methods of treatment has its own contraindications adverse invents and it is required new approaches in the treatment of these diseases. Treatment with the use of modern biological drugs makes it possible to selectively affect the main mechanisms of autoimmune damage in Graves' disease with minimal systemic effect on the body. The review examines the main pathogenetic mechanisms of Graves' disease and endocrine ophthalmopathy, as well as highlights the issues of correction of these disorders using targeted therapy.
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________________________________________________
1. Petunina NA, Trukhina LV, Martirosyan NS. Endocrine ophthalmopathy: state-of-the-art approaches. Problems of Endocrinology. 2012;6:24-32 (in Russian).
2. Shustov SB, Khalimov IuSh, Salukhov VV, Trufanov GE. Funktsional’naia i topicheskaia diagnostika v endokrinologii: rukovodstvo dlia vrachei. 3-e izd., pererab. i dop. Moscow: GEOTAR-Media, 2017 (in Russian).
3. Lane LC, Cheetham TD, Perros P, Pearce SHS. New Therapeutic Horizons for Graves’ Hyperthyroidism. Endocr Rev. 2020;41(6):873-84. DOI:10.1210/endrev/bnaa022
4. Burch HB, Perros P, Bednarczuk T, et al. Management of Thyroid Eye Disease: A Consensus Statement by the American Thyroid Association and the European Thyroid Association. Thyroid. 2022;32(12):1439-70. DOI:10.1089/thy.2022.0251
5. Zdor VV, Markelova EV, Geltser BI. New players in altered tolerance to thyroid gland antigens: an immunopathogenesis concept of autoimmune thyroid disease (review). Medical Immunology (Russia). 2016;18(3):209-20 (in Russian). DOI:10.15789/1563-0625-2016-3-209-220
6. Cheredanova VR, Poteshkin YE. Monoclonal antibodies in the treatment of thyroid eye disease. Russian Annals of Ophthalmology. 2021;137(4):116-22 (in Russian). DOI:10.17116/oftalma2021137041116
7. Gel’tser BI, Zdor VV, Kotel’nikov BN. Evolution of the views on pathogenesis of autoimmune thyroid diseases and prospects for their target therapy. Clinical Medicine.
2017; 95(6):524-34 (in Russian). DOI:10.18821/002321492017-956524534
8. LiVolsi VA, Baloch ZW. The Pathology of Hyperthyroidism. Front Endocrinol (Lausanne). 2018;9:737. DOI:10.3389/fendo.2018.00737
9. Yaglova NV, Yaglov VV. Ultrastructural characteristics of molecular release of secretory products from thyroid mast cells induced by lipopolysaccharide. Bull Exp Biol Med. 2013;155(2):260-3. DOI:10.1007/s10517-013-2127-z
10. Lee HJ, Lombardi A, Stefan M, et al. CD40 Signaling in Graves Disease Is Mediated Through Canonical and Noncanonical Thyroidal Nuclear Factor κB Activation. Endocrinology. 2017;158(2):410-8. DOI:10.1210/en.2016-1609
11. Campi I, Tosi D, Rossi S, et al. B Cell Activating Factor (BAFF) and BAFF Receptor Expression in Autoimmune and Nonautoimmune Thyroid Diseases. Thyroid.
2015;25(9):1043-9. DOI:10.1089/thy.2015.0029
12. Maksim OV, Romashevsky BV, Demyanenco NYu. Features of the pathogenesis of thyroid diseases in COVID-19. Pharmateca. 2023;3:34-43 (in Russian). DOI:10.18565/pharmateca.2023.3.34-43
13. Kandror V. Pathogenesis of Graves Disease and Mechanism of Action of Thiroid Hormones. Clinical and Experimental Thyroidology. 2008;4(1):26-34 (in Russian). DOI:10.14341/ket20084126-34
14. Taskina ES, Charinzeva SV, Charinzev VV, Serkin DM. New opportunities in endocrine ophthalmopathy diagnostics (review). Clinical and Experimental Thyroidology. 2017;13(3):20-8 (in Russian). DOI:10.14341/ket2017320-28
15. Saprina TV, Prochorenko TS, Ryasanzeva NV, Vorochzova IN. Cytokine-dependent mechanisms in development of autoimmune thyroid disorders. Clinical and Experimental Thyroidology. 2010;6(4):22-7 (in Russian).
16. Sviridenko NYu, Bessmertnaya EG, Belovalova IM, et al. Autoantibodies, immunoglobulins and cytokine profile in patients with graves’ disease and Graves’ orbitopathy. Problems of Endocrinology. 2020;66(5):15-23 (in Russian). DOI:10.14341/probl12544
17. Salukhov VV, Kovalevskaya EA. Amiodarone-induced thyrotoxicosis: a modern view of the problem. Pharmateca. 2023;3:54-63 (in Russian). DOI:10.18565/pharmateca.2023.3.54-63
18. Mohyi M, Smith TJ. IGF1 receptor and thyroid-associated ophthalmopathy. J Mol Endocrinol. 2018;61(1):T29-43. DOI:10.1530/JME-17-0276
19. Wang Y, Smith TJ. Current concepts in the molecular pathogenesis of thyroid-associated ophthalmopathy. Invest Ophthalmol Vis Sci. 2014;55(3):1735-48. DOI:10.1167/iovs.14-14002
20. Strianese D, Rossi F. Interruption of autoimmunity for thyroid eye disease: B-cell and T-cell strategy. Eye (Lond). 2019;33(2):191-9. DOI:10.1038/s41433-018-0315-9
21. Krajewska-Węglewicz L, Radomska-Leśniewska DM, Dorobek M, et al. Update on pathogenesis and immunology of Graves’ ophthalmopathy. Cent Eur J Immunol. 2018;43(4):458-65. DOI:10.5114/ceji.2018.81360
22. Sadovskaya OP, Dravitsa LV. Modern View on the Etiology and Pathogenesis of Endocrine Ophthalmopathy. Health and Ecology Issues. 2019;59(1):9-14 (in Russian).
23. Fang S, Huang Y, Wang S, et al. IL-17A Exacerbates Fibrosis by Promoting the Proinflammatory and Profibrotic Function of Orbital Fibroblasts in TAO. J Clin Endocrinol Metab. 2016;101(8):2955-65. DOI:10.1210/jc.2016-1882
24. Pavanello F, Zucca E, Ghielmini M. Rituximab: 13 open questions after 20 years of clinical use. Cancer Treat Rev. 2017;53:38-46. DOI:10.1016/j.ctrv.2016.11.015
25. Leandro MJ. B-cell subpopulations in humans and their differential susceptibility to depletion with anti-CD20 monoclonal antibodies. Arthritis Res Ther. 2013;15(Suppl. 1):S3. DOI:10.1186/ar3908
26. Heemstra KA, Toes RE, Sepers J, et al. Rituximab in relapsing Graves’ disease, a phase II study. Eur J Endocrinol. 2008;159(5):609-15. DOI:10.1530/EJE-08-0084
27. Khanna D, Chong KK, Afifiyan NF, et al. Rituximab treatment of patients with severe, corticosteroid-resistant thyroid-associated ophthalmopathy. Ophthalmology.
2010;117(1):133-9.e2. DOI:10.1016/j.ophtha.2009.05.029
28. Stan MN, Garrity JA, Carranza Leon BG, et al. Randomized controlled trial of rituximab in patients with Graves’ orbitopathy. J Clin Endocrinol Metab. 2015;100(2):432-41. DOI:10.1210/jc.2014-2572
29. Du FH, Mills EA, Mao-Draayer Y. Next-generation anti-CD20 monoclonal antibodies in autoimmune disease treatment. Auto Immun Highlights. 2017;8(1):12.
DOI:10.1007/s13317-017-0100-y
30. Ristov J, Espie P, Ulrich P, et al. Characterization of the in vitro and in vivo properties of CFZ533, a blocking and non-depleting anti-CD40 monoclonal antibody. Am J Transplant. 2018;18(12):2895-904. DOI:10.1111/ajt.14872
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Авторы
О.В. Максим, В.В. Салухов*, Б.В. Ромашевский
ФГБВОУ ВО «Военно-медицинская академия им. С.М. Кирова», Санкт-Петербург, Россия
*vlasaluk@yandex.ru
________________________________________________
Oksana V. Maksim, Vladimir V. Salukhov*, Boris V. Romashevskiy
Kirov Military Medical Academy, Saint Petersburg, Russia
*vlasaluk@yandex.ru