Udskriv Udskriv
Switch language
Rigshospitalet - en del af Københavns Universitetshospital

Beyond the TNF-α Inhibitors: New and Emerging Targeted Therapies for Patients with Axial Spondyloarthritis and their Relation to Pathophysiology

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review


  1. Targeting Bruton's Tyrosine Kinase Across B-Cell Malignancies

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  2. Clinical Implications of P-Glycoprotein Modulation in Drug-Drug Interactions

    Publikation: Bidrag til tidsskriftReviewForskningpeer review

  3. Food-drug interactions

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  4. Urinary tract infections in patients with spinal cord lesions: treatment and prevention

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

  5. Mononitrates in combination with beta-blocker therapy in the treatment of severe angina pectoris

    Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Vis graf over relationer

Axial spondyloarthritis (axSpA) is a complex disease that affects the joints and entheses of axial and peripheral joints, and is associated with inflammation in extra-articular sites such as the gut. Improved knowledge on genetics and immunology has improved treatment options with the availability of treatments targeting tumor necrosis factor-α (TNF-α) and interleukin (IL)-17. However, these agents do not provide clinical benefit for about 40% of patients, and additional therapeutic options are necessary. Theories on pathogenesis includes misfolding of HLA-B*27 during its assembly leading to endoplasmic reticulum stress and autophagy/unfolded protein response (UPR). HLA-B*27 may express free heavy chain on the cell surface, which activates innate immune receptors on T, natural killer, and myeloid cells with pro-inflammatory effects. Activation of UPR genes is associated with increased TNF-α, interleukin-23 (IL-23), IL-17, interferon-γ expression, and expansion of T helper (Th)-17 cells. Certain genotypes of endoplasmic reticulum aminopeptidase (ERAP) 1 and 2 are associated with ankylosing spondylitis (AS) and functionally interact with the HLA-B27 peptidome. Innate immune cells type 3, which express RORγt, regulate expression of IL-17 and IL-22 in T cells. Stimulation of gamma-delta T cells with IL-23 also induces IL-17. Mucosa-associated invariant T cells residing in the gut mucosa express IL-17 in AS patients after stimulation with IL-7. Prostaglandin E2 induces IL-17A independent of IL-23 via IL-1β and IL-6. The pathogenic role of gut inflammation, zonulin and microbiota, which has a different composition in AS patients, remains to be elucidated. This article also includes a comprehensive review on the mechanism of action and efficacy of the biological treatments currently approved for axSpA (TNF-α inhibitors and IL-17 inhibitors) and future targets for treatment (other IL-17 family member (s), Janus kinase, IL-23, and phosphodiesterase 4).

Udgave nummer14
Sider (fra-til)1397-1418
Antal sider22
StatusUdgivet - sep. 2018

ID: 56659150