„Tlące się stwardnienie rozsiane” — wyzwanie kliniczne i terapeutyczne
Streszczenie
Wstęp. Ocena przebiegu klinicznego, zmian neuroobrazowych oraz histopatologicznych sugeruje, że stwardnienie rozsiane (SM) nie powinno być definiowane jedynie jako ogniskowa choroba zapalna ośrodkowego układu ner wowego (OUN), ponieważ istota schorzenia wynika z rozlanego, „tlącego się” procesu patofizjologicznego.
Aktualny wiedzy. Klinicznym wykładnikiem „tlącego się SM” jest postęp choroby niezależny od aktywności rzutowej (PIRA); zaś ciągła aktywacja mikrogleju jest źródłem tlącego się zapalenia i niepowodzenia remielinizacji w przebiegu choroby.
Implikacje kliniczne. Wraz z czasem trwania SM skuteczność stosowanego obecnie leczenia immunomodulującego jest mniejsza, a jego działanie niewystarczające do opanowania „tlącego się SM”. Wskazano nowe markery neuroobrazowe obejmujące paramagnetic rim lesions (PRLs) oraz wolno powiększające się zmiany (SELs), potencjalne metody oceny klinicznej oraz obiecujące opcje terapeutyczne, tj. stosowanie inhibitorów kinazy tyrozynowej Brutona (BTK inhibitors), zapobiegających PIRA w przebiegu „tlącego się SM”.
Kierunki działań w przyszłości. Innowacyjne spojrzenie na patofizjologię i pr zebieg kliniczny uzasadnia konieczność podejścia holistycznego do SM. Działania klinicystów powinny dążyć do wskazania subtelnych deficytów neurologicznych, zarówno w zakresie sprawności fizycznej jak i funkcjonowania poznawczego celem scharakteryzowania postępu choroby już we wczesnych etapach jej rozwoju. Niewątpliwie nadchodzi nowa era SM, w której wykorzystywane będą nowatorskie markery rezonansowe oraz kliniczne metody oceny „tlącego się SM”, a leczenie obejmie terapię skojarzoną, z uwzględnieniem zarówno leków zmniejszających aktywność rzutową jak i terapię hamującą progresję choroby.
Słowa kluczowe: „tlące stwardnienie rozsiane”mikroglejinhibitory kinazy tyrozynowej Brutona
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