Zusammenfassung
Das Sjögren-Syndrom (SS) ist eine systemische Autoimmunerkrankung, die durch lymphozytäre Infiltrate exokriner Drüsen - vor allem der Speichel- und Tränendrüsen - charakterisiert ist. In ca. 20 % aller Fälle sind auch einige inner Organe, wie Nieren und Lunge, betroffen. Die Pathogenese des SS ist weitgehend ungeklärt. Genetische und Umweltfaktoren scheinen eine Schlüsselrolle im Rahmen der Entstehung des SS zu spielen. Insbesondere wurde gezeigt, dass einige Virusinfekte die Krankheit auslösen können. In den betroffenen Organen sind die meisten infiltrierenden Zellen CD4 + CD27 + Gedächtniszellen. Darüber hinaus finden sich in den Infiltraten B-Zellen, auf die einige charakteristische Merkmale des SS zurückzuführen sind. Autoantikörper, wie Anti-SSA und -SSB hängen mit B-Zellen zusammen, die sich gegen ubiquitäre Kernantigene richten und die wahrscheinlich bei der Apoptose der Drüsen-Epithelzellen freigesetzt werden. Spezifische Anti-Muscarin(M3)rezeptor-Antikörper könnten, nachdem das Epithel durch chronisch entzündliche Infiltrate geschädigt ist, für die reduzierte Sekretionsleistung der Drüsen bedeutsam sein. Die permanente T-Zell-assoziierte Stimulation und Aktivierung von B-Zellen könnte Ursache der neoplastischen Umwandlung und der Bildung von Lymphomen sein.
Abstract
Sjögren’s syndrome (SS) is a systemic autoimmune disease characterised by lymphocytic infiltrates in exocrine glands, particularly in salivary and lachrymal glands, and in about 20 % of patients also in some internal organs, like kidney and lung. The pathogenesis of SS is poorly understood. Genetic and environmental factors appear to have a key role in favouring the disease development. In particular some viral infections have been demonstrated to be able to trigger the disease process. The majority of the infiltrating cells in target organs are CD4 + CD27 + memory cells. Furthermore, a number of B cells are present in the infiltrates and several features of SS are attributed to their presence. The presence of autoantibodies, such as anti-SSA and -SSB is related to the presence of reactive B cell against ubiquitous nuclear antigens, probably released during the apoptotic process of glandular epithelial cells. The presence of specific anti-muscarinic (M3) receptor antibodies may have some importance in reducing the glandular secretion, behind the epithelial damage caused by the chronic inflammatory infiltrates. The continuous T cell-related stimulation and activation of B cells may induce neoplastic transformation and development of lymphomas.
Schlüsselwörter
Sjögren-Syndrom - Ätiopathogenese - Virusinfekte - T- und B-Zellen - Autoantikörper
Key words
Sjögren’s syndrome - Etiopathogenesis - viral infections - T- and B-cells - autoantibodies
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Claudio Vitali, MD
Dept. of Internal Medicine and Rheumatology, ‘Villamarina’ Hospital
Via Forlanini
57025 Piombino
Italy
Email: hyqprgbv@tin.it
