ΑΝΟΣΙΑ - ΤΟΜΟΣ 3, ΤΕΥΧΟΣ 01-02, 2007

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ΑΝΟΣΙΑ - ΤΟΜΟΣ 3, ΤΕΥΧΟΣ 01-02, 2007

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ΑΝΟΣΙΑ - ΤΟΜΟΣ 3, ΤΕΥΧΟΣ 01-02, 2007

  1. 1. E§§HNIKH HELLENIC ETAIPEIA SOCIETY OF ANO™O§O°IA™ IMMUNOLOGY ′ ανοσια TPIMHNIAIA EK¢O™H TH™ E§§HNIKH™ ETAIPEIA™ ANO™O§O°IA™ TOMO™ 3, TEYXO™ 1-2 ñ 2007 ISSN 1790-6490 anosia QUARTERLY EDITION OF THE HELLENIC SOCIETY OF IMMUNOLOGY VOLUME 3, NUMBER 1-2 ñ 2007
  2. 2. E§§HNIKH ETAIPEIA ANO™O§O°IA™ TPIMHNIAIA EK¢O™H TH™ E§§HNIKH™ ETAIPEIA™ ANO™O§O°IA™ ISSN 1790-6490 TOMO™ 3 ñ TEYXO™ 1-2 ª·È¿Ó‰ÚÔ˘ 23, 115 28 ∞ı‹Ó· | ΔËÏ. +30 210 7211845 | F·¯: +30 210 7215082 | E-mail: helsocimmun@yahoo.com | περιεχόμενα http: //mednet.gr/hsi ¢IOIKHTIKO ™YMBOY§IO E.E.A. ¶Úfi‰ÚÔ˜ : ¶. MÔ‡Ú· AÓÙÈÚfi‰ÚÔ˜ : X. NÈÎÔÏ¿Ô˘ ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÛÙË ÓfiÛÔ A‰·Ì·ÓÙÈ¿‰Ë-Behçet °ÂÓ. °Ú·ÌÌ·Ù¤·˜ : º. ¶·ÏËÔÁÈ¿ÓÓË Eȉ. °Ú·ÌÌ·Ù¤·˜ : A. TÛÈÚÔÁÈ¿ÓÓË º. ∫·ÎÏ·Ì¿Ó˘, ∂. ∫·ÎÏ·Ì¿ÓË ............................................................................................ 7 T·Ì›·˜ : O. MˆÚ·ÏfiÁÏÔ˘-MÂÓ¤ÙÔ˘ M¤ÏË : X. ÕÓÙ˙Ô˘-AÁÁÔ˘Úȉ¿ÎË ÃÚfiÓȘ ∏·Ù›Ùȉ˜ ππ – ÃÚfiÓÈ· ∏·Ù›Ùȉ· C £. KÂÚ·ÌÈÙÛfiÁÏÔ˘ E. °ÈÁ‹, ª. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹ ............................................................................................. 17 ™YNTAKTIKH E¶ITPO¶H ¶Úfi‰ÚÔ˜ : ¶. MÔ‡Ú· TÔ Û˘Ìϋڈ̷ ÛÙȘ ·ÁÁÂȷΤ˜ ÓÂÊÚÈΤ˜ ·ı‹ÛÂȘ Y‡ı˘ÓÔÈ Û‡ÓÙ·Í˘ ∫. ¶·Ï¤Ù·˜ ............................................................................................................................... 35 X. NÈÎÔÏ¿Ô˘ º. ¶·ÏËÔÁÈ¿ÓÓË ∞ÓÔÛÈ·Îfi Û‡ÛÙËÌ· Î·È Á‹Ú·ÓÛË A. TÛÈÚÔÁÈ¿ÓÓË ¶. ™Î¤Ó‰ÚÔ˜ ............................................................................................................................ 40 O. MˆÚ·ÏfiÁÏÔ˘-MÂÓ¤ÙÔ˘ X. ÕÓÙ˙Ô˘-AÁÁÔ˘Úȉ¿ÎË °ÂÓˆÌÈ΋: ªÈ· ηıÔÚÈÛÙÈ΋ ÚfiÎÏËÛË ÁÈ· ÙÔ Ì¤ÏÏÔÓ Ù˘ ·ÓÔÛÔÏÔÁ›·˜ £. KÂÚ·ÌÈÙÛfiÁÏÔ˘ ™YMBOY§EYTIKH E¶ITPO¶H ∞.£. ∫·ÏÔÁÂÚ›‰Ë˜ ................................................................................................................... 44 EÈÙÚÔ‹ ¶ÚÔ¤‰ÚˆÓ EEA † M. ¶·˘Ï¿ÙÔ˘ ªÂϤÙË Î·È ·ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ ÙˆÓ Î˘„ÂÏȉÈÎÒÓ Î˘ÙÙ¿ÚˆÓ Û ·ÛıÂÓ›˜ I. OÈÎÔÓÔÌ›‰Ô˘ Ì Ó¢ÌÔÓÈ΋ ÚÔÛ‚ÔÏ‹ ·fi ÓÔÛ‹Ì·Ù· ÙÔ˘ Û˘Ó‰ÂÙÈÎÔ‡ ÈÛÙÔ‡ E. K·ÎÏ·Ì¿ÓË ¢. ¶··ÎÒÛÙ·, ∫. ª·Ó›Î·, °. ∫˘ÚÈ·˙‹˜, ∞. °·Ú‡Ê·ÏÏÔ˜, £. ∫ÔÓÙ·ÎÈÒÙ˘, AÈÎ. ™Ù·˘ÚÔÔ‡ÏÔ˘-°ÎÈfiη M. B¿ÚÏ·-§Â˘ıÂÚÈÒÙË £. ¶ÔÏ˘˙ÒÓË, ¶. ∞ÚÁ˘ÚÔÔ‡ÏÔ˘, ¢. °ÎÈÔ˘Ï¤Î·˜, ¢. ªÔ‡ÚÔ˜, ¢. ¶·Ù¿Î·˜ ....... 65 Z. ¶ÔÏ˘ÌÂÓ›‰Ë˜ X. ¶··ÛÙÂÚÈ¿‰Ë ∏ Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÚÂÙÚÔ˚ÒÓ ÛÙËÓ ·ÓÔÛÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Graves M. ¢·ÓÈËÏ›‰Ë˜ °. ΔÛÈڷΛ‰Ë˜, ª. ¢·ÓÈËÏ›‰Ë˜, °. ∫ÔηڿÎË, ∑. ¶ÔÏ˘ÌÂÓ›‰Ë˜, ¡. ∫·Ú·ÓÙ¿ÓË, °. K˘ÚÈ·˙‹˜ º. ÷ÚÛÔ‡Ï˘ ........................................................................................................................ 73 K·ıËÁËÙ¤˜ AÓÔÛÔÏÔÁ›·˜ M. P·ÙÔÔ‡ÏÔ˘-°ÈÁ‹ ∏ ¤ÎÊÚ·ÛË ÙÔ˘ ˘Ô‰Ô¯¤· Ù˘ IL-2 ÛÙ· Δ-ÏÂÌÊÔ·ÙÙ·Ú· ·ÛıÂÓÒÓ º. K·Ó·ÎÔ‡‰Ë-T۷ηϛ‰Ô˘ ¶. ªÔ‡Ú· Ì ȉÈÔ·ı‹ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·. ∏ Â›‰Ú·ÛË Ù˘ ·ÓıÚÒÈÓ˘ EΉfiÙ˜ ηډȷ΋˜ Ì˘ÔÛ›Ó˘ A. M¿ÓıÔ˜ π. ∂˘ı˘ÌÈ¿‰Ë˜, ¶. ™Î¤Ó‰ÚÔ˜, ∞. ™·Ú·ÓÙfiÔ˘ÏÔ˜, ¶. ªÔ‡Ú· .................................. 81 A. °ÂÚÌÂÓ‹˜ °. B¤ÚÁÔ˘Ï·˜ ªÂϤÙË Ù˘ Â›‰Ú·Û˘ ÙˆÓ Gram ·ÚÓËÙÈÎÒÓ Î·È Gram ıÂÙÈÎÒÓ E¶ITPO¶H E¶IME§EIA™ ™YNTA•H™ ÙÔÍÈÓÒÓ ÛÙ· ÌÔÓÔ·ÙÙ·Ú·-ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú· A. ™·Ú·ÓÙfiÔ˘ÏÔ˜ ¶. ™Î¤Ó‰ÚÔ˜ π. ∫˘ÚÈ·ÎÔÔ‡ÏÔ˘, L. Reynolds, ∂. πˆ·ÓÓ›‰Ô˘, ™. ÷ڷϷÌ›‰Ô˘, ∫. ΔÛ¤ÏÈÔ˜ π. ∫ψÓÈ˙¿Î˘ .......................................................................................................................... 89 Y¶OBO§H AP£PøN-™YN¢POME™ °È· ÙÔ ÂÚÈÔ‰ÈÎfi √ ˘Ô‰Ô¯¤·˜ ÙˆÓ ÔÈÛÙÚÔÁfiÓˆÓ ER· Ú˘ıÌ›˙ÂÈ ÙËÓ ¤ÎÊÚ·ÛË ÙÔ˘ ¶. ªÔ‡Ú· ∏·ÙÈÎÔ‡ ¶˘ÚËÓÈÎÔ‡ ¶·Ú¿ÁÔÓÙ· HNF3· ÛÙÔÓ Î·ÚΛÓÔ ÙÔ˘ Ì·ÛÙÔ‡ ΔÌ‹Ì· ∫ÏÈÓÈ΋˜ ∞ÓÔÛÔÏÔÁ›·˜ μ′ ¶·ıÔÏÔÁÈ΋˜ ∫ÏÈÓÈ΋˜ ∞¶£ πÔÎÚ¿ÙÂÈÔ °.¶.N.£. | ∫ˆÓÛÙ·ÓÙÈÓÔ˘fiψ˜ 49 Ã.£. ∫·Ú·‰¤‰Ô˘, ª. ¢·ÓÈËÏ›‰Ë˜, ∫. °È·ÓÓÔ‡Ï˘, ∂. °È·ÓÓÔ‡Ï˘ .............................. 97 546 42 £ÂÛÛ·ÏÔÓ›ÎË | TËÏ. 2310 892239 & 2310 992810 e-mail: anosia@universitystudiopress.gr EÙ‹ÛÈ· Û˘Ó‰ÚÔÌ‹ € 30,00 ºˆÙÔÁÚ·Ê›· Â͈ʇÏÏÔ˘: ∞ÂÈÎfiÓÈÛË ÙÔ˘ ÂÓ‰Ô΢ÙÙ¿ÚÈÔ˘ ÂÈÎÔÈÓˆÓÈ·ÎÔ‡ ‰ÈÎÙ‡Ô˘, ̤ۈ ÙÔ˘ ÔÔ›Ô˘, ÙÔ Y¶EY£YNO™ TY¶O°PAºEIOY-¢IAºHMI™EøN ›‰ÈÔ ÂÓÈ·›Ô ÁÂÁÔÓfi˜ ÂÓÂÚÁÔÔÈ› ‰È·ÊÔÚÂÙÈο ‚ÈÔÏÔÁÈο ÚÔÁÚ¿ÌÌ·Ù·, ‰›ÓÔÓÙ·˜ ÙÔ ÁÂÓÂÙÈÎfi ÏÂÔÓ¤ÎÙË- UNIVERSITY STUDIO PRESS Ì· Û ¿ÙÔÌ· ÙÔ˘ ÂÓfi˜ ÏËı˘ÛÌÔ‡. ¶·Ú¤Ì‚·ÛË ÛÙ· ÛËÌ›· ÂϤÁ¯Ô˘ (check points) ÙˆÓ ‚ÈÔÏÔÁÈÎÒÓ ÚÔ- §ÂˆÓ›‰·˜ A. Mȯ¿Ï˘ AÚÌÂÓÔÔ‡ÏÔ˘ 32, 546 35 £ÂÛÛ·ÏÔÓ›ÎË ÁÚ·ÌÌ¿ÙˆÓ ·ÔÙÂÏ› ‰˘ÓËÙÈÎfi ıÂÚ·¢ÙÈÎfi ÛÙfi¯Ô. TËÏ. 2310 209637, 2310 209837, Fax 2310 216647 ∞.£. ∫·ÏÔÁÂÚ›‰Ë˜. °ÂÓˆÌÈ΋ – ¶ÚˆÙˆÌÈ΋ – ∫˘ÙÙ·ÚˆÌÈ΋: ∂Ê·ÚÌÔÁ¤˜ Ì Ӥ˜ ÚÔÔÙÈΤ˜ ÛÙËÓ ∞ÓÔ- E-mail: info@universitystudiopress.gr ÛÔÏÔÁ›·. ∞ÓÔÛ›· 2007; ™˘ÌÏËڈ̷ÙÈÎfi Ù‡¯Ô˜: 107-115.
  3. 3. anosia TRIMESTRAL EDITION OF THE HELLENIC SOCIETY OF IMMUNOLOGY ISSN 1790-6490 VOLUME 3 ñ NUMBER 1-2 HELLENIC SOCIETY OF IMMUNOLOGY Meandrou 23, 115 28 Athens | Tel. + 30 210 7211845 | F·¯: + 30 210 7215082 | E-mail: helsocimmun@yahoo.com | contents http: //mednet.gr/hsi BOARD OF H.S.I. President : P. Boura Vice President : Ch. Nikolaou Etiopathogenetic mechanisms in Adamantiades-Behçet disease General Secretary: F. Palioyianni Specific Secretary : A. Tsiroyianni Ph. Kaklamanis, E. Kaklamani .............................................................................................. 7 Treasurer : O. Moraloglou-Benetou Members : Ch. Antzou-Agouridaki Chronic hepatitis II – Chronic Hepatitis C Th. Keramitsoglou E. Gigi, M. Raptopoulou-Gigi ............................................................................................... 17 EDITORIAL BOARD Editor in Chief : P. Boura The complement in renal vascular diseases Co-editors K. Paletas .................................................................................................................................. 35 Ch. Nikolaou F. Palioyianni Ageing and the immune system A. Tsiroyianni P. Skendros .............................................................................................................................. 40 O. Moraloglou-Benetou Ch. Antzou-Agouridaki Genomics: a major challenge for the future of immunology Th. Keramitsoglou ADVISORY COMMITTEE A. Kalogeridis ........................................................................................................................... 44 Board of Presidents of H.S.I. † M. Pavlatou Immunophenotyping study of alveolar cells in patients with I. Ekonomidou connective tissue diseases and lung involvement E. Kaklamani D. Papakosta, K. Manika, G. Kiriazis, A. Garifallos, Th. Kontakiotis, A. Stavropoulou-Gioka M. Varla-Leftherioti Th. Polizoni, P. Argiropoulou, D. Gioulekas, D. Bouros, D. Patakas ........................ 65 Z. Polymenidis Ch. Papasteriadi Retroviruses in immunopathogenesis of Graves’ disease M. Daniilidis G. Tsirakidis, M. Daniilidis, G. Kokaraki, Z. Polimenidis, N. Karadani, G. Kiriazis Ph. Harsoulis ............................................................................................................................ 73 Professors of Immunology M. Raptopoulou-Gigi T lymphocyte interleukin-2 receptor expression in patients with F. Kanakoudi-Tsakalidou P. Boura idiopathic dilated cardiomyopathy: the effect of human cardiac Editors myosin A. Manthos J. Efthimiadis, P. Skendros, A. Sarantopoulos, P. Boura .............................................. 81 A. Germenis G. Vergoulas The effect of Gram (–) and Gram (+) toxins on monocytes EDITORIAL ASSISTANT COMMITTEE and endothelial cells A. Sarantopoulos P. Skendros J. Kiriakopoulou, L. Reynolds, E. Ioannidou, S. Haralambidou, J. Klonizakis ......... 89 K. Tselios Estrogen receptor · (ER·) regulates the expression of Hepatic SUBMISSION OF ARTICLES-SUBSCRIPTIONS anosia Nuclear Factor 3· (HNF3·) in breast cancer P. Boura, editor-in-chief C. Karadedou, M. Daniilidis, K. Giannoulis, E. Giannoulis .......................................... 97 Clinical Immunology Unit, 2nd Medical Clinic, Hippokratio Gen. Hospital of Thessaloniki. |49 Konstantinoupoleos Str. 546 42 Thessaloniki, Greece TËÏ. +30 2310 892239 & +30 2310 992810 e-mail: anosia@universitystudiopress.gr Annual subscription € 30,00 Cover Figure: The intracellular transduction pathway. The same extracellular stimuli activate different biological programs, offering the genetic advantage in certain members of a population. Manipulation of the PUBLISHER check points represents a potent therapeutic target. UNIVERSITY STUDIO PRESS A. Kalogeridis. Genomics – Proteomics – Cytomics: Prospective applications in Immunology: Anosia 2002; Leonidas A. Michalis Armenopoulou 32, 546 35 Thessaloniki Suppl: 107-115. Tel. 2310 209637, 2310 209837, Fax 2310 216647 E-mail: info@universitystudiopress.gr
  4. 4. ∞Ó·ÛÎfiËÛË ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÛÙË ÓfiÛÔ A‰·Ì·ÓÙÈ¿‰Ë-Behçet º. ∫·ÎÏ·Ì¿Ó˘1, ∂. ∫·ÎÏ·Ì¿ÓË2 1 K·ıËÁËÙ‹˜ ƒÂ˘Ì·ÙÔÏÔÁ›·˜ 2 ∫·ıËÁ‹ÙÚÈ· ÀÁÈÂÈÓ‹˜ Î·È ∂ȉËÌÈÔÏÔÁ›·˜, ∂ıÓÈÎfi Î·È ∫·Ô‰ÈÛÙÚÈ·Îfi ¶·ÓÂÈÛÙ‹ÌÈÔ ∞ıËÓÒÓ 2007; 3, 1-2: 7 – 16 ¶∂ƒI§∏æ∏ ∏ ÓfiÛÔ˜ ∞‰·Ì·ÓÙÈ¿‰Ë-Behçet Â›Ó·È ¯ÚfiÓÈ· ÔÏ˘Û˘ÛÙËÌ·ÙÈ΋ ·ÁÁÂÈ›Ùȉ· Ì ·ÚȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙȘ ˘ÔÙÚÔÈ¿˙Ô˘Û˜ ·ÊıÒ‰ÂȘ ÂÍÂÏÎÒÛÂȘ ÙÔ˘ ÛÙfiÌ·ÙÔ˜ Î·È ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ηıÒ˜ Î·È ‚Ï¿‚˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÙˆÓ ÔÊı·ÏÌÒÓ. ∏ ·ÈÙÈÔ- ÏÔÁ›· Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙË, ˆÛÙfiÛÔ Î·Ù·‰ÂÈÎÓ‡ÂÙ·È Ù· ÙÂÏÂ˘Ù·›· ¤ÙË fiÙÈ ÁÂÓÂÙÈÎÔ› Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·- Ú¿ÁÔÓÙ˜ ¤¯Ô˘Ó ȉȷ›ÙÂÚË ı¤ÛË ÛÙËÓ ·ıÔÁ¤ÓÂÛ‹ Ù˘. ∏ ·ÚÔ˘Û›· ÙÔ˘ ·ÏÏËÏ›Ô˘ HLA-B51 Û¯ÂÙ›˙ÂÙ·È Ì ·˘ÍË̤ÓË ÂȉÂÎÙÈÎfiÙË- Ù· Î·È ‚·Ú‡ÙÂÚË ÓfiÛÔ. ∂˘Ú‡ Ê¿ÛÌ· ·ıÔÁfiÓˆÓ ÌÈÎÚÔÔÚÁ·ÓÈÛÌÒÓ ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÂΉËÏÒÛÂȘ ·˘ÙÔ·ÓfiÛÔ˘ Ù‡Ô˘ ̤- Ûˆ Ì˯·ÓÈÛÌÒÓ ÌÔÚÈ·ÎÔ‡ ÌÈÌËÙÈÛÌÔ‡. ¶·Ú¿ÏÏËÏ·, ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ‰È·Ù·Ú·¯¤˜ Û ‰È¿ÊÔÚ· Â›‰· Ù˘ ·ÓÔÛȷ΋˜ ·fiÎÚÈ- Û˘, Ô˘ ÂÌϤÎÔ˘Ó ÙfiÛÔ ÙË Ê˘ÛÈ΋ fiÛÔ Î·È ÙËÓ ÂȉÈ΋ ·ÓÔÛ›·, ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ¤¯ÂÈ Î·Ù·‰Âȯı› ÂȉÈ΋ ÁÈ· ÙË ÓfiÛÔ ‚Ï¿‚Ë. ™ÎÔ- fi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ Â›Ó·È Ë ·Ó·ÛÎfiËÛË Ù˘ Û‡Á¯ÚÔÓ˘ ‚È‚ÏÈÔÁÚ·Ê›·˜, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, Ì ȉȷ›ÙÂÚË ¤ÌÊ·ÛË ÛÙȘ ÂÈ̤ÚÔ˘˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. §¤ÍÂȘ-ÎÏÂȉȿ: NfiÛÔ˜ ∞‰·Ì·ÓÙÈ¿‰Ë-μehçet, ·ÓÔÛÔ·ıÔÁ¤ÓÂÈ·, ÁÂÓÂÙÈ΋ ÚԉȿıÂÛË. H ÓfiÛÔ˜ A‰·Ì·ÓÙÈ¿‰Ë-Behçet (∞μ) Â›Ó·È ÔÏ˘Û˘- ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ Î·È Û˘Ì- ÛÙËÌ·ÙÈ΋, ¯ÚfiÓÈ·, ÊÏÂÁÌÔÓ҉˘, ˘ÔÙÚÔÈ¿˙Ô˘Û· ÌÂÙ¤¯Ô˘Ó ÁÂÓÂÙÈÎÔ› Î·È ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜, Ì ·ÚȘ ÎÏÈÓÈΤ˜ ÂΉËÏÒÛÂȘ ÙȘ ¿Êı˜ ÛÙfiÌ·ÙÔ˜, Ù· ÂÓÒ ‰È·ÈÛÙÒÓÔÓÙ·È ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ·ÓÔÛÈ·ÎÔ‡ Û˘- ¤ÏÎË ÙˆÓ ÁÂÓÓËÙÈÎÒÓ ÔÚÁ¿ÓˆÓ, ÙËÓ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ÛÙ‹Ì·ÙÔ˜4,6,7. √È ·ÓÔÛȷΤ˜ ‰È·Ù·Ú·¯¤˜ ‰ÂÓ ÏËÚÔ‡Ó ÔÊı·ÏÌÔ‡, ÙÔ˘ ‰¤ÚÌ·ÙÔ˜, ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡ Û˘ÛÙ‹- Ù· ÎÚÈÙ‹ÚÈ· Ù˘ ·ÌÈÁÔ‡˜ ·˘ÙÔ·ÓÔÛ›·˜8, ÒÛÙÂ Ë ÓfiÛÔ˜ Ì·ÙÔ˜ Î·È ÙȘ ‚Ï¿‚˜ ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹- Ó· ıˆÚËı› ·˘ÙÔ¿ÓÔÛÔ˜. √È ‚Ï¿‚˜ ÙˆÓ ·ÁÁ›ˆÓ ›- Ì·ÙÔ˜1,2. ∫‡ÚÈ· ÁÓˆÚ›ÛÌ·Ù· Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ÂÚÈÔ- Ó·È ÛËÌ·ÓÙÈÎfi ÎÏÈÓÈÎÔÂÚÁ·ÛÙËÚÈ·Îfi ‡ÚËÌ· Î·È ı· ‰È΋ Î·È Ë Î·Ù¿ Ì·ÎÚ¤˜ ÂÚÈfi‰Ô˘˜ ÂÌÊ¿ÓÈÛË ÙˆÓ ÎÏÈ- ÌÔÚÔ‡ÛÂ Ë ÓfiÛÔ˜ Ó· ηٷٷÁ› ÛÙËÓ Â˘Ú›· ÔÈÎÔÁ¤- ÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Î·È Ë ¤ÏÏÂÈ„Ë ·ıÔÁÓˆÌÔÓÈ΋˜ ÎÏÈ- ÓÂÈ· ÙˆÓ Û˘ÛÙËÌ·ÙÈÎÒÓ ·ÁÁÂÈÈÙ›‰ˆÓ9. ¶ÚfiÛÊ·Ù· ·Îfi- ÓÈ΋˜ ÂΉ‹ÏˆÛ˘ ‹ ÂÚÁ·ÛÙËÚÈ·ÎÔ‡ Â˘Ú‹Ì·ÙÔ˜1-3. Ì· Û˘˙ËÙÂ›Ù·È Ë Û¯¤ÛË Ù˘ Ì ٷ ηÏÔ‡ÌÂÓ· ÎÏËÚÔ- ∏ ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ ‰È·ÈÛÙÒ- ÓÔÌÈο ·˘ÙÔÊÏÂÁÌÔÓÒ‰Ë ÓÔÛ‹Ì·Ù·10. ¶Ú¤ÂÈ fï˜ ÓÂÙ·È ÛÙËÓ Õˆ ∞Ó·ÙÔÏ‹, ÛÙË ª¤ÛË ∞Ó·ÙÔÏ‹ Î·È ÛÙȘ Ó· ÛËÌÂȈı› fiÙÈ ÌÂÙ¿ ·fi Û‡ÁÎÚÈÛË ÙˆÓ ÎÏÈÓÈÎÔÂÚ- ¯ÒÚ˜ Ù˘ ªÂÛÔÁ›Ԣ1,3,4. ¶ÚÔÛ‚¿ÏÏÔÓÙ·È Î·È Ù· ‰‡Ô Á·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÚÔ·ÙÔ˘Ó ÛËÌ·ÓÙÈΤ˜ ʇϷ Û fiϘ ÙȘ ËÏÈ˘, Ì ‰È·ÊÔÚ¤˜ Û˘¯ÓfiÙËÙ·˜ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ Ù˘ ÓfiÛÔ˘ ∞μ Î·È ÙˆÓ ·˘ÙÔÊÏÂÁ- ·Ó¿ÏÔÁ· Ì ÙȘ ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜4,5. ∏ ·ÈÙÈÔ·- ÌÔÓˆ‰ÒÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ Ë ÔÏ˘ÁÔÓÈÎfiÙËÙ·, Ë
  5. 5. 8 ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÛÙË ÓfiÛÔ ∞‰·Ì·ÓÙÈ¿‰Ë-Behçet Û¯¤ÛË Ì ÙÔ ∏LA Û‡ÛÙËÌ·, Ë ÎÏÈÓÈ΋ ÔÚ›· Î·È Ë ıÂ- ̤ÏË ÔÈÎÔÁÂÓÂÈÒÓ ·ÛıÂÓÒÓ. √È ÂÚ¢ÓËÙ¤˜ ·˘ÙÔ› ˘Ô- Ú·¢ÙÈ΋ ·ÓÙ·fiÎÚÈÛË11. ÛÙËÚ›˙Ô˘Ó ÙË Û˘ÌÌÂÙÔ¯‹ ÁÂÓÂÙÈÎÒÓ Î·È ÂÚÈ‚·ÏÏÔÓÙÈ- ÎÒÓ ·Ú·ÁfiÓÙˆÓ ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘22. 1. ¶ÂÚÈ‚·ÏÏÔÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∞ӷʤÚıËΠÂ›Û˘ ÚfiÛÊ·Ù· Û¯¤ÛË Ù˘ ÓfiÛÔ˘ Ì ÙÔ ÃϷ̇‰ÈÔ Ù˘ Ó¢ÌÔÓ›·˜23 Î·È ÙÔ ª˘ÎfiÏ·ÛÌ· ∏ Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ ∞μ ÛÙÔÓ ÁÂÚÌ·ÓÈÎfi ÏËı˘- fermentans24. ÛÌfi Â›Ó·È 0,30 ·Ó¿ 100.000 ηÙÔ›ÎÔ˘˜. ∏ ÌÂÁ·Ï‡ÙÂÚË T· ‰È¿ÊÔÚ· ›‰Ë ÛÙÚÂÙfiÎÔÎÎÔ˘ (S. sanguis, S. ÂıÓÈ΋ Û˘¯ÓfiÙËÙ· Â›Ó·È ÙÔ˘ÚÎÈ΋˜ ÚÔ¤Ï¢Û˘ (ÂıÓÈ- pyogenes, S. salivarius) ‰ÈηÈÔÏÔÁË̤ӷ ¤¯Ô˘Ó ÂÓÔ¯Ô- ΋ 15,13: 100.000 Î·È μÂÚÔÏ›ÓÔ˘ 77,37: 100.000)12. ÔÈËı› ˆ˜ ·ÈÙÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ÓfiÛÔ˘. √È ™ÙËÓ ∞Ó·ÙÔÏÈ΋ ΔÔ˘ÚΛ· Ë Û˘¯ÓfiÙËÙ· Î˘Ì·›ÓÂÙ·È ·fi ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ ¤¯Ô˘Ó Û ÌÂÁ¿ÏË Û˘¯ÓfiÙËÙ· 20-80: 100.000 ηÙÔ›ÎÔ˘˜13. Δ· ‰Â‰Ô̤ӷ ·˘Ù¿ ÛÙË- (70%) ÛÙÔÌ·ÙÔÊ·Ú˘ÁÁÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ ¿Êı˜, Ú›˙Ô˘Ó ÙËÓ ¿Ô„Ë Ù˘ ·ÚÈ·˜ Â›‰Ú·Û˘ ÙˆÓ ÁÂÓÂÙÈ- ÏÔÈÌÒÍÂȘ ÚÈÓÔÊ¿Ú˘ÁÁ· Î·È ÙÂÚˉÔÓÈṲ̂ÓÔ˘˜ Ô‰fi- ÎÒÓ ·Ú·ÁfiÓÙˆÓ14 Î·È ·ÓÙ›ÎÂÈÓÙ·È Û ÚÔËÁÔ‡ÌÂÓ˜ ÓÙ˜. ∞ӷʤÚÂÙ·È Â›Û˘ ˘ÂÚ¢·ÈÛıËÛ›· ÌÂÙ¿ ·fi ·Ú·‰Ô¯¤˜ Ù˘ Û˘ÌÌÂÙÔ¯‹˜ ÙˆÓ ÂÚÈ‚·ÏÏÔÓÙÈÎÒÓ ÂÓ‰Ô‰ÂÚÌÈ΋ ¤Á¯˘ÛË ÛÙÚÂÙÔÎÔÎÎÈÎÔ‡ ·ÓÙÈÁfiÓÔ˘, ·Ú·ÁfiÓÙˆÓ. ∞ÓÙ›ıÂÙ·, Ë ÓfiÛÔ˜ Â›Ó·È Û¯Â‰fiÓ ¿ÁÓˆ- ÂÓÒ ‚ÂÏÙÈÒÓÔÓÙ·È ÙfiÛÔ ÔÈ ·ÚıÚÈΤ˜ fiÛÔ Î·È ÔÈ ‚ÏÂÓ- ÛÙË Û π¿ˆÓ˜ Ô˘ ¤¯Ô˘Ó ÌÂÙ·Ó·ÛÙ‡ÛÂÈ ÛÙËÓ Ã·- ÓÔÁÔÓÈΤ˜ ÂΉËÏÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÌÂÙ¿ ·fi ıÂÚ·›· ‚¿Ë Î·È ÛÙËÓ ∞ÌÂÚÈηÓÈ΋ ◊ÂÈÚÔ15, ·Ú¿ ÙË ÌÂÁ¿ÏË Ì ÂÓÈÎÈÏÏ›ÓË Î·È ÎÔϯÈΛÓË7,25,26. Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ Û˘¯ÓfiÙËÙ· Ù˘ ÓfiÛÔ˘ ÛÙËÓ π·ˆÓ›·. Δ· ·ÓˆÙ¤Úˆ Ù· ÛÙÚÂÙÔÎÔÎÎÈο ·ÓÙÈÁfiÓ· ¢ԉÒÓÔ˘Ó ÙËÓ ·Ú·- ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÂÎÙfi˜ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÁˆÁ‹ Ù˘ ÈÓÙÂÚÊÂÚfiÓ˘-Á (IFN-Á) ·fi Ù· Δ ÏÂÌÊÔ- Î·È ÔÈ ÂÚÈ‚·ÏÏÔÓÙÈΤ˜ ÂȉڿÛÂȘ ÌÂÙ¤¯Ô˘Ó ÛÙËÓ ÂÎ- ·ÙÙ·Ú· ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ27 Î·È ·˘Ùfi ·ÔÙÂÏ› ‰‹ÏˆÛË Ù˘ ÓfiÛÔ˘. ¤Ó‰ÂÈÍË Ù˘ Δ Î˘ÙÙ·ÚÈ΋˜ ˘ÂÚ¢·ÈÛıËÛ›·˜ Û ‰È¿- ªÂ ÙË ÓfiÛÔ ∞μ ¤¯ÂÈ Î·Ù¿ ηÈÚÔ‡˜ Û˘Û¯ÂÙÈÛı› ¢- ÊÔÚ· ‚·ÎÙËÚȉȷο ·ÓÙÈÁfiÓ·, ÁÂÁÔÓfi˜ Ô˘ ›Ûˆ˜ Û¯Â- Ú‡ Ê¿ÛÌ· ÏÔÈ̈‰ÒÓ ·Ú·ÁfiÓÙˆÓ, ¯ˆÚ›˜ fï˜ Ó· Ù›˙ÂÙ·È Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘. ™˘ÌÂÚ·ÛÌ·ÙÈ- ¤¯Ô˘Ó ‰È·ÈÛÙˆı› ÛÙ·ıÂÚ¿ Î·È ÙÂÎÌËÚȈ̤ӷ Â˘Ú‹Ì·Ù·. ο, Ô ÛÙÚÂÙfiÎÔÎÎÔ˜ Â›Ó·È Èı·ÓfiÓ Ó· ÚÔηÏ› ÙÔ √È ÈÔ› Ù˘ Ë·Ù›Ùȉ·˜ ∞, μ, C Î·È ∂ ¤¯Ô˘Ó ÂÓÔ- ¤Ó·˘ÛÌ· Ù˘ ÓfiÛÔ˘ Ì ÙË Û˘Ó¤ÚÁÂÈ· Î·È ¿ÏÏˆÓ ·- ¯ÔÔÈËı› ¯ˆÚ›˜ fï˜ Ó· ˘¿Ú¯Ô˘Ó ·ԉ›ÍÂȘ16,17. Ú·ÁfiÓÙˆÓ28. ΔÔ Á¤ÓˆÌ· ÙÔ˘ ÈÔ‡ ∏SV ·ÔÌÔÓÒıËΠ·fi ÙÔÓ ˘Ú‹Ó· ÙˆÓ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ Î·È ·fi ‚ÈÔÏÔÁÈο ˘ÁÚ¿ ¶ÚˆÙ½Ó˜ ÙÔ˘ ıÂÚÌÈÎÔ‡ shock (HSP) ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ, ÂÓÒ ‰È·ÈÛÙÒıËÎÂ Î·È ·˘ÍË̤- ÓË Û˘¯ÓfiÙËÙ· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ¤Ó·ÓÙÈ √È ÚˆÙ½Ó˜ ·˘Ù¤˜ ·Ú¿ÁÔÓÙ·È ·fi Ù· ¢ηڢˆÙÈο ÙÔ˘ ∏SV. ŸÙ·Ó fï˜ ÂÊ·ÚÌfiÛıËÎÂ Ë Ì¤ıÔ‰Ô˜ Ù˘ ·ÙÙ·Ú· ÌÂÙ¿ ·fi Â›‰Ú·ÛË ÔÏÏÒÓ ÂÚÂıÈÛÌ¿ÙˆÓ, ·Ï˘ÛȉˆÙ‹˜ ·ÓÙ›‰Ú·Û˘ ÔÏ˘ÌÂÚ¿Û˘ (PCR) ÛÙÔ fiˆ˜ Ë Ïԛ̈ÍË ·fi ‰È¿ÊÔÚÔ˘˜ ÌÈÎÚÔ‚È·ÎÔ‡˜ ·- Û›ÂÏÔ, ÛÙ· ÂÚÈÊÂÚÈο Ï¢ÎÔ·ÙÙ·Ú· Î·È Û Âȯڛ- Ú¿ÁÔÓÙ˜, Ô ÙÚ·˘Ì·ÙÈÛÌfi˜, Ë ıÂÚÌfiÙËÙ·, ÙÔ „‡¯Ô˜ ÛÌ·Ù· ÛÙfiÌ·ÙÔ˜ ÁÈ· HSV-DNA ‰ÂÓ ·Ú·ÙËÚ‹ıËÎÂ Î·È ¿ÏÏ·. √È ÚˆÙ½Ó˜ ÙÔ˘ ıÂÚÌÈÎÔ‡ shock, ÂȉÈο Ë ‰È·ÊÔÚ¿ ÌÂٷ͇ ·ÛıÂÓÒÓ Î·È ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ7. ∏ ıÂ- 60/65 ∫D· (∏SP 65), Â›Ó·È Èı·ÓÔ› ·ÓÙÈÁÔÓÈÎÔ› ·Ú¿- Ú·›· ÂÍ¿ÏÏÔ˘ Ì ·ÓÙÈÈο Ê¿Ú̷η (acyclovir) ‰ÂÓ ÁÔÓÙ˜ Ù˘ ÓfiÛÔ˘. ÂËÚ¿˙ÂÈ Ù· ÛÙÔÌ·ÙÔÁÂÓÓËÙÈο ¤ÏÎË Ù˘ ÓfiÛÔ˘18, ·Ó ∞Ó¿ÏÔÁ˜ ÚˆÙ½Ó˜ ·Ú¿ÁÔÓÙ·È Î·È ·fi ÚÔ- Î·È ÙÔ famciclovir ÙÚÔÔÔÈ› Ù· Û˘ÌÙÒÌ·Ù· Ù˘ Ófi- ηڢˆÙÈο ·ÙÙ·Ú·. ∏ ÚÔηڢˆÙÈ΋ 65∫D· ∏SP ÛÔ˘ Û ÔÓÙ›ÎÈ·18. ÕÏÏÔ˜ Èfi˜ Ô˘ ˘ÔÙ›ıÂÙ·È fiÙÈ Û¯Â- ¤¯ÂÈ Ôχ ÛËÌ·ÓÙÈ΋ ·ÏÏËÏÔ˘¯›· Ì ÙËÓ ·ÓıÚÒÈÓË Ù›˙ÂÙ·È Ì ÙË ÓfiÛÔ Â›Ó·È Ô ·Ú‚Ô˚fi˜19. ¶Ú¤ÂÈ Ó· ÛË- ÌÈÙÔ¯ÔӉȷ΋ 60 ∫D· ∏SP26. H 65 KD· ∏SP ·Ó¢ڛ- ÌÂȈı› fiÙÈ Ì¤¯ÚÈ ÙÒÚ· ‰ÂÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÌÂÙ¿‰ÔÛË ÛÎÂÙ·È ÛÙ· ·Ó·ÊÂÚı¤ÓÙ· ›‰Ë ÛÙÚÂÙfiÎÔÎÎÔ˘ Ô˘ Ù˘ ÓfiÛÔ˘ ·fi ¿ÙÔÌÔ Û ¿ÙÔÌÔ7. ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ·ÈÙÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘ ÕÏÏÔÈ ÌÈÎÚÔ‚È·ÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÓÔ¯ÔÔÈ‹- ∞μ26. Δ· ÂÙ›‰È· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙË ÌÈÎÚÔ- ıËηÓ, ¯ˆÚ›˜ fï˜ ·ԉ›ÍÂȘ ›ӷÈ: Ë μorrelia burg- ‚ȷ΋ 65KD· HSP Î·È Ù· ·ÓÙ›ÛÙÔȯ¿ Ù˘ 60 KD· HSP dorferi, ÙÔ ÂÏÈÎÔ‚·ÎÙËÚ›‰ÈÔ ÙÔ˘ ˘ÏˆÚÔ‡20 Î·È Ô ™·Î- ÙˆÓ ıËÏ·ÛÙÈÎÒÓ, ÚÔηÏÔ‡Ó ·ÌÊfiÙÂÚ· ·˘ÙÔ·ÓÔÛ›· ¯·ÚÔ̇ÎËÙ·˜ cerevisiae. ∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ™·Î- Ì ÔÌÔÏÔÁ›· ·ÏÏËÏÔ˘¯›·˜ 60%. ∞‰›¯ıË ÚfiÛÊ·- ¯·ÚÔ̇ÎËÙ· cerevisiae ‰È·ÈÛÙÒıËÎ·Ó Û ·ÛıÂÓ›˜ Ù· fiÙÈ ‰ÈÂÁ›ÚÔ˘Ó ÙË ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈ΋ ·¿ÓÙËÛË Ì ÓfiÛÔ ∞μ Î·È ÚÔÙ›ÓÔÓÙ·È Ù· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ7. Δ· ÂÙ›‰È· Ù˘ Ì˘ÎÔ‚·- Û·Ó ‰Â›ÎÙ˘ ÂÓÂÚÁfiÙËÙ·˜ ÓfiÛÔ˘21. ™Â ÚfiÛÊ·ÙË ÌÂ- ÎÙËÚȷ΋˜ 65KDa HSP Î·È Ù˘ ·ÓıÚÒÈÓ˘ 60 KD· ϤÙË ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ Û˘ÁÁÚ·Ê›˜ ‰È·ÈÛÙÒıËΠfiÙÈ HSP Â›Ó·È ·˘ÍË̤ӷ Û ΔÔ‡ÚÎÔ˘˜ ·ÛıÂÓ›˜ Ì ÓfiÛÔ Ù· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ‹Ù·Ó ·˘ÍË̤ӷ Â›Û˘ Û ˘ÁÈ‹ ∞μ Û˘ÁÎÚÈÙÈο Ì ̿ÚÙ˘Ú˜29. ™ÙË ÓfiÛÔ ∞μ ‰È·È-
  6. 6. º. ∫·ÎÏ·Ì¿Ó˘ Î·È Û˘Ó. 9 ÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ¤ÎÊÚ·ÛË Ù˘ 60/65 ¶·ÚfiÌÔȘ ΢ÙÙ·ÚÈΤ˜ ‰ÈËı‹ÛÂȘ ·Ó¢ڛÛÎÔÓÙ·È ∫Da HSP Û ‚ÏÂÓÓÔÁÔÓÔ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ Ù˘ Ófi- Î·È Û ¿ÏϘ ÈÛÙÈΤ˜ ‚Ï¿‚˜ Ù˘ ÓfiÛÔ˘. ªÂϤÙ˜ ÔÈ ÛÔ˘30. Δ¤ÛÛÂÚ· ÂÙ›‰È· ÚÔÂÚ¯fiÌÂÓ· ·fi ÙËÓ 65 K Ôԛ˜ ·ÎÔÏÔ‡ıËÛ·Ó ·¤‰ÂÈÍ·Ó ·˘ÍË̤ÓË ÌÂÙ·Ó¿- Da HSP Ì˘ÎÔ‚·ÎÙËÚȉ›Ô˘ Î·È Ù· ÔÌfiÏÔÁ· ÂÙ›‰È· ÛÙ¢ÛË ÔÏ˘ÌÔÚÊÔ‡ÚËÓˆÓ in vivo Û ·ÛıÂÓ›˜ Ì Ù˘ ·ÓıÚÒÈÓ˘ 60 K Da HSP ‰È·ÈÛÙÒıËÎ·Ó Î·Ù¿ ÙË ÂÓÂÚÁfi ÛÙ¿‰ÈÔ ÓfiÛÔ˘ ∞μ Ë ÔÔ›· Û ·ÓÂÓÂÚÁfi ÛÙ¿- ¯·ÚÙÔÁÚ¿ÊËÛË ÂÈÙfiˆÓ Δ Î˘ÙÙ¿ÚˆÓ Î·È ıˆڋıË- ‰ÈÔ ÔÌ·ÏÔÔÈ‹ıËΠ·ÓÂÍ¿ÚÙËÙ· Ù˘ ·Ô˘Û›·˜ ‹ Û˘- Î·Ó ˘‡ı˘Ó· ÁÈ· ÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘31. Ó¯È˙fiÌÂÓ˘ ıÂÚ·›·˜38. ∂ÓÂÚÁÔÔÈË̤ÓË Ì˘ÂÏÔÂ- ∞fi ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· Δ ÚÔÍÂȉ¿ÛË Ï¿ÛÌ·ÙÔ˜, Ë ÔÔ›· ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ Î·È μ ÏÂÌÊÔ·ÙÙ·Ú·, fiˆ˜ Î·È ÔÈ ÚˆÙ½Ó˜ ÙÔ˘ ıÂÚ- ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈψÓ, ‚Ú¤ıËΠ·˘ÍË̤- ÌÈÎÔ‡ shock, ÂËÚ¿˙Ô˘Ó ÙËÓ ÔÚ›· ÙˆÓ ÔÊı·ÏÌÈÎÒÓ ÓË ÂȉÈο Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘7. ∞˘Ùfi ˘Ô- Î·È ‚ÏÂÓÓÔÁÔÓÔ‰ÂÚÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ Ù˘ ÓfiÛÔ˘ ∞μ Û˘- ‰ËÏÒÓÂÈ ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ÔÏ˘- ÓÂ›· ÙˆÓ ·ÎfiÏÔ˘ıˆÓ ‰Â‰ÔÌ¤ÓˆÓ Î·È ·Ú·ÙËÚ‹ÛˆÓ: ÌÔÚÊÔ‡ÚËÓˆÓ ÛÙËÓ ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘ 1) ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ‚·ÎÙËÚȉȷ΋˜ Î·È ·ÓıÚÒÈÓ˘ ∞μ7. ΔfiÛÔ Ë ¯ËÌÂÈÔÙ·Í›· ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ fiÛÔ 60/65 KD· HSP ¤¯Ô˘Ó ‰È·ÛÙ·˘ÚÔ‡ÌÂÓË ·ÓÙ›‰Ú·ÛË ÌÂ Î·È Ë Ê·ÁÔ΢ÙÙ¿ÚˆÛË Â›Ó·È ·˘ÍË̤ӷ Û ‰ÂÚÌ·ÙÈΤ˜ ·ÓÙÈÁfiÓ· ÙÔ˘ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜, 2) Ë ¤ÎıÂÛË Û ·ÏÏÔÈÒÛÂȘ Ù˘ ÓfiÛÔ˘39. Δ· Â›‰· Ù˘ ·Ú·ÁˆÁ‹˜ Â͈ÁÂÓ›˜ ‹ ÂÓ‰ÔÁÂÓ›˜ HSPs ÚÔηÏ› ÔÏÏ·Ï·ÛÈ·- ÙÔ˘ ˘ÂÚÔÍÂȉ›Ô˘ ·fi Ù· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ·ÛıÂ- ÛÌfi ÙˆÓ ÂÚÈÊÂÚÈÎÒÓ Δ ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ·ÛıÂÓÒÓ Ì ÓÒÓ, fiˆ˜ Î·È Ë ¯ËÌÂÈÔÙ·Í›· ÙÔ˘˜, ‹Ù·Ó ÛËÌ·ÓÙÈο ÔÊı·ÏÌÈ΋ ÚÔÛ‚ÔÏ‹ Ù˘ ÓfiÛÔ˘ ∞μ ηÙ¢ı˘ÓfiÌÂÓÔ ˘„ËÏfiÙÂÚ· ·fi ·˘Ù¿ ÙˆÓ Ì·ÚÙ‡ÚˆÓ Î·È Û¯ÂÙ›˙ÔÓÙ·Ó ¤Ó·ÓÙÈ ·ÓÙÈÁfiÓˆÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉԇ˜ ̤ۈ Ì˯·ÓÈ- Ì ÙËÓ ‡·ÚÍË ÙÔ˘ HLA-B5139,40. ∏ ·˘ÍË̤ÓË ¯ËÌÂÈ- ÛÌÔ‡ ÌÔÚÈ·ÎÔ‡ ÌÈÌËÙÈÛÌÔ‡, 3) ÙÔÈΤ˜ ‰ÂÚÌ·ÙÈΤ˜ ÔÙ·Í›· ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î·È Ë ·˘ÍË̤ÓË ·Ú·Áˆ- ‚Ï¿‚˜ Ù˘ ÓfiÛÔ˘ ÂÚȤ¯Ô˘Ó ·˘ÍË̤ÓÔ ·ÚÈıÌfi ·ÌÊÔ- Á‹ ˘ÂÚÔÍÂȉ›Ô˘ Î·È Ï˘ÛÔۈ̷ÙÈÎÒÓ ÂÓ˙‡ÌˆÓ ·Ó·Ì- Ù¤ÚˆÓ 60 KD· HSP Î·È TCR Á‰+ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ, ÊÈÛ‚‹ÙËÙ· ÚÔηÏÔ‡Ó ÈÛÙÈΤ˜ ‚Ï¿‚˜41. 4) Á‰+ Δ ÏÂÌÊÔ·ÙÙ·Ú· ·Ó¢ڛÛÎÔÓÙ·È Û ÛËÌ›· ∞ÎfiÌ·, Ù· ÌfiÚÈ· ÚÔÛÎfiÏÏËÛ˘ ÙˆÓ Ï¢ÎÔ΢Ù- fiÔ˘ Ë ¤ÎÊÚ·ÛË Ù˘ 65 KD· HSP Â›Ó·È ¿ÊıÔÓË ÂȉÈ- Ù¿ÚˆÓ (P Î·È L Selectins, mac-1 Î·È CD44) ÂÎÊÚ¿˙Ô- ο Û ÂȉÂÚÌÈΤ˜ ÂÚÈÔ¯¤˜ ÂÓÂÚÁÒÓ ‰ÂÚÌ·ÙÈÎÒÓ ÓÙ·È ÛÙ· ÂÚÈÊÂÚÈο Ï¢ÎÔ·ÙÙ·Ú· Î·È Ï·Ì‚¿ÓÔ˘Ó ‚Ï·‚ÒÓ, fiˆ˜ ÙÔ Ô˙҉˜ ÂÚ‡ıËÌ· Î·È ¿ÏϘ ‚ÏÂÓÓÔ- ̤ÚÔ˜ ÛÙÔÓ Î·Ù·ÚÚ¿ÎÙË Ù˘ ¯ËÌÂÈÔÙ·Í›·˜ Î·È ÚÔ- ÁÔÓÔ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ Î·È Ù¤- ÛÎfiÏÏËÛ˘, ÂÓ‰ÂÈÎÙÈο ÙÔ˘ ÂÓÂÚÁÔÔÈË̤ÓÔ˘ ·ÓÔÛÈ·- ÏÔ˜ 5) ÔÈ ·˘ÍË̤Ó˜ ∏SPs ¢ÓÔÔ‡Ó ÙË Ú‡ıÌÈÛË Ù˘ ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÛÙË ÓfiÛÔ ∞μ7,42, 43. ¤ÎÊÚ·Û˘ ÙÔ˘ ÙfiÔ˘ ªπCA Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ ÎÔÓÙ¿ ÛÙË ı¤ÛË HLA-B51017,30,32. 2‚. ªÔÓÔ‡ÚËÓ· Œ¯ÂÈ Â›Û˘ ·Ó·ÊÂÚı› fiÙÈ Ù· ÂÙ›‰È· 336-351 Δ· ÌÔÓÔ·ÙÙ·Ú· ÛÙË ÓfiÛÔ ∞μ Â›Ó·È ÂÓÂÚÁÔÔÈ- ∏SP Â¿ÁÔ˘Ó ÔÏÏ·Ï·ÛÈ·ÛÌfi ÙˆÓ Δ Î˘ÙÙ¿ÚˆÓ ÛÙË Ë̤ӷ in vivo Î·È ·Ú¿ÁÔ˘Ó ÊÏÂÁÌÔÓÒ‰ÂȘ ΢ÙÙ·ÚÔ- ÓfiÛÔ ∞μ33. Δ· ÂÙ›‰È· ·˘Ù¿ (336-351) ¤¯Ô˘Ó ÌÂÁ¿- ÏÔ ‚·ıÌfi ·ÓÙÈÁÔÓÈÎfiÙËÙ·˜ Î·È ÚÔηÏÔ‡Ó ÚfiÛıÈ· ΛÓ˜, ÔÈ Ôԛ˜ ·ÛÎÔ‡Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙË ¯ÚfiÓÈ· Ú·ÁÔÂȉ›Ùȉ· fiÙ·Ó ¯ÔÚËÁÔ‡ÓÙ·È ·fi ÙÔ ÛÙfiÌ· ‹ ̤- ÊÏÂÁÌÔÓ‹ Ù˘ ÓfiÛÔ˘44. ∂›Û˘, ÛÙÔÓ ÔÚfi ·˘ÙÒÓ ÙˆÓ Ûˆ ÙÔ˘ ÚÈÓÈÎÔ‡ ‚ÏÂÓÓÔÁfiÓÔ˘ Û ÔÓÙ›ÎÈ· Lewis Ô˘ ·ÛıÂÓÒÓ ‰È·ÈÛÙÒıËΠ·˘ÍË̤ÓÔ˜ Ô ‰È·Ï˘Ùfi˜ CD14, ·ÓÔÛÔÔÈ‹ıËÎ·Ó ˘Ô‰fiÚÈ· Ì ÂÓ‰ÔÂÚÈÙÔÓ·˚Îfi μ. Ô˘ ·ÔÙÂÏ› ‰Â›ÎÙË ÂÓÂÚÁÔÔ›ËÛ˘ ÙˆÓ ÌÔÓÔ΢ÙÙ¿- pertusis Î·È ÂÓÈÛ¯˘ÙÈÎfi Freund34. ÚˆÓ. ∂ÈϤÔÓ, ‰Â›ÎÙ˜ ÂÓÂÚÁÔÔ›ËÛ˘/‰È·ÊÔÚÔÔ›Ë- Û˘, fiˆ˜ ÂÎÊÚ¿˙ÔÓÙ·È Ì ÙÔ CD14 Î·È Ù· ÂÈÊ·ÓÂÈ- ·Î¿ ·ÓÙÈÁfiÓ·, Ô˘ ·ÓÙȉÚÔ‡Ó Ì ٷ ÌÔÓÔÎψÓÈο 2. AÓÔÛÈ·ÎÔ› Ì˯·ÓÈÛÌÔ› ·ÓÙÈÛÒÌ·Ù· 25F9 Î·È G-16/1, ·Ó¢ڛÛÎÔÓÙ·È Û ·˘- 2·. ¶ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· Ï¢ÎÔ·ÙÙ·Ú· ÍË̤ÓÔ ·ÚÈıÌfi ÌÔÓÔ΢ÙÙ¿ÚˆÓ ÛÙË ÓfiÛÔ44. ∏ ·˘Ùfi- Ì·ÙË Â›Û˘ ˘ÂÚ·Ú·ÁˆÁ‹ ÙÔ˘ Δ¡F·, IL-6 Î·È πL-8 ∞˘ÍË̤ÓË ¯ËÌÂÈÔÙ·ÎÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÙˆÓ ÔÏ˘- ·fi Ù· ÌÔÓÔ·ÙÙ·Ú· ÙˆÓ ·ÛıÂÓÒÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ÌÔÚÊÔ‡ÚËÓˆÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ·Ó·Ê¤ÚıËΠÌÂÙ¿ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘45. ·fi Â›‰Ú·ÛË ¯ËÌÂÈÔÙ·ÎÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ35, Ë ÔÔ›· ‰ÂÓ ÂȂ‚·ÈÒıËΠ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜36. ∂›Ó·È fi- ̈˜ ·ԉ‰ÂÈÁ̤ÓÔ fiÙÈ ÛÙÔ ÛËÌÂ›Ô Ù˘ ·ÓÙ›‰Ú·Û˘ 2Á. μ-ÏÂÌÊÔ·ÙÙ·Ú· ·ı¤ÚÁÂÈ·˜ (Pathergy test), Ë ÔÔ›· ·ÓÙÈÚÔÛˆ‡ÂÈ ∞Ó Î·È Ë ·Ó·ÏÔÁ›· ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ μ-ÏÂÌÊÔ- ÌË ÂȉÈ΋ ˘ÂÚ·ÓÙȉڷÛÙÈÎfiÙËÙ· ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ Î˘ÙÙ¿ÚˆÓ ‰ÂÓ ‹Ù·Ó ·˘ÍË̤ÓË ÛÙË ÓfiÛÔ ∞μ, ‰È·È- Û ÙÔÈÎfi ÂÚ¤ıÈÛÌ·, ·ıÚÔ›˙ÔÓÙ·È Ô˘‰ÂÙÂÚfiÊÈÏ·, Δ ÛÙÒıËΠÂÓÙÔ‡ÙÔȘ ÛÙ· μ ·ÙÙ·Ú· ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË ÏÂÌÊÔ·ÙÙ·Ú· Î·È ÌÔÓÔ·ÙÙ·Ú·/Ì·ÎÚÔÊ¿Á·37. Ù˘ ÌÂÌ‚Ú·ÓÈ΋˜ Û˘Ó‰Â‰Â̤Ó˘ πgA46. º˘ÛÈÔÏÔÁÈÎfi
  7. 7. 10 ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÛÙË ÓfiÛÔ ∞‰·Ì·ÓÙÈ¿‰Ë-Behçet ·ÚÈıÌfi μ-ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ ‰È·›ÛÙˆÛ·Ó Î·È ¿ÏÏÔÈ ˘ÔÏÔÁÈṲ̂ÓË Ì ÙËÓ ∫562 ΢ÙÙ·ÚÔÙÔÍÈÎfiÙËÙ· ‰È·È- ÂÚ¢ÓËÙ¤˜45. Δ· ·˘ÍË̤ӷ Â›‰· ÂÓÂÚÁÔÔÈËÌ¤ÓˆÓ ÛÙÒıËΠfiÙÈ ‹Ù·Ó ¯·ÌËÏ‹ ÏfiÁˆ ·ÓÒÚÈÌˆÓ Î˘ÙÙ¿ÚˆÓ Î·È ˘ÔÙ‡ˆÓ ÌÓËÌÔÓÈÎÒÓ μ ΢ÙÙ¿ÚˆÓ ·Ô‰ÂÈÎÓ‡Ô˘Ó Ê˘ÛÈÎÒÓ ÊÔÓ¤ˆÓ Û ÂÓÂÚÁfi ÓfiÛÔ56. ∞˘ÍË̤ӷ Â›- ÙÚÔÔÔÈË̤ÓË ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ μ ΢ÙÙ¿ÚˆÓ, Ë ÔÔ›· ‰· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·˘ÙÒÓ ‚Ú¤ıËÎ·Ó ÌÂÙ¿ ·fi ‚·- ÌÔÚ› Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÂÚ¤ıÈÛÌ· ·fi ¿ÁÓˆÛÙÔ Â͈- ÎÙËÚȉȷ΋ ‰È¤ÁÂÚÛË Ì ‰‡Ô ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÌÈÎÚÔÔÚ- ÙÂÚÈÎfi ·ÓÙÈÁfiÓÔ46. √ ‰Â›ÎÙ˘ Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÈÊ¿- Á·ÓÈÛÌÔ‡˜57. ™Â ÚÔËÁÔ‡ÌÂÓË ÌÂϤÙË ·Ó¢ڤıËΠÓÂÈ·˜, Ô˘ ·Ó¢ڛÛÎÂÙ·È Û ÂÓÂÚÁÔÔÈË̤ӷ ·ÙÙ·Ú· ·˘ÍË̤ÓÔ˜ ·ÚÈıÌfi˜ ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ Î˘ÙÙ¿ÚˆÓ Ê˘- Î·È Î‡ÙÙ·Ú· ÌÓ‹Ì˘ (CD45R√), ηٷ‰Â›¯ıËΠÛËÌ·- ÛÈÎÒÓ ÊÔÓ¤ˆÓ Î·È ıˆڋıËΠfiÙÈ ¤¯ÂÈ ·ıÔÁÂÓÂÙÈ΋ ÓÙÈο ˘„ËÏfiÙÂÚÔ˜ Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ Î·È ¿ÏÏ· Û¯¤ÛË Ì ÙË ÓfiÛÔ. ÓÔÛ‹Ì·Ù· Û˘ÁÎÚÈÙÈο Ì ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜47. ∂ÈϤÔÓ, Ô ‰Â›ÎÙ˘ ÂÓÂÚÁfiÙËÙ·˜ CD80 ‹Ù·Ó ·˘ÍË̤ÓÔ˜ ÌfiÓÔ 3. πÓÙÂÚÏ¢ΛÓ˜ ÛÙË ÓfiÛÔ ∞μ. 3·. πÓÙÂÚÏ¢ΛÓË 1 (πL-1) 2‰. Δ-ÏÂÌÊÔ·ÙÙ·Ú· H ÈÓÙÂÚÏ¢ΛÓË 1‚ (πL -1‚) ‚Ú¤ıËÎÂ Ê˘ÛÈÔÏÔÁÈ΋ ‹ ∞fi ÔÏϤ˜ ÌÂϤÙ˜ ·‰›¯ıË ÛÙË ÓfiÛÔ ∞μ ·˘ÍË- ·˘ÍË̤ÓË ÛÙË ÓfiÛÔ ∞μ. ∏ πL-1‚ ‰È·ÈÛÙÒıËΠfiÙÈ Ì¤ÓÔ˜ ·ÚÈıÌfi˜ Á‰ Δ Î˘ÙÙ¿ÚˆÓ Û˘ÁÎÚÈÙÈο Ì ̿ÚÙ˘- ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋ ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ, Ú˜46,48-50. Δ· ÂÓÂÚÁÔÔÈË̤ӷ Á‰ Δ Î‡ÙÙ·Ú·, Ô˘ fiˆ˜ Î·È ÛÙÔ˘˜ Ì¿ÚÙ˘Ú˜58. ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ‰È·›- ·Ú¿ÁÔ˘Ó πFN-Á Î·È Δ¡F-·, ·Ó¢ڛÛÎÔÓÙ·È ÛÙÔ ÂÚÈ- ÛÙˆÛ·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘ πL-1 Û ·Û˘Ìو̷- ÊÂÚÈÎfi ·›Ì·, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ fiÙÈ Ù· Á‰ Δ Î‡ÙÙ·Ú· ÙÈÎÔ‡˜ ·ÛıÂÓ›˜, ÌÂÙ¿ fï˜ ·fi ‰È¤ÁÂÚÛË ÂÚÈÊÂÚÈ- Ú˘ıÌ›˙Ô˘Ó ‰˘Ó·ÌÈο ÙÔ˘˜ ·ÓÔÛÔ·ıÔÁÂÓÂÙÈÎÔ‡˜ ÌË- ÎÒÓ Ï¢ÎÔ΢ÙÙ¿ÚˆÓ Ì ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜ ÔÈ ÙÈ̤˜ ¯·ÓÈÛÌÔ‡˜48. º·ÈÓÔÙ˘ÈÎÔ› ˘ÔÏËı˘ÛÌÔ› ÙˆÓ Á‰Δ Ù˘ ·˘Í‹ıËηÓ, ¯ˆÚ›˜ fï˜ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Î˘ÙÙ¿ÚˆÓ CD45RA+CD45RO-VÁ9+V‰2+ ÚÔÊ·ÓÒ˜ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘59. ™Â ¿ÏÏË ÌÂϤÙË Â›Û˘ ‰È·- Û˘ÌÌÂÙ¤¯Ô˘Ó Û ·ÓÔÛȷΤ˜ ‰È·Ù·Ú·¯¤˜, ÔÈ Ôԛ˜ ÈÛÙÒıËΠfiÙÈ ÔÈ Î˘ÙÙ·ÚÔΛÓ˜ πL-1· Î·È πL-1‚ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ıÔÊ˘ÛÈÔÏÔÁ›· Ù˘ ÓfiÛÔ˘51. ™Â ‹Ù·Ó ·˘ÍË̤Ó˜ ÛÙÔÓ ÔÚfi ÙˆÓ ·ÛıÂÓÒÓ60. ¿ÏÏË ÌÂϤÙË ‰È·ÈÛÙÒıËΠÈÛ¯˘Ú‹ ÛÙÚÔÊ‹ ÚÔ˜ Ù· Δh1 ·ÙÙ·Ú·. Δ· ·ÙÙ·Ú· ·˘Ù¿ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ 3‚. πÓÙÂÚÏ¢ΛÓË 2 (πL-2) ÔÚ›· Ù˘ ÓfiÛÔ˘, ‰ÈfiÙÈ ·Ó¢ڛÛÎÔÓÙ·È ·˘ÍË̤ӷ Ù· CD3+/IFNÁ+ Î·È CD3+/IL-2+ Û ·ÛıÂÓ›˜ Ì ÂÓÂÚÁfi ¢È·ÈÛÙÒıËΠfiÙÈ Ô ˘fiÙ˘Ô˜ ÙˆÓ Á‰ Δ Î˘ÙÙ¿ÚˆÓ ÓfiÛÔ Û˘ÁÎÚÈÙÈο Ì ·ÛıÂÓ›˜ Ì Ï‹ÚË ‡ÊÂÛË Î·È CD45RA ÂͤÊÚ·˙ πL-2R‚ Î·È ∏LA-DR ÌfiÓÔ Û ˘ÁÈ‹ ¿ÙÔÌ·52. Δ· Á‰+ Δ Î‡ÙÙ·Ú· ·Ó¢ڛÛÎÔÓÙ·È Û ÂÓ- ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, ˘Ô‰ÂÈÎÓ‡ÔÓÙ·˜ ÙËÓ ÂÓÂÚ- ‰ÔıËÏȷΤ˜ ÂÈÊ¿ÓÂȘ Î·È ÂÍ·ÛÎÔ‡Ó Ú˘ıÌÈÛÙÈÎfi Úfi- ÁÔÔ›ËÛË in vivo ÛÙÔ ÛÙ¿‰ÈÔ ·˘Ùfi Ù˘ ÓfiÛÔ˘51. √ ÏÔ Û ‰È¿ÊÔÚ˜ ·ÓÔÛȷΤ˜ ·ÔÎÚ›ÛÂȘ. ∏ ·Ó‡ÚÂÛ‹ ‰È·Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ Ù˘ πL-2 (sIL2-R) ·Ó¢ڤıËΠÙÔ˘˜ ÂÍ¿ÏÏÔ˘ Û ÛËÌ›· ÊÏÂÁÌÔÓ‹˜ ˘Ô‰ËÏÒÓÂÈ ÙË ·˘ÍË̤ÓÔ˜ ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ Ì ÙË ÓfiÛÔ ∞μ59,61. Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ ÛÙËÓ ÙÔÈ΋ ÈÛÙÈ΋ ‚Ï¿‚Ë. ™Â Úfi- ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ·Ó·Ê¤ÚıËÎ·Ó ·˘ÍË̤ӷ Â›Â- ÛÊ·ÙË ÂÍ¿ÏÏÔ˘ ÌÂϤÙË ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ‰· ÛÙÔÓ ÔÚfi ÙÔ˘ ‰È·Ï˘ÙÔ‡ ˘Ô‰Ô¯¤· Ù˘ πL-2 Î·È Ù· CD4+CD25+ Ú˘ıÌÈÛÙÈο Δ Î‡ÙÙ·Ú· Â›Ó·È ·˘ÍË̤ӷ Â›‰· ·˘Ù¿ ‹Ù·Ó ÈÔ ·˘ÍË̤ӷ Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Û ÂÓÂÚÁfi ÓfiÛÔ Û˘ÁÎÚÈÙÈο Ì ·ÓÂÓÂÚÁfi ÓfiÛÔ Î·È Ù˘ ÓfiÛÔ˘62. ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ‚Ú‹Î·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜53. Δ· Δh-1 ÏÂÌÊÔ·ÙÙ·Ú· ·Ú¿ÁÔ˘Ó ÙÈ̤˜ Ù˘ πL-2 ÛÙË ÓfiÛÔ ∞μ63. ∞ÓÙ›ıÂÙ·, Û ¿ÏÏË ÌÂ- ÚÔÊÏÂÁÌÔÓÒ‰ÂȘ ΢ÙÙ·ÚÔΛÓ˜ (πL-2, IL-6, IL-8, IL- ϤÙË ‰È·ÈÛÙÒıËÎ·Ó Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Î·È 12, IL-18, TNF-· Î·È πFN-Á) ÔÈ Ôԛ˜ Â›Ó·È ·˘ÍË̤Ó˜ Û ·ÛıÂÓ›˜ Ô˘ ‰ÂÓ ˘Ô‚¿ÏÏÔÓÙ·Ó Û ıÂÚ·›· ·˘- ÛÙË ÓfiÛÔ ∞μ7. ÍË̤ӷ Â›‰· Ù˘ πL-2 Û˘ÁÎÚÈÙÈο Ì ·ÛıÂÓ›˜ ÛÂ Δ· Δh-2 ÏÂÌÊÔ·ÙÙ·Ú· ·ÛÎÔ‡Ó ·ÓÙ›ıÂÙ˜ ‰Ú¿- ·ÓÂÓÂÚÁfi ÛÙ¿‰Èfi Ù˘64. ÛÂȘ ·fi ·˘Ù¤˜ ÙˆÓ Δh-1 ΢ÙÙ¿ÚˆÓ ·ÎfiÌ· Î·È Û fiÙÈ ·ÊÔÚ¿ ÙËÓ ·Ú·ÁˆÁ‹ ÈÓÙÂÚÏ¢ÎÈÓÒÓ. 3Á. πÓÙÂÚÏ¢ΛÓË 4 (πL-4) T· ÔÏ˘ÌÔÚÊÔ‡ÚËÓ· ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ ·Ú¿- 2Â. ∫‡ÙÙ·Ú· Ê˘ÛÈÎÔ› ÊÔÓ›˜ (¡∫) ÁÔ˘Ó ·˘ÍË̤ӷ Â›‰· πL-463 Î·È È‰È·›ÙÂÚ· Û ÂÓÂÚ- √ ÚfiÏÔ˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Ê˘ÛÈÎÒÓ ÊÔÓ¤ˆÓ ÛÙË ÓfiÛÔ Áfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘65. ∞ÓÙ›ıÂÙ·, ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ∞μ Â›Ó·È ·ÌÊÈÛ‚ËÙÔ‡ÌÂÓÔ˜. ™Â ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ Ù· ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ‰È·ÊÔÚ¿ ÙˆÓ ÂÈ¤‰ˆÓ Ù˘ πL-4 Û ·ÙÙ·Ú· ·˘Ù¿ Â›Ó·È Ê˘ÛÈÔÏÔÁÈο, Û ¿ÏϘ ÌÂȈ̤ӷ ‹ ·ÛıÂÓ›˜ Ì ÂÓÂÚÁfi, ·ÓÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Î·È ·˘ÍË̤ӷ54-56. ∏ ÂÓÂÚÁfiÙËÙ· ÙˆÓ Î˘ÙÙ¿ÚˆÓ ·˘ÙÒÓ Û ÔÌ¿‰· ÂϤÁ¯Ô˘64,66.
  8. 8. º. ∫·ÎÏ·Ì¿Ó˘ Î·È Û˘Ó. 11 3‰. πÓÙÂÚÏ¢ΛÓË 6 (πL-6) ÓÔ˘Ó IL-2, IL-4, πL-10, IL-13 Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ63. ∞‡ÍËÛË ÂÓÙÔ‡ÙÔȘ Ù˘ πL-10 ·Ó·Ê¤ÚıËΠÌfiÓÔ ∏ ·˘ÙfiÌ·ÙË ·Ú·ÁˆÁ‹ Ù˘ IL-6 ·fi Ù· ÌÔÓÔ·ÙÙ·Ú· Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓË- ‚Ú¤ıËΠ·˘ÍË̤ÓË È‰È·›ÙÂÚ· ÛÙÔ ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ Ù¤˜65. ÓfiÛÔ˘60. ∏ ‰È¤ÁÂÚÛË Ì ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜ Û˘ÓÂ- ¿ÁÔÓÙ·Ó ÛËÌ·ÓÙÈο ·˘ÍË̤ÓË ÈÓÙÂÚÏ¢ΛÓË 659. ∞ÓÙ›- ıÂÙ·, ¿ÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ‰ÂÓ ‰È·›ÛÙˆÛ·Ó ·‡ÍËÛË ·˘- 3˙. πÓÙÂÚÏ¢ΛÓË 12 (πL-12) Ù‹˜ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ ÛÙË ÓfiÛÔ58,67. ∏ ÔÏ˘ÏÂÈÙÔ˘Ú- H IL-12 Â›Ó·È ÈÛ¯˘Ú¿ ·ÓÔÛÔÚÚ˘ıÌÈÛÙÈ΋ Î·È Â˘ÓÔ› ÙË ÁÈ΋ ÚÔÊÏÂÁÌÔÓ҉˘ ·˘Ù‹ ΢ÙÙ·ÚÔΛÓË ‚Ú¤ıËΠ‰È·ÊÔÚÔÔ›ËÛË Î·È ÙËÓ ˘ÂÚÏ·Û›· ÙˆÓ Δh1 ΢ÙÙ¿- ·˘ÍË̤ÓË ÛÙÔ ·ÓÂÓÂÚÁfi, ·ÏÏ¿ ΢ڛˆ˜ ÛÙÔ ÂÓÂÚÁfi ÚˆÓ52. ∏ IL-12 ·Ú¿ÁÂÙ·È ·fi Ù· ·ÓÙÈÁÔÓÔ·ÚÔ˘ÛÈ·- ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Û˘ÁÎÚÈÙÈο Ì ̿ÚÙ˘Ú˜62. ∂›Û˘, ÛÙÈο ·ÙÙ·Ú· (Ì·ÎÚÔÊ¿Á· Î·È ‰ÂÓ‰ÚÈÙÈο ·ÙÙ·- Û ÂÓÂÚÁfi Ó¢ÚÔÂÁÎÂÊ·ÏÈÎfi Û‡Ó‰ÚÔÌÔ Ù˘ ÓfiÛÔ˘ Ë Ú·)52. ∏ ΢ÙÙÙ·ÚÔΛÓË ·˘Ù‹ ‚Ú¤ıËΠ¿Óˆ ·fi Ù· πL-6 ‹Ù·Ó ·˘ÍË̤ÓË ÛÙÔ ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi68. Ê˘ÛÈÔÏÔÁÈο Â›‰· ÛÙÔ Ï¿ÛÌ· Û ÔÛÔÛÙfi 64% ÙˆÓ ·ÛıÂÓÒÓ Î·È Ù· Â›‰¿ Ù˘ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·Ó Ì 3Â. πÓÙÂÚÏ¢ΛÓË 8 (πL-8) ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘72. ∞˘ÍË̤ӷ Â›‰· Ù˘ πL-12 ‰È·ÈÛÙÒıËÎ·Ó Û ·ÛıÂÓ›˜ Ì ÂÓÂÚÁfi ÓfiÛÔ65. ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ Û¯¤Û˘ Ù˘ πL-8 Ì ÙË ÓfiÛÔ ∞μ ÚÔÛ‹Ï΢Û ÌÂÁ·Ï‡ÙÂÚÔ ÂӉȷʤÚÔÓ ÛÙÔ˘˜ ÂÚ¢ÓË- Ù¤˜, ÏfiÁˆ Ù˘ Û˘ÌÌÂÙÔ¯‹˜ Ù˘ ÛÙË ÊÏÂÁÌÔÓ‹. Δ· 3Ë. πÓÙÂÚÏ¢ΛÓË 13 (πL-13) CD45RA+Á‰ Δ Î‡ÙÙ·Ú· Î·È Ù· CD45+R√+ ·Ú¿- ∞˘ÍË̤ÓË ¤ÎÎÚÈÛË ·˘Ù‹˜ Ù˘ ÈÓÙÂÚÏ¢ΛÓ˘ ‰È·ÈÛÙÒ- ÁÔ˘Ó ›Û· ÔÛ¿ πL-851. ∏ ÈÓÙÂÚÏ¢ΛÓË ·˘Ù‹ ·Ú¿ÁÂÙ·È ıËΠÛÙË ÓfiÛÔ ∞μ Û˘ÁÎÚÈÙÈο Ì ÂÏÂÁ¯fiÌÂÓË ÔÌ¿‰·63. ·fi Ù· ÌÔÓÔ·ÙÙ·Ú·, ÙÔ˘˜ ÈÓÔ‚Ï¿ÛÙ˜ Î·È Ù· ÂÓ‰Ô- Δ· ›‰È· ·Ó·Ê¤ÚÔÓÙ·È Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘65. ıËÏȷο ·ÙÙ·Ú·, fiÙ·Ó ‰ÈÂÁ›ÚÔÓÙ·È Ì ÔÏ˘Û·Î¯·Ú›- Ù˜, Ì πL-1 ‹ Ì ·Ú¿ÁÔÓÙ· ÓÂÎÚÒÛˆ˜ ÙÔ˘ fiÁÎÔ˘ 3ı. πÓÙÂÚÏ¢ΛÓË 18 (πL-18) (Δ¡F). ªÂ ÈÛÙÔ¯ËÌÈ΋ ÌÂϤÙË ·ԉ›¯ıËÎÂ Ë ‡·ÚÍË ∏ ΢ÙÙ·ÚÔΛÓË ·˘Ù‹ Â›Ó·È Â›Û˘ ·˘ÍË̤ÓË ÛÙË ÓfiÛÔ Ù˘ πL-8 Û ·ÙÙ·Ú· ‰ÂÚÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ Ù˘ ÓfiÛÔ˘69. ∞μ ÌfiÓÔ Û ·ÛıÂÓ›˜ Ì ÂÓÂÚÁfi ÓfiÛÔ73. ∏ πL-8 ‰È·ÈÛÙÒıËΠ·˘ÍË̤ÓË Û ·ÛıÂÓ›˜ Ì ÂÓÂÚ- Áfi ÓfiÛÔ, ÏÈÁfiÙÂÚÔ Û ·ÛıÂÓ›˜ Ì ·ÓÂÓÂÚÁfi ÓfiÛÔ ‹ ÛÂ Ê˘ÛÈÔÏÔÁÈÎÔ‡˜ Ì¿ÚÙ˘Ú˜70. ∞fi ÔÏÏÔ‡˜ ÂÚ¢ÓË- 3È. ¶·Ú¿ÁÔÓÙ˜ ÓÂÎÚÒÛˆ˜ ÙÔ˘ fiÁÎÔ˘ Ù¤˜59,61,62,70 ‰È·ÈÛÙÒıËÎ·Ó ·˘ÍË̤ӷ Â›‰· Ù˘ πL- (TNF) 8 ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ È‰È·›ÙÂÚ· Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ. T· ·Ó·ÊÂÚfiÌÂÓ· ·ÔÙÂϤÛÌ·Ù· ÁÈ’ ·˘Ù‹ ÙËÓ Î˘ÙÙ·- ∞ӷʤÚıËΠÂ›Û˘ ·˘ÙfiÌ·ÙË ·Ú·ÁˆÁ‹ ÙÔ˘ RNA ÚÔΛÓË Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ·. ∞ÓȯÓ‡ÛÈ̘ ÙÈ̤˜ πL-8 ·fi Ù· ÏÂÌÊÔ·ÙÙ·Ú· ·ÛıÂÓÒÓ Î·È Èı·ÓÒ˜ ·˘- ·Ó¢ڤıËÛ·Ó Û 10 Î·È ÛËÌ·ÓÙÈο ·˘ÍË̤Ó˜ Û 4 Ù‹ Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ¿ÓÔÛÔ ÂÓÂÚÁÔÔ›ËÛË Î·È ‰È¤- ·fi ÙÔ˘˜ 32 ÂÍÂÙ·Ûı¤ÓÙ˜ ·ÛıÂÓ›˜61. ∞˘ÍË̤ӷ Â›- ÁÂÚÛË ÚÔÊÏÂÁÌÔÓˆ‰ÒÓ Î˘ÙÙ·ÚÔÎÈÓÒÓ ÚÔηÏÒ- ‰· ‰È·ÈÛÙÒıËÎ·Ó Û ·ÓÂÓÂÚÁfi ΢ڛˆ˜, fï˜ Î·È ÓÙ·˜ ÊÏÂÁÌÔÓ‹ Î·È ÈÛÙÈ΋ ‚Ï¿‚Ë. π‰È·›ÙÂÚÔ ÂӉȷʤ- Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, Û˘ÁÎÚÈÙÈο Ì ̿ÚÙ˘- ÚÔÓ ¤¯Ô˘Ó ÔÈ ÌÂϤÙ˜ ¿ÏÏˆÓ ÂÚ¢ÓËÙÒÓ ÔÈ Ôԛ˜ Ú˜59. ªÂÙ¿ ‰Â ·fi ‰È¤ÁÂÚÛË Ì ÏÈÔÔÏ˘Û·Î¯·Ú›Ù˜ ¤‰ÂÈÍ·Ó fiÙÈ Ë πL-8 ‹Ù·Ó ·˘ÍË̤ÓË Û ÂÓÂÚÁ¤˜ ‚Ï¿‚˜ Ù· Â›‰· ÙÔ˘ Δ¡F ·˘Í¿ÓÔÓÙ·Ó ÛËÌ·ÓÙÈο59. √ ‰È·- ÛÙfiÌ·ÙÔ˜ Î·È Ó¢ÚÈÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Î·È fiÙÈ Ù· ÂÓ‰Ô- Ï˘Ùfi˜ ˘Ô‰Ô¯¤·˜ 75 ÙÔ˘ Δ¡F (soluble TNFR75) ıËÏȷο ·ÙÙ·Ú· Â›Ó·È Î˘Ú›ˆ˜ ˘‡ı˘Ó· ÁÈ· ÙËÓ ¤Î- ÂÍ¿ÏÏÔ˘ ‚Ú¤ıËΠ·˘ÍË̤ÓÔ˜ Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Î·È ÎÚÈÛ‹ Ù˘ Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘60. ¶ÚfiÛÊ·Ù· ÚÔÙ›ÓÂÙ·È Ó· ¯ÚËÛÈ̇ÛÂÈ Û·Ó ‚ÈÔÏÔÁÈÎfi˜ ‰Â›ÎÙ˘ ÂȂ‚·ÈÒıËÎÂ Ë ·‡ÍËÛË Ù˘ πL-8 ÛÙË ÓfiÛÔ ∞μ, fiˆ˜ ÂÓÂÚÁfiÙËÙ·˜ Ù˘ ÓfiÛÔ˘72. Î·È Ë Û¯¤ÛË Ù˘ ˆ˜ ‰Â›ÎÙË ÂÓÂÚÁÔ‡ ÓfiÛÔ˘ ηχÙÂÚÔ˘ Ì¿ÏÈÛÙ· ·’ fi,ÙÈ Ë Δ∫∂ Î·È Ë C-·ÓÙȉÚÒÛ· ÚˆÙ½ÓË71. 3Î. πÓÙÂÚÊÂÚfiÓË Á (IFN-Á) ¶ÚÈÓ ·fi ‰ÂηÂٛ˜ ·Ó·Ê¤ÚıËΠ·˘ÙfiÌ·ÙË ·Ú·Áˆ- 3ÛÙ. πÓÙÂÚÏ¢ΛÓË 10 (πL-10) Á‹ Ù˘ πFN-Á Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ74. ∂›Û˘, Û ∏ πL-10 ‰ÂÓ ‚Ú¤ıËΠ·˘ÍË̤ÓË Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ÌË ıÂÚ·¢fiÌÂÓÔ˘˜ ·ÛıÂÓ›˜ Î·È Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ ∞μ Û˘ÁÎÚÈÙÈο Ì ¿ÏϘ ÔÌ¿‰Â˜66. ∞fi ¿ÏÏÔ˘˜ ÂÚ¢- Ù· Â›‰· Ù˘ πFN-Á ‹Ù·Ó ÛËÌ·ÓÙÈο ˘„ËÏfiÙÂÚ· ·’ ÓËÙ¤˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ù· ·ÓÙÈ-CD3/ ·ÓÙÈ-CD40 ‰ÈÂ- fi,ÙÈ Û ·ÓÂÓÂÚÁfi ÛÙ¿‰ÈÔ64. ÁÂṲ́ӷ ÂÚÈÊÂÚÈο ÌÔÓÔ·ÙÙ·Ú· Ô˘ ˘Ô‰ËÏÒÓÔ˘Ó ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ·ÓÙÈÎÚÔ˘fiÌÂÓ· ·ÔÙÂϤ- ÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Th1 Î·È Δh2 ΢ÙÙ¿ÚˆÓ ÂÎÎÚ›- ÛÌ·Ù· Û’ fi,ÙÈ ·ÊÔÚ¿ ÙȘ ΢ÙÙ·ÚÔΛÓ˜ ÌÔÚÔ‡Ó Ó·
  9. 9. 12 ∞ÈÙÈÔ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÛÙË ÓfiÛÔ ∞‰·Ì·ÓÙÈ¿‰Ë-Behçet ·Ô‰ÔıÔ‡Ó ÛÙË ÌÂıÔ‰ÔÏÔÁ›·, ÛÙÔÓ ·ÚÈıÌfi ÙˆÓ ·ÛıÂ- ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ (πgG Î·È πgM) Û ÔÛÔÛÙfi ÌfiÓÔ ÓÒÓ Û οı ÌÂϤÙË, ÛÙÔ ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘ Î·È ÛÙË ıÂ- 2,4%80. ™Â ¿ÏϘ ÌÂϤÙ˜ ·fi ÙËÓ ΔÔ˘ÚΛ· Ë Û˘¯Ófi- Ú·¢ÙÈ΋ ·ÁˆÁ‹ Ô˘ ˘Ô‚¿ÏÏÔÓÙ·Ó ÔÈ ·ÛıÂÓ›˜. ÙËÙ· ‹Ù·Ó 9,5%80. 4. ∂Ó‰ÔıËÏȷ΋ ÂÓÂÚÁÔÔ›ËÛË/‚Ï¿‚Ë 5Á. ∞ÓÙÈÂÓ‰ÔıËÏȷο ·ÓÙÈÛÒÌ·Ù· ŒÓ· ·fi Ù· ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÓfiÛÔ˘ ∞μ ›- ∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ ·- Ó·È Ë ÚÔÛ‚ÔÏ‹ fiÏˆÓ ÙˆÓ ·ÁÁ›ˆÓ (·ÚÙËÚÈÒÓ Î·È Ó¢ڤıËÎ·Ó Û ·ÛıÂÓ›˜ (πgG Î·È IgM 18.1%) fi¯È ÊÏ‚ÒÓ)1. ∏ Ù¿ÛË ÁÈ· ıÚÔÌ‚ˆÙÈο ÂÂÈÛfi‰È·, ÂȉÈο fï˜ Û ˘ÁÈ‹ ¿ÙÔÌ·81. ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ·Ó¤ÊÂÚ·Ó ÛÙÔ ÊÏ‚ÈÎfi ÛΤÏÔ˜ ÙˆÓ ·ÁÁ›ˆÓ, Â›Ó·È Â›Û˘ Û˘Ó‹- Û˘¯ÓfiÙËÙ· ·˘ÙÒÓ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Û ÔÛÔÛÙfi ı˘. ∏ ÂÓÂÚÁÔÔ›ËÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ‹Íˆ˜ Î·È Ë 29%82. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ÙÔ ÔÛÔÛÙfi ıÂÙÈÎfiÙËÙ·˜ ÈÓˆ‰ÔÏ˘ÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ·, Ô˘ ·ÓÙ·Ó·ÎÏÔ‡Ó ÙËÓ ‹Ù·Ó 13,1% ÁÈ· Ù· Ù¿Í˘ IgG Î·È 6,8% ÁÈ· Ù· Ù¿Í˘ ÂÓ‰ÔıËÏȷ΋ ÂÓÂÚÁÔÔ›ËÛË Î·È ‚Ï¿‚Ë, Â›Ó·È ÁÓˆÛÙ¿ πgM Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ, ÂÓÒ ‹Ù·Ó ÛÂ Ê˘ÛÈÔÏÔ- ÛÙË ÓfiÛÔ75. ∏ ‡·ÚÍË ÌÂÙ¿ÏÏ·Í˘ ÙÔ˘ ÚÔËÎÙÈÎÔ‡ ÁÈÎÔ‡˜ Ì¿ÚÙ˘Ú˜ 4% ÁÈ· Ù· Ù¿Í˘ πgG Î·È 8,0 % ÁÈ· ·Ú¿ÁÔÓÙ·, fiˆ˜ ÙÔ˘ ·Ú¿ÁÔÓÙ· V Leiden Î·È Ë ÌÂ- Ù· Ù¿Í˘ πgM, ¯ˆÚ›˜ Ó· ˘¿Ú¯ÂÈ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ- Ù¿ÏÏ·ÍË ÙÔ˘ ÁÔÓȉ›Ô˘ Ù˘ ÚÔıÚÔÌ‚›Ó˘ ·˘Í¿ÓÔ˘Ó Î‹ ‰È·ÊÔÚ¿83. ÙÔÓ Î›Ó‰˘ÓÔ ıÚfiÌ‚ˆÛ˘75 ˆ˜ ·ÓÂÍ¿ÚÙËÙÔÈ ·Ú¿ÁÔ- Δ· ·ÔÙÂϤÛÌ·Ù· ·˘Ù¿ ·Ô‰ÂÈÎÓ‡Ô˘Ó ÙȘ ÌÂıÔ- ‰ÔÏÔÁÈΤ˜ ‰È·ÊÔÚ¤˜ Î·È Ë Û¯¤ÛË ÙÔ˘˜ Ì ÙË ‚Ï¿‚Ë ÓÙ˜ ÎÈÓ‰‡ÓÔ˘. ∞ÎfiÌ·, Ë ıÚÔÌ‚ÔÌÔÓÙÔ˘Ï›ÓË, ÁÏ˘ÎÔ- ÙÔ˘ ·ÁÁ›Ԣ ·Ú·Ì¤ÓÂÈ ˘ÔıÂÙÈ΋ Î·È Èı·ÓfiÓ ·ÓÙ·- ÚˆÙ½ÓË Ù˘ ΢ÙÙ·ÚÈ΋˜ ÂÈÊ¿ÓÂÈ·˜ ÙÔ˘ ÂÓ‰ÔıËÏ›Ô˘, Ó·ÎÏ¿ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È ‰Â˘ÙÂÚÔ·ıÒ˜ Ë ÔÔ›· Â›Ó·È ·˘ÍË̤ÓË Û ÂÓÂÚÁfi ÛÙ¿‰ÈÔ Ù˘ ÓfiÛÔ˘, ÚfiÎÏËÛË Ù˘ ·ÁÁÂȷ΋˜ ‚Ï¿‚˘75. ÚÔηÏ› ‚Ï¿‚Ë ÛÙ· ÂÓ‰ÔıËÏȷο ·ÙÙ·Ú·5. ∏ ·ÚÔ˘- Û›· ·ÓÙÈÂÓ‰ÔıËÏÈ·ÎÒÓ ·ÓÙÈÛˆÌ¿ÙˆÓ Û¯ÂÙ›˙ÂÙ·È Â›Û˘ Ì ÙȘ ·ÁÁÂȷΤ˜ ‚Ï¿‚˜. 6. ∞˘ÙÔ·ÓÙÈÁfiÓ· 6·. ∞ÓÙÈÁfiÓÔ S 5. ∞ÓÙÈÛÒÌ·Ù· E›Ó·È ÙÔ ÈÔ ÈÛ¯˘Úfi ÚˆÙÂ˚ÓÈÎfi ·˘ÙÔ·ÓÙÈÁfiÓÔ Ù˘ Ú·- 5·. ∞ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÔ˘ ΢ÙÙ·ÚÔÏ¿- ÁÔÂȉ›Ùȉ·˜ Î·È ÂÓÙÔ›˙ÂÙ·È ÛÙÔÓ ·ÌÊÈ‚ÏËÛÙÚÔÂȉ‹. ÛÌ·ÙÔ˜ ÙˆÓ Ô˘‰ÂÙÂÚfiÊÈÏˆÓ ΔÔ ·ÓÙÈÁfiÓÔ ·˘Ùfi ÚÔηÏ› ÂÈÚ·Ì·ÙÈ΋ ·˘ÙÔ¿ÓÔÛË Ú·ÁÔÂȉ›Ùȉ· Î·È ·ÓȯÓ‡ÂÙ·È ÛÙÔÓ ÔÚfi ·ÛıÂÓÒÓ Ì ◊‰Ë ·fi ÙÔ 199359 ·Ó·˙ËÙ‹ıËÎ·Ó Ù· ·ÓÙÈÛÒÌ·Ù· ÓfiÛÔ ∞μ34. ∞˘ÍË̤ÓË ·¿ÓÙËÛË ÙˆÓ Δ Î˘ÙÙ¿ÚˆÓ Û ANCA Û ·ÛıÂÓ›˜ Ì ÂÓÂÚÁfi Î·È ·ÓÂÓÂÚÁfi ÓfiÛÔ Ì ηÏÏȤÚÁÂȘ ¤Ó·ÓÙÈ ÙÔ˘ S ·ÓÙÈÁfiÓÔ˘ ·Ú·ÙËÚ‹ıËΠ¤ÌÌÂÛÔ ·ÓÔÛÔÊıÔÚÈÛÌfi ¯ˆÚ›˜ fï˜ Ó· ·Ó¢ÚÂ- Û ·ÛıÂÓ›˜ Ì ÔÊı·ÏÌÈ΋ ÓfiÛÔ ∞μ ·Ú¿ Û’ ·˘ÙÔ‡˜ ıÔ‡Ó. ∏ ·Ó·˙‹ÙËÛË ·˘ÙÒÓ ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙË Ófi- ¯ˆÚ›˜ ÔÊı·ÏÌÈ΋ ÚÔÛ‚ÔÏ‹. √È ‰Â‡ÙÂÚÔÈ Â›¯·Ó ÛÔ ∞μ ÌÔÚÔ‡Û ӷ ‰ÈηÈÔÏÔÁËı› ·fi ÙËÓ ·ÁÁÂÈ›ÙÈ- fiÌÔÈ· ·¿ÓÙËÛË Ì ÙÔ˘˜ Ì¿ÚÙ˘Ú˜34. ∂›Ó·È ÂӉȷʤ- ‰· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙË ÓfiÛÔ. ™Â ÌÂϤÙ˜ fï˜ Ô˘ ÚÔÓ fiÙÈ ÙÔ S ·ÓÙÈÁfiÓÔ ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈËı› ÁÈ· ÙË ıÂ- ·ÎÔÏÔ‡ıËÛ·Ó Ù· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ·Ó¢ڤıËÛ·Ó Ìfi- Ú·›· ·˘ÙÔ¿ÓÔÛˆÓ Ú·ÁÔÂȉÈÙ›‰ˆÓ Û˘ÌÂÚÈÏ·Ì‚·ÓÔ- ÓÔ Û ÌÈÎÚfi ·ÚÈıÌfi ·ÛıÂÓÒÓ ‹ ‰ÂÓ ·Ó¢ڤıËÛ·Ó Û ̤Ó˘ Ù˘ Ú·ÁÔÂȉ›Ùȉ·˜ Ù˘ ÓfiÛÔ˘ ∞μ34. ηӤӷ ·ÛıÂÓ‹76,77. 6‚. ΔÚÔÔÌ˘ÔÛ›ÓË ∞ 5‚. ∞ÓÙÈηډÈÔÏÈÈÓÈο ·ÓÙÈÛÒÌ·Ù· ∂›Ó·È ÌÈ· ÔÈÎÔÁ¤ÓÂÈ· ÚˆÙÂ˚ÓÒÓ Ô˘ ÂÎÊÚ¿˙ÔÓÙ·È ∂·ÓÂÈÏËÌ̤ӷ Ù· ·ÓÙÈÛÒÌ·Ù· ·˘Ù¿ ·ÔÙ¤ÏÂÛ·Ó ÛÙfi- ÛÙÔ˘˜ Ì˘˜ Î·È Û ¿ÏÏ· ·ÙÙ·Ú· (ÂÈıËÏȷο, ÈÓÔ‚Ï¿- ¯Ô ·Ó·˙ËÙ‹Ûˆ˜ ·fi ÙÔ˘˜ ÂÚ¢ÓËÙ¤˜. ∞˘ÍË̤ӷ ÛÙ˜ Î·È ·ÈÌÔÂÙ¿ÏÈ·)84. ™ÙÔÓ ÔÚfi ·ÛıÂÓÒÓ Ì ÓfiÛÔ ·ÓÙÈηډÈÔÏÈÈÓÈο ·ÓÙÈÛÒÌ·Ù· ·Ó·Ê¤ÚıËÎ·Ó Û Ô- ∞μ ·Ó¢ڤıËÛ·Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ·˘ÙÔ‡ ÙÔ˘ ·ÓÙÈ- ÛÔÛÙfi 35% ÙˆÓ ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ Î·È Û¯ÂÙ›ÛıË- ÁfiÓÔ˘ Î·È Ë ·ÓÔÛÔÔ›ËÛË Ì ÙÚÔÔÌ˘ÔÛ›ÓË ∞ ÚÔ- Î·Ó Ì ‚·ÚÈ¿ ÓfiÛÔ78. ∞‡ÍËÛË ÙˆÓ ·ÓÙÈÛˆÌ¿ÙˆÓ ·˘- οÏÂÛ ڷÁÔÂȉ›Ùȉ· Î·È ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ Û ÔÓÙ›- ÙÒÓ ·Ó·Ê¤ÚıËΠ۠ÂÓÂÚÁfi ÓfiÛÔ ÛÙÔ 46,7%, ‰ÂÓ ıÂ- ÎÈ· Lewis85. ∂Í¿ÏÏÔ˘ Û ÔÛÔÛÙfi 26,6% ÙˆÓ ·ÛıÂ- ˆÚ‹ıËΠfï˜ fiÙÈ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ıÔÁ¤ÓÂÈ· Ù˘ ÓÒÓ Ì ÓfiÛÔ ∞μ, ¯ˆÚ›˜ Ô›ÛıÈ· Ú·ÁÔÂȉ›Ùȉ·, ·Ó¢- ÓfiÛÔ˘, ÂÓÒ ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ¤Ó‰ÂÈÍË ÁÈ· ÂÌÊ¿- Ú¤ıËÛ·Ó ·ÓÙÈÛÒÌ·Ù· ¤Ó·ÓÙÈ ÙÚÔÔÌ˘ÔÛ›Ó˘84. ∞Îfi- ÓÈÛË ‰ÂÚÌ·ÙÈ΋˜ ·ÁÁÂÈ›Ùȉ·˜, fiˆ˜ ÙÔ Ô˙҉˜ ÂÚ‡ıË- Ì· Û ÔÛÔÛÙfi 33%, ·ÛıÂÓ›˜ Ì Ô›ÛıÈ· Ú·ÁÔÂȉ›- Ì·79. ∂ÓÙÔ‡ÙÔȘ Û ÚfiÛÊ·ÙË ÌÂϤÙË ·fi ÙËÓ ΔÔ˘Ú- Ùȉ·, ·ÚÔ˘Û›·Û·Ó ÏÂÌÊÔ¸ÂÚÏ·ÛÙÈ΋ ·ÓÙ·fiÎÚÈÛË Î›·, Û ÌÂÁ¿ÏÔ ·ÚÈıÌfi ·ÛıÂÓÒÓ, ‰È·ÈÛÙÒıËÎ·Ó Ù· ÛÙËÓ ÙÚÔÔÌ˘ÔÛ›ÓË ∞ in vitro ‹ ÛÙ· ·Ú¿ÁˆÁ· Â-
  10. 10. º. ∫·ÎÏ·Ì¿Ó˘ Î·È Û˘Ó. 13 Ù›‰È¿ Ù˘ fi¯È fï˜ Î·È ÔÈ Ì¿ÚÙ˘Ú˜84. ∏ ·ÚÔ˘Û›· ÛÙ‹Ì·ÙÔ˜97. ™Â ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ‰ÂÓ ‰È·ÈÛÙÒıËΠ·˘ÙÒÓ ÙˆÓ ‰È·Ù·Ú·¯ÒÓ ·Ô‰ÂÈÎÓ‡ÂÈ ÙÔÓ Èı·Ófi ÚfiÏÔ ·˘Ù‹ Ë Û¯¤ÛË Î·È Ú¤ÂÈ Ë ·ÈÙÈÔ·ıÔÁ¤ÓÂÈ· Ù˘ ÓfiÛÔ˘, Ù˘ ÙÚÔÔÌ˘ÔÛ›Ó˘ ∞, Û·Ó ·˘ÙÔ·ÓÙÈÁfiÓÔ, Û ÂȉÈ΋ fiˆ˜ ·Ó·Ê¤ÚıËΠ‹‰Ë, Ó· Û¯ÂÙ›˙ÂÙ·È Ì ÁÂÓÂÙÈÎÔ‡˜ Î·È Î·ÙËÁÔÚ›· ·ÛıÂÓÒÓ Ì ÓfiÛÔ ∞μ. ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜98. ™Â ÌÂϤÙË 62 ∂ÏÏ‹- ÓˆÓ ·ÛıÂÓÒÓ ‰È·ÈÛÙÒıËΠ·ÛıÂÓ‹˜ Û¯¤ÛË ÌÂٷ͇ 7. ÕÓÔÛ· Û˘ÌϤÁÌ·Ù· μ*5101, Ú·ÁÔÂȉ›Ùȉ·˜ Î·È Ô˙Ò‰Ô˘˜ ÂÚ˘ı‹Ì·ÙÔ˜. ΔÔ ·ÏÏ‹ÏÈÔ ·˘Ùfi ‚Ú¤ıËΠ۠ÔÛÔÛÙfi 80% ÙˆÓ ·ÛıÂÓÒÓ ∏ ‡·ÚÍË Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ·ÓfiÛˆÓ Û˘ÌÏÂÁÌ¿ÙˆÓ Î·È 26% ÙˆÓ ˘ÁÈÒÓ Ì·ÚÙ‡ÚˆÓ Î·È ıˆڋıËΠÚÔ- Û ·ÛıÂÓ›˜ Ì ÓfiÛÔ ∞μ ¤¯ÂÈ ·Ó·ÊÂÚı› ·fi ÔÏ- ‰È·ıÂÛÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÁÈ· ÙË ÓfiÛÔ ∞μ99. ™¯¤ÛË ÌÂ- ÏÔ‡˜ ÂÚ¢ÓËÙ¤˜34. ÕÓÔÛÔÛ˘ÌϤÁÌ·Ù· ¤¯Ô˘Ó Â›Û˘ ٷ͇ ÙˆÓ μ5, Ú·ÁÔÂȉ›Ùȉ·˜ Î·È ·ÁÁÂÈ›Ùȉ·˜ ·Ó·Ê¤Ú- ÂÓÙÔÈÛÙ› Û ÈÛÙÈΤ˜ ‚Ï¿‚˜ Î·È Î˘Ú›ˆ˜ ÛÙÔ ÙÔ›¯ˆÌ· ıËΠ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜100. ÙˆÓ ·ÁÁ›ˆÓ86. Δ· Â›‰· ÙˆÓ Î˘ÎÏÔÊÔÚÔ‡ÓÙˆÓ ∞Ó¿Ï˘ÛË ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ ·ÓfiÛÔÛ˘ÌÏÂÁÌ¿ÙˆÓ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÓÂÚÁfiÙËÙ· ¤‰ÂÈÍ fiÙÈ 3 ·ÏÏ‹ÏÈ· (ªπCA-A6,MIμ-348, C1-4-1- Ù˘ ÓfiÛÔ˘ fi¯È fï˜ Ì ÙË ‰È¿ÚÎÂÈ· ‹ ÙËÓ ÚÔÛÂ΂Ô- 217) Î·È ÙÔ HLA-B*551 Û¯ÂÙ›˙ÔÓÙ·È ¿ÌÂÛ· Ì ÙË Ófi- Ï‹ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ÔÚÁ¿ÓÔ˘87. ÕÏÏÔÈ ÂÚ¢ÓËÙ¤˜ ‰È·›- ÛÔ95,96. ™Â ¿ÏÏË ÌÂϤÙË ·Ú·ÙËÚ‹ıËΠ·‡ÍËÛË ÙÔ˘ ÛÙˆÛ·Ó ˘„ËÏfiÙÂÚ· Â›‰· ΢ÎÏÔÊÔÚÔ‡ÓÙˆÓ ·ÓÙÈ- MICA 006 Î·È fi¯È ÙÔ˘ ªπCA 009 Û ·ÛıÂÓ›˜ Û˘- ÛˆÌ¿ÙˆÓ Û ·ÛıÂÓ›˜ Ì ٷ˘Ùfi¯ÚÔÓË ÚÔÛ‚ÔÏ‹ ÁÎÚÈÙÈο Ì ̿ÚÙ˘Ú˜101. ÕÏÏË Û˘Û¯¤ÙÈÛË Ì ÙË ÓfiÛÔ ‰¤ÚÌ·ÙÔ˜ Î·È ·ÚıÚÒÛˆÓ88. ™Â ÔÛÔÛÙfi 44%-60% Â›Ó·È ·˘Ù‹ Ì ÙÔ ∏LA-CW 1602102. ™Â ÚfiÛÊ·ÙË ÌÂ- ÙˆÓ ·ÛıÂÓÒÓ Ù· ΢ÎÏÔÊÔÚÔ‡ÓÙ· ¿ÓÔÛ· Û˘ÌϤÁÌ·- ϤÙË ·Ó·Ê¤ÚÔÓÙ·È ÂӉ›ÍÂȘ ÁÂÓÂÙÈ΋˜ ÂÙÂÚÔÁ¤ÓÂÈ·˜ Ù· Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙËÓ ÂÓÂÚÁfiÙËÙ· Ù˘ ÓfiÛÔ˘34. ™ÙÔ ÛÙË ÓfiÛÔ ∞μ Î·È Û ·È‰È·ÙÚÈ΋ ÔÌ¿‰· ·ÛıÂÓÒÓ Ì ÂÁÎÂÊ·ÏÔÓˆÙÈ·›Ô ˘ÁÚfi ·Ó¢Ú‡ıËÛ·Ó ¿ÓÔÛ· Û˘- ÓfiÛÔ ·Ú·ÙËÚ‹ıËΠ‡·ÚÍË ª·ÓÙÂÏÈ·ÓÔ‡ ÚÔÙ‡Ô˘ ÌϤÁÌ·Ù· ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂÁÎÂÊ·Ï›Ùȉ·˜, ÂÓÒ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Ì ·˘ÙfiÛˆÌÔ ˘ÔÏÂÈfiÌÂÓÔ ¯·- ‰È·ÈÛÙÒıËÎ·Ó ÙfiÛÔ Ë ·Ú·ÁˆÁ‹ πgG, IgM, IgA fiÛÔ Ú·ÎÙ‹Ú·103. Î·È ÔÈ ˘„ËϤ˜ Û˘ÁÎÂÓÙÚÒÛÂȘ ÙˆÓ C3, C4 Î·È CD8+ T ÏÂÌÊÔ΢ÙÙ¿ÚˆÓ7. μÈ‚ÏÈÔÁÚ·Ê›· 1. Kaklamani VG, Vaiopoulos G, Kaklamanis Ph. Behcet’s di- 8. ∞ÓÔÛÔÁÂÓÂÙÈ΋ sease. Semin Arthritis Rheum 1998; 27: 197-217. ∏ Û¯¤ÛË Ù˘ ·ÓÔÛÔÁÂÓÂÙÈ΋˜ Ì ÙË ÓfiÛÔ ∞μ ÛÙËÚ›- 2. Sakane T, Takeno M, Suzuki N, Inaba G. Behcet’s disease. N ˙ÂÙ·È ÛÙË ÁˆÁÚ·ÊÈ΋ ηٷÓÔÌ‹ Ù˘ ÓfiÛÔ˘, ÛÙËÓ ÔÈ- Engl J Med 1999; 341: 1284-91. ÎÔÁÂÓ‹ ÂÌÊ¿ÓÈÛ‹ Ù˘ Î·È ÛÙË Û¯¤ÛË Ù˘ Ì ÙÔ Û‡- 3. Direskeneli H. Behcet’s disease: Infectious aetiology, new autoantigens and HLA-B52 Ann Rheum Dis 2001; 60: ÛÙËÌ· ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ (∏LA). H Û¯¤ÛË Ù˘ ÓfiÛÔ˘ 996-1002. Ì ÙÔ Û‡ÛÙËÌ· ÈÛÙÔÛ˘Ì‚·ÙfiÙËÙ·˜ Â›Ó·È ·ԉ‰ÂÈÁ̤- 4. Zouboulis CC. Epidemiology of Adamantiades – Behcet’s ÓË Û ÌÂÁ¿ÏË ÛÂÈÚ¿ ÌÂÏÂÙÒÓ ‰ÈÂıÓÒ˜. ΔÔ ∏LA B*551 disease. Ann Med Intern 1999; 150: 448-98. ‰È·ÈÛÙÒıËΠ۠ÔÛÔÛÙfi Î˘Ì·ÈÓfiÌÂÓÔ ·fi 54,1% 5. Zouboulis CC, May T. Pathogenesis of Adamantiades-Beh- ÛÙËÓ ΔÔ˘ÚΛ·89 ̤¯ÚÈ Î·È 76,2% ÛÙÔ πÛÚ·‹Ï90. ΔÔ cet’s disease. Med Microbiol Immunol 2003; 192: 149-55. ∏LA-B*551 ¤¯ÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ 34 ÔÈÎÈϛ˜ ·ÏÏËÏ›ˆÓ 6. Krause I, Uziel Y, Guedj D, et al. Mode of presentation and Î·È ÔÈ Û˘ÓËı¤ÛÙÂÚÔÈ ˘fiÙ˘ÔÈ Â›Ó·È ÔÈ HLA-B*5101 multisystemic involvement in Behcet’s disease. The influ- ence of sex and age of disease onset. J Rheumatol 1998; Î·È ÔÈ ∏LA-B*510891. O ÈÔ Û˘¯Ófi˜ ˘fiÙ˘Ô˜ Â›Ó·È 25: 1566-9. Ô ∏LA-B*5101. ∏ ‡·ÚÍË Û¯¤Û˘ ÙÔ˘ HLA-B*551 7. Evereklioglu C. Current concepts in the aetiology and treat- Ì ÙË ÓfiÛÔ ¤¯ÂÈ Û˘˙ËÙËı› ÚÔ ÔÏÏÒÓ ÂÙÒÓ ment of Behcet Disease. Survey of ophthalmology 2005; (1975)92. √ ˘fiÙ˘Ô˜ ∏LA-B*5108, fiˆ˜ Î·È Ô 50: 297-350. ˘fiÙ˘Ô˜ ∏LA-B*5101, ·Ó¢ڤıËÛ·Ó Û ÌÂÁ·Ï‡ÙÂ- 8. Yazici H. The place of Behcet’s disease syndrome among ÚË Û˘¯ÓfiÙËÙ· Û ·ÛıÂÓ›˜ ·fi ÙËÓ πÙ·Ï›· Î·È ÙË ™·- the autoimmune diseases. Intern Rev Immunol 1997; 14: Ô˘‰È΋ ∞Ú·‚›·93. ∞ÎfiÌ· ·fi ÙÔ˘˜ ›‰ÈÔ˘˜ ÂÚ¢ÓËÙ¤˜ 1-10. ‰È·ÈÛÙÒıËΠÈÛ¯˘Ú‹ Û¯¤ÛË ÙÔ˘ HLA-B51 Û πÚ·ÓÔ‡˜ 9. Hamuryudan V, Yurdakul S. Moral F, et al. Pulmonary arte- rial aneurysms in Behcet’s syndrome. A report of 24 ·ÛıÂÓ›˜. ™ÙË ¯ÒÚ· Ì·˜ ¤¯ÂÈ ‰ÈÂÚ¢ÓËı› Ë Û¯¤ÛË ÙÔ˘ cases. Br J Rheumatol 1994; 33: 48-51. ∏LA-B*551 Û ÛÂÈÚ¿ ÌÂÏÂÙÒÓ94-96. ÀÔÛÙËÚ›˙ÂÙ·È fiÙÈ 10. Gul A. Behcet’s disease as an auto-inflammatory disorder. ÙÔ ∏LA-B551 Û¯ÂÙ›˙ÂÙ·È Ì ÙË ‚·Ú‡ÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È Current Drug Targets Inflammation and Allergy 2005; 4: Â›Ó·È ÈÔ Û˘¯Ófi Û ·ÛıÂÓ›˜ Ì ÚfiÛıÈ· Ú·ÁÔÂȉ›Ùȉ· 81-3. Î·È ÂÍÂÏÈÛÛfiÌÂÓË ‚Ï¿‚Ë ÙÔ˘ ÎÂÓÙÚÈÎÔ‡ Ó¢ÚÈÎÔ‡ Û˘- 11. Yazici H, Fresco I. Behcet’s disease and other autoinflam-
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  14. 14. ∞Ó·ÛÎfiËÛË ÃÚfiÓȘ ∏·Ù›Ùȉ˜ ππ – ÃÚfiÓÈ· ∏·Ù›Ùȉ· C E. °ÈÁ‹, ª. ƒ·ÙÔÔ‡ÏÔ˘-°ÈÁ‹ ∏·ÙÔÏÔÁÈÎfi ΔÌ‹Ì· μ′ ¶·ıÔÏÔÁÈ΋ ∫ÏÈÓÈ΋ ∞¶£, πÔÎÚ¿ÙÂÈÔ ¡ÔÛÔÎÔÌÂ›Ô £ÂÛÛ·ÏÔӛ΢ 2007; 3, 1-2: 17 – 34 ¶∂ƒI§∏æ∏ ∏ ¯ÚfiÓÈ· Ë·Ù›Ùȉ· C ·ÔÙÂÏ› Û‹ÌÂÚ· ¤Ó· ÛÔ‚·Úfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜ ·ÁÎfiÛÌÈ· ÏfiÁˆ ÙˆÓ ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ Ù˘ ¯ÚfiÓÈ·˜ ÓfiÛÔ˘. ∏ ÌÂϤÙ˘ Ù˘ Ê˘ÛÈ΋˜ ÈÛÙÔÚ›·˜ Ù˘ ÓfiÛÔ˘ Â›Ó·È È‰È·›ÙÂÚ· ‰‡ÛÎÔÏË Î˘Ú›ˆ˜ ÏfiÁˆ Ù˘ ·‰˘Ó·Ì›·˜ ηıÔÚÈÛÌÔ‡ ÙÔ˘ ·ÎÚÈ‚‹ ¯ÚfiÓÔ˘ ÌfiÏ˘ÓÛ˘. √ HCV ‰È·ÎÚ›ÓÂÙ·È Û 6 ÁÔÓfiÙ˘Ô˘˜ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ Ó· ÌÂÙ·ÏÏ¿ÛÛÂÙ·È Û ٷ¯‡ Ú˘ıÌfi Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÂÈ‚ÈÒÓÂÈ Û οı ›ÂÛË Ô˘ ‰¤¯ÂÙ·È Â›Ù ·fi ÙËÓ ·ÓÔÛȷ΋ ·¿ÓÙËÛË ÙÔ˘ ÍÂÓÈÛÙ‹ ‹ ·fi ÙË ıÂ- Ú·¢ÙÈ΋ ·Ú¤Ì‚·ÛË. ∏ ıÂÚ·›· Ù˘ HCV Ïԛ̈͢ Û‹ÌÂÚ·, Ë ÔÔ›· ·ÔÛÎÔ› ÛÙËÓ ÂÎÚ›˙ˆÛË ÙÔ˘ ÈÔ‡ Î·È ÛÙËÓ Â›Ù¢ÍË Ì·- ÎÚ¿˜ ‰È¿ÚÎÂÈ·˜ ÈÔÏÔÁÈ΋˜ ·¿ÓÙËÛ˘ (SVR), ¤ÁÎÂÈÙ·È ÛÙË ¯ÔÚ‹ÁËÛË Û˘Ó‰˘·Ṳ̂Ó˘ ıÂÚ·›· Ì ÂÁ΢ÏȈ̤ÓË ÈÓÙÂÊÂÚfiÓË-· Î·È ÚÈÌ·‚ÈÚ›ÓË Â› 48 ‚‰ÔÌ¿‰Â˜ Û Ïԛ̈ÍË ·fi ÙÔÓ ÁÔÓfiÙ˘Ô 1 Î·È 24 ‚‰ÔÌ¿‰Â˜ ÁÈ· ÙÔÓ ÁÔÓfiÙ˘Ô 3 Ì ÔÛÔÛÙ¿ SVR ÂÚ›Ô˘ 42-56% Î·È 75-84% ·ÓÙ›ÛÙÔȯ·. ∂ÓÙÔ‡ÙÔȘ Ë ıÂÚ·›· ·˘Ù‹ Â›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÊ·ÚÌÔÛı› Û ÂȉÈΤ˜ ÔÌ¿‰Â˜ ·ÛıÂÓÒÓ fiˆ˜ Û ·ÛıÂÓ›˜ ÔÈ ÔÔ›ÔÈ ‰ÂÓ ·ÓÙ·ÔÎÚ›ıËÎ·Ó ÛÙË ıÂÚ·›· ‹ ˘ÔÙÚÔ›·Û·Ó, Û ·ÛıÂÓ›˜ Ì ΛÚÚˆÛË Î·È È‰È·›ÙÂÚ· Û ·ÛıÂÓ›˜ Ì ÌË ·ÓÙÈÚÚÔÔ‡ÌÂÓË Î›ÚÚˆÛË ÔÈ ÔÔ›ÔÈ Â›Ó·È ˘Ô„‹ÊÈÔÈ ÁÈ· ÌÂÙ·ÌfiÛ¯Â˘ÛË ‹·ÙÔ˜, ÏfiÁˆ ÙˆÓ ÛÔ‚·ÚÒÓ ÂÈÏÔÎÒÓ Ù˘ ıÂÚ·›·˜. °È· ÙÔ ÏfiÁÔ ·˘Ùfi ÙÔ Úfi‚ÏËÌ· Ù˘ ˘ÔÙÚÔ‹˜ Ù˘ HCV Ïԛ̈͢ ÌÂÙ¿ ÙË ÌÂÙ·ÌfiÛ¯Â˘ÛË ÚÔηÏ› ȉȷ›ÙÂÚÔ ÚÔ‚ÏËÌ·ÙÈÛÌfi ‰ÈfiÙÈ fiˆ˜ ‰È·ÈÛÙÒÓÂÙ·È Ë ˘ÔÙÚÔ‹ Ù˘ Ïԛ̈͢ Â›Ó·È Û¯Â‰fiÓ Î·ıÔÏÈ΋. ∏ ϤÔÓ ·Ô‰ÂÎÙ‹ ·ÓÙÈÌÂÙÒÈÛË Ù˘ HCV ˘ÔÙÚÔ‹˜ Û˘- Ó›ÛÙ·Ù·È ÛÙË ¯ÔÚ‹ÁËÛË Û˘Ó‰˘·Ṳ̂Ó˘ ıÂÚ·›·˜ PEG IFN-· Î·È ÚÈÌ·‚ÈÚ›Ó˘ Ì Ùˆ¯¿ ·ÔÙÂϤÛÌ·Ù· ¤ÙÛÈ, ÒÛÙ ӷ ··ÈÙÂ›Ù·È Â·Ó·ÌÂÙ·ÌfiÛ¯Â˘ÛË, Ë ÔÔ›· fï˜ Û¯ÂÙ›˙ÂÙ·È Ì ÌÈÎÚ‹ ÂÈ‚›ˆÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È Ì ÙÔ ÛÔ‚·Úfi Úfi‚ÏËÌ· Ù˘ ÂÎ Ó¤Ô˘ ˘Ô- ÙÚÔ‹˜ Ù˘ ÓfiÛÔ˘. §¤ÍÂȘ-ÎÏÂȉȿ: XÚfiÓÈ· Ë·Ù›Ùȉ· C, ·ıÔÁ¤ÓÂÈ·, ıÂÚ·›·, ÈÓÙÂÚÊÂÚfiÓË. ∏ Ë·Ù›Ùȉ· C ·ÔÙÂÏ› Û‹ÌÂÚ· ÙËÓ Î˘ÚÈfiÙÂÚË ·ÈÙ›· ηÚΛÓÔ (∏∫∫). π‰È·›ÙÂÚ· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·‡ÍËÛË ¯ÚfiÓÈ·˜ Ë·ÙÈ΋˜ ÓfiÛÔ˘ Î·È ÙËÓ ÈÔ Û˘¯Ó‹ ¤Ó‰ÂÈÍË ÙÔ˘ ∏∫∫ ·ÁÎfiÛÌÈ· ÛÙËÓ ·ıÔÁ¤ÓÂÛË ÙÔ˘ ÔÔ›Ô˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÙÔ˘ ‹·ÙÔ˜. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÂÚÈÛ- ÂÌϤÎÂÙ·È Ô HCV, Ë HCV Ïԛ̈ÍË ÛÙȘ ÂÚÈÛÛfiÙÂ- ÛfiÙÂÚÔ ·fi 170.000.000 ¿ÓıÚˆÔÈ ¤¯Ô˘Ó ÌÔÏ˘Óı› Ú˜ ÂÚÈÙÒÛÂȘ ¤¯ÂÈ Â¤ÏıÂÈ ÚÈÓ ·fi ‰ÂηÂٛ˜1,2. Ì ÙÔÓ Èfi Ù˘ Ë·Ù›Ùȉ·˜ C (HCV)1. H Ë·Ù›Ùȉ· C ÌÂÙ·‰›‰ÂÙ·È ÌÂÙ¿ ·fi Â·Ê‹ Ì ¶·Ú¿ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ·Ú·Ì¤- ÌÔÏ˘Ṳ̂ÓÔ ·›Ì· ‹ ÚÔ˚fiÓÙ· ·›Ì·ÙÔ˜. ™‹ÌÂÚ· Ô Î˘- ÓÔ˘Ó ·Û˘Ìو̷ÙÈÎÔ› ÁÈ· ÔÏÏ¿ ›Ûˆ˜ ¯ÚfiÓÈ·, Ë ÏÔ›- ÚÈfiÙÂÚÔ˜ ÙÚfiÔ˜ ÌÂÙ¿‰ÔÛ˘ Â›Ó·È Ë ÂÓ‰ÔÊϤ‚È· ̈ÍË Ì ÙÔÓ HCV ¢ı‡ÓÂÙ·È ÁÈ· ÙË ¯ÚfiÓÈ· Ë·ÙÈ΋ ¯Ú‹ÛË Ó·ÚΈÙÈÎÒÓ Ô˘ÛÈÒÓ. ÕÏÏÔÈ ‰˘ÓËÙÈÎÔ› ÙÚfiÔÈ ÓfiÛÔ, Ë ÔÔ›· Î˘Ì·›ÓÂÙ·È ·fi ÙË ¯ÚfiÓÈ· Ë·Ù›Ùȉ·, ÌÂÙ¿‰ÔÛ˘ ›ӷÈ: Ë Â·ÁÁÂÏÌ·ÙÈ΋ ¤ÎıÂÛË, Ë ÛÂÍÔ˘·- ÙËÓ Î›ÚÚˆÛË ÙÔ˘ ‹·ÙÔ˜ ¤ˆ˜ ÙÔÓ Ë·ÙÔ΢ÙÙ·ÚÈÎfi ÏÈ΋ ÌÂÙ¿‰ÔÛË, Ë ÂÓ‰ÔÚÚÈÓÈ΋ ¯Ú‹ÛË ÎÔη˝Ó˘, ÙÔ Ù·-
  15. 15. 18 XÚfiÓȘ Ë·Ù›Ùȉ˜ ππ. ÃÚfiÓÈ· ∏·Ù›Ùȉ· C ÙÔ˘¿˙, ÙÔ ÙÚ‡ËÌ· ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È Ë ÌÂÙ¿‰ÔÛË ·fi ¶›Ó·Î·˜ 1 ÙË ÌËÙ¤Ú· ÛÙÔ ·È‰›. √ ΛӉ˘ÓÔ˜ Ù˘ ÌÂÙ¿‰ÔÛ˘ ̤ۈ ÙˆÓ ÚÔ˚fi- ÃêåÝá èðáôÝôéäá C ÓÙˆÓ ·›Ì·ÙÔ˜ ‹ Ù˘ ÌÂÙ·ÌfiÛ¯Â˘Û˘ ÔÚÁ¿ÓˆÓ Ô˘ÛÈ·- ÛÙÈο ÂÏ·¯ÈÛÙÔÔÈ‹ıËΠÌÂÙ¿ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢- AùôïðåòéïòéóõåÝóá ÌòÞîéá HCV ìïÝíöêè Û˘ ÙˆÓ antiHCV ·ÓÙÈÛˆÌ¿ÙˆÓ ÛÙ· ̤۷ ÙÔ˘ 1992. 15% 85% ™‹ÌÂÚ· Ù· ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ HCV Ïԛ̈͢ (70- 90%) ·Ó·Ê¤ÚÔÓÙ·È Û ∂º ¯Ú‹ÛÙ˜ Ó·ÚΈÙÈÎÒÓ Ô˘- ªôáõåòÜ ºÝòòöóè ÛÈÒÓ Î·È Û ·ÛıÂÓ›˜ ÌÀ

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