nach oben

Current Rheumatology Reports

Erschienen in:

01.09.2013 | RHEUMATOID ARTHRITIS (LW MORELAND, SECTION EDITOR)

Treg Cells in Rheumatoid Arthritis: An Update

verfasst von: Faye A. H. Cooles, John D. Isaacs, Amy E. Anderson

Erschienen in: Current Rheumatology Reports | Ausgabe 9/2013

Einloggen, um Zugang zu erhalten

Abstract

Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease arising from a breakdown in immunological self-tolerance, which leads to aberrant immune responses to autoantigens. Regulatory CD4⁺ T-cells (Tregs) underpin one of the key mechanisms of self-tolerance and are a major focus of study in RA and other autoimmune diseases. In order to design new and improved therapies to reinstate self-tolerance, and perhaps cure disease, we need to understand the complex mechanism of action of Tregs. This review addresses recent findings in the field of Tregs in RA, with particular focus on identification of potential defects in Treg-mediated self-tolerance mechanisms present in RA patients, as well as how Tregs interact with other cells in the inflamed joints. As antigen-specific Tregs are a potential route for the reinstatement of immune tolerance, we also discuss new strategies currently being investigated which expand or induce de novo generation of Tregs.

Sakaguchi S, Sakaguchi N, Asano M, et al. Immunologic self-tolerance maintained by activated T cells expressing IL-2 receptor alpha-chains (CD25). Breakdown of a single mechanism of self-tolerance causes various autoimmune diseases. J Immunol. 1995;155(3):1151–64.PubMed

Hori S, Nomura T, Sakaguchi S. Control of regulatory T cell development by the transcription factor Foxp3. Science. 2003;299(5609):1057–61.PubMedCrossRef

Bilate AM, Lafaille JJ. Induced CD4 + Foxp3+ regulatory T cells in immune tolerance. Annu Rev Immunol. 2012;30:733–58.PubMedCrossRef

Thornton AM, Korty PE, Tran DQ, et al. Expression of Helios, an Ikaros transcription factor family member, differentiates thymic-derived from peripherally induced Foxp3+ T regulatory cells. J Immunol. 2010;184(7):3433–41.PubMedCrossRef

van Amelsfort JM, Jacobs KM, Bijlsma JW, et al. CD4(+)CD25(+) regulatory T cells in rheumatoid arthritis: differences in the presence, phenotype, and function between peripheral blood and synovial fluid. Arthritis Rheum. 2004;50(9):2775–85.PubMedCrossRef

Liu MF, Wang CR, Fung LL, et al. The presence of cytokine-suppressive CD4 + CD25+ T cells in the peripheral blood and synovial fluid of patients with rheumatoid arthritis. Scand J Immunol. 2005;62(3):312–7.PubMedCrossRef

Mottonen M, Heikkinen J, Mustonen L, et al. CD4+ CD25+ T cells with the phenotypic and functional characteristics of regulatory T cells are enriched in the synovial fluid of patients with rheumatoid arthritis. Clin Exp Immunol. 2005;140(2):360–7.PubMedCrossRef

Ehrenstein MR, Evans JG, Singh A, et al. Compromised function of regulatory T cells in rheumatoid arthritis and reversal by anti-TNFalpha therapy. J Exp Med. 2004;200(3):277–85.PubMedCrossRef

Lawson CA, Brown AK, Bejarano V, et al. Early rheumatoid arthritis is associated with a deficit in the CD4 + CD25high regulatory T cell population in peripheral blood. Rheumatology (Oxford). 2006;45(10):1210–7.CrossRef

10.

Xiao H, Wang S, Miao R, Kan W. TRAIL is associated with impaired regulation of CD4 + CD25- T cells by regulatory T cells in patients with rheumatoid arthritis. J Clin Immunol. 2011;31(6):1112–9.PubMedCrossRef

11.

van Amelsfort JM, van Roon JA, Noordegraaf M, et al. Proinflammatory mediator-induced reversal of CD4+, CD25+ regulatory T cell-mediated suppression in rheumatoid arthritis. Arthritis Rheum. 2007;56(3):732–42.PubMedCrossRef

12.

Nadkarni S, Mauri C, Ehrenstein MR. Anti-TNF-alpha therapy induces a distinct regulatory T cell population in patients with rheumatoid arthritis via TGF-beta. J Exp Med. 2007;204(1):33–9.PubMedCrossRef

13.

Flores-Borja F, Jury EC, Mauri C, Ehrenstein MR. Defects in CTLA-4 are associated with abnormal regulatory T cell function in rheumatoid arthritis. Proc Natl Acad Sci U S A. 2008;105(49):19396–401.PubMedCrossRef

14.

Biton J, Semerano L, Delavallee L, et al. Interplay between TNF and regulatory T cells in a TNF-driven murine model of arthritis. J Immunol. 2011;186(7):3899–910.PubMedCrossRef

15.

Valencia X, Stephens G, Goldbach-Mansky R, et al. TNF downmodulates the function of human CD4 + CD25hi T-regulatory cells. Blood. 2006;108(1):253–61.PubMedCrossRef

16.

Nagar M, Jacob-Hirsch J, Vernitsky H, et al. TNF activates a NF-kappaB-regulated cellular program in human CD45RA- regulatory T cells that modulates their suppressive function. J Immunol. 2010;184(7):3570–81.PubMedCrossRef

17.

•• Zanin-Zhorov A, Ding Y, Kumari S, et al. Protein kinase C-theta mediates negative feedback on regulatory T cell function. Science. 2010;328(5976):372–6. This paper provides convincing explanations as to why Tregs may be defective in RA.PubMedCrossRef

18.

•• Zanin-Zhorov A, Lin J, Scher J, et al. Scaffold protein Disc large homolog 1 is required for T-cell receptor-induced activation of regulatory T-cell function. Proc Natl Acad Sci U S A. 2012;109(5):1625–30. This paper provides convincing explanations as to why Tregs may be defective in RA.PubMedCrossRef

19.

Chistiakov DA, Chistiakov AP. Is FCRL3 a new general autoimmunity gene? Hum Immunol. 2007;68(5):375–83.PubMedCrossRef

20.

Swainson LA, Mold JE, Bajpai UD, McCune JM. Expression of the autoimmune susceptibility gene FcRL3 on human regulatory T cells is associated with dysfunction and high levels of programmed cell death-1. J Immunol. 2010;184(7):3639–47.PubMedCrossRef

21.

Nagata S, Ise T, Pastan I. Fc receptor-like 3 protein expressed on IL-2 nonresponsive subset of human regulatory T cells. J Immunol. 2009;182(12):7518–26.PubMedCrossRef

22.

Haufe S, Haug M, Schepp C, et al. Impaired suppression of synovial fluid CD4 + CD25- T cells from patients with juvenile idiopathic arthritis by CD4 + CD25+ Treg cells. Arthritis Rheum. 2011;63(10):3153–62.PubMedCrossRef

23.

Wehrens EJ, Mijnheer G, Duurland CL, et al. Functional human regulatory T cells fail to control autoimmune inflammation due to PKB/c-akt hyperactivation in effector cells. Blood. 2011;118(13):3538–48.PubMedCrossRef

24.

Maddur MS, Miossec P, Kaveri SV, Bayry J. Th17 cells: biology, pathogenesis of autoimmune and inflammatory diseases, and therapeutic strategies. Am J Pathol. 2012;181(1):8–18.PubMedCrossRef

25.

Koenen HJ, Smeets RL, Vink PM, et al. Human CD25highFoxp3pos regulatory T cells differentiate into IL-17-producing cells. Blood. 2008;112(6):2340–52.PubMedCrossRef

26.

Voo KS, Wang YH, Santori FR, et al. Identification of IL-17-producing FOXP3+ regulatory T cells in humans. Proc Natl Acad Sci U S A. 2009;106(12):4793–8.PubMedCrossRef

27.

Deknuydt F, Bioley G, Valmori D, Ayyoub M. IL-1beta and IL-2 convert human Treg into T(H)17 cells. Clin Immunol. 2009;131(2):298–307.PubMedCrossRef

28.

Beriou G, Costantino CM, Ashley CW, et al. IL-17-producing human peripheral regulatory T cells retain suppressive function. Blood. 2009;113(18):4240–9.PubMedCrossRef

29.

Valmori D, Raffin C, Raimbaud I, Ayyoub M. Human RORgammat + TH17 cells preferentially differentiate from naive FOXP3 + Treg in the presence of lineage-specific polarizing factors. Proc Natl Acad Sci U S A. 2010;107(45):19402–7.PubMedCrossRef

30.

Xu L, Kitani A, Fuss I, Strober W. Cutting edge: regulatory T cells induce CD4 + CD25-Foxp3- T cells or are self-induced to become Th17 cells in the absence of exogenous TGF-beta. J Immunol. 2007;178(11):6725–9.PubMed

31.

Yang XO, Nurieva R, Martinez GJ, et al. Molecular antagonism and plasticity of regulatory and inflammatory T cell programs. Immunity. 2008;29(1):44–56.PubMedCrossRef

32.

Wang W, Shao S, Jiao Z, et al. The Th17/Treg imbalance and cytokine environment in peripheral blood of patients with rheumatoid arthritis. Rheumatol Int. 2012;32(4):887–93.PubMedCrossRef

33.

Niu Q, Cai B, Huang ZC, et al. Disturbed Th17/Treg balance in patients with rheumatoid arthritis. Rheumatol Int. 2012;32(9):2731–6.PubMedCrossRef

34.

Annunziato F, Cosmi L, Santarlasci V, et al. Phenotypic and functional features of human Th17 cells. J Exp Med. 2007;204(8):1849–61.PubMedCrossRef

35.

• McGovern JL, Nguyen DX, Notley CA, et al. Th17 cells are restrained by Treg cells via the inhibition of interleukin-6 in patients with rheumatoid arthritis responding to anti-tumor necrosis factor antibody therapy. Arthritis Rheum. 2012;64(10):3129–38. This paper provides evidence that anti-TNF therapy can confer a capacity for Tregs to suppress Th17 cells.PubMedCrossRef

36.

E XQ, Meng HX, Cao Y, et al. Distribution of regulatory T cells and interaction with dendritic cells in the synovium of rheumatoid arthritis. Scand J Rheumatol. 2012;41(6):413–20.PubMedCrossRef

37.

Darrasse-Jeze G, Deroubaix S, Mouquet H, et al. Feedback control of regulatory T cell homeostasis by dendritic cells in vivo. J Exp Med. 2009;206(9):1853–62.PubMedCrossRef

38.

Svensson MN, Andersson SE, Erlandsson MC, et al. Fms-like tyrosine kinase 3 ligand controls formation of regulatory T cells in autoimmune arthritis. PLoS One. 2013;8(1):e54884.PubMedCrossRef

39.

Dehlin M, Bokarewa M, Rottapel R, et al. Intra-articular fms-like tyrosine kinase 3 ligand expression is a driving force in induction and progression of arthritis. PLoS One. 2008;3(11):e3633.PubMedCrossRef

40.

Pasare C, Medzhitov R. Toll pathway-dependent blockade of CD4 + CD25+ T cell-mediated suppression by dendritic cells. Science. 2003;299(5609):1033–6.PubMedCrossRef

41.

Walter GJ, Evans HG, Menon B, et al. Interaction with activated monocytes enhances cytokine expression and suppressive activity of human CD4 + CD45ro + CD25 + CD127(low) regulatory T cells. Arthritis Rheum. 2013;65(3):627–38.PubMedCrossRef

42.

Miranda-Carus ME, Balsa A, Benito-Miguel M, et al. IL-15 and the initiation of cell contact-dependent synovial fibroblast-T lymphocyte cross-talk in rheumatoid arthritis: effect of methotrexate. J Immunol. 2004;173(2):1463–76.PubMed

43.

Benito-Miguel M, Garcia-Carmona Y, Balsa A, et al. A dual action of rheumatoid arthritis synovial fibroblast IL-15 expression on the equilibrium between CD4 + CD25+ regulatory T cells and CD4 + CD25- responder T cells. J Immunol. 2009;183(12):8268–79.PubMedCrossRef

44.

Kim SH, Youn J. Rheumatoid Fibroblast-like synoviocytes downregulate Foxp3 expression by regulatory t cells via GITRL/GITR interaction. Immune Netw. 2012;12(5):217–21.PubMedCrossRef

45.

Zaiss MM, Axmann R, Zwerina J, et al. Treg cells suppress osteoclast formation: a new link between the immune system and bone. Arthritis Rheum. 2007;56(12):4104–12.PubMedCrossRef

46.

Kelchtermans H, Geboes L, Mitera T, et al. Activated CD4 + CD25+ regulatory T cells inhibit osteoclastogenesis and collagen-induced arthritis. Ann Rheum Dis. 2009;68(5):744–50.PubMedCrossRef

47.

Zaiss MM, Frey B, Hess A, et al. Regulatory T cells protect from local and systemic bone destruction in arthritis. J Immunol. 2010;184(12):7238–46.PubMedCrossRef

48.

Kong N, Lan Q, Chen M, et al. Induced T regulatory cells suppress osteoclastogenesis and bone erosion in collagen-induced arthritis better than natural T regulatory cells. Ann Rheum Dis. 2012;71(9):1567–72.PubMedCrossRef

49.

Zheng SG, Wang J, Horwitz DA. Cutting edge: Foxp3 + CD4 + CD25+ regulatory T cells induced by IL-2 and TGF-beta are resistant to Th17 conversion by IL-6. J Immunol. 2008;180(11):7112–6.PubMed

50.

Xinqiang S, Fei L, Nan L, et al. Therapeutic efficacy of experimental rheumatoid arthritis with low-dose methotrexate by increasing partially CD4 + CD25+ Treg cells and inducing Th1 to Th2 shift in both cells and cytokines. Biomed Pharmacother. 2010;64(7):463–71.PubMedCrossRef

51.

Oh JS, Kim YG, Lee SG, et al. The effect of various disease-modifying anti-rheumatic drugs on the suppressive function of CD4(+)CD25(+) regulatory T cells. Rheumatol Int. 2013;33(2):381–8.PubMedCrossRef

52.

Wang TY, Li J, Li CY, et al. Leflunomide induces immunosuppression in collagen-induced arthritis rats by upregulating CD4 + CD25+ regulatory T cells. Can J Physiol Pharmacol. 2010;88(1):45–53.PubMedCrossRef

53.

Blache C, Lequerre T, Roucheux A, et al. Number and phenotype of rheumatoid arthritis patients’ CD4 + CD25hi regulatory T cells are not affected by adalimumab or etanercept. Rheumatology (Oxford). 2011;50(10):1814–22.CrossRef

54.

Aravena O, Pesce B, Soto L, et al. Anti-TNF therapy in patients with rheumatoid arthritis decreases Th1 and Th17 cell populations and expands IFN-gamma-producing NK cell and regulatory T cell subsets. Immunobiology. 2011;216(12):1256–63.PubMedCrossRef

55.

• Pesce B, Soto L, Sabugo F, et al. Effect of interleukin-6 receptor blockade on the balance between regulatory T cells and T helper type 17 cells in rheumatoid arthritis patients. Clin Exp Immunol. 2013;171(3):237–42. This paper provides evidence in an RA population of the potential therapeutic effect of IL-6 inhibition on Tregs.PubMedCrossRef

56.

• Samson M, Audia S, Janikashvili N, et al. Brief report: inhibition of interleukin-6 function corrects Th17/Treg cell imbalance in patients with rheumatoid arthritis. Arthritis Rheum. 2012;64(8):2499–503. This paper provides evidence in an RA population of the potential therapeutic effect of IL-6 inhibition on Tregs.PubMedCrossRef

57.

Yoshida H, Hashizume M, Suzuki M, Mihara M. Anti-IL-6 receptor antibody suppressed T cell activation by inhibiting IL-2 production and inducing regulatory T cells. Eur J Pharmacol. 2010;634(1–3):178–83.PubMedCrossRef

58.

Alvarez-Quiroga C, Abud-Mendoza C, Doniz-Padilla L, et al. CTLA-4-Ig therapy diminishes the frequency but enhances the function of Treg cells in patients with rheumatoid arthritis. J Clin Immunol. 2011;31(4):588–95.PubMedCrossRef

59.

Ko HJ, Cho ML, Lee SY, et al. CTLA4-Ig modifies dendritic cells from mice with collagen-induced arthritis to increase the CD4 + CD25 + Foxp3+ regulatory T cell population. J Autoimmun. 2010;34(2):111–20.PubMedCrossRef

60.

Hamel KM, Cao Y, Ashaye S, et al. B cell depletion enhances T regulatory cell activity essential in the suppression of arthritis. J Immunol. 2011;187(9):4900–6.PubMedCrossRef

61.

Feuchtenberger M, Muller S, Roll P, et al. Frequency of regulatory T cells is not affected by transient B cell depletion using anti-CD20 antibodies in rheumatoid arthritis. Open Rheumatol J. 2008;2:81–8.PubMedCrossRef

62.

Tang TT, Song Y, Ding YJ, et al. Atorvastatin upregulates regulatory T cells and reduces clinical disease activity in patients with rheumatoid arthritis. J Lipid Res. 2011;52(5):1023–32.PubMedCrossRef

63.

Cao T, Wenzel SE, Faubion WA, et al. Enhanced suppressive function of regulatory T cells from patients with immune-mediated diseases following successful ex vivo expansion. Clin Immunol. 2010;136(3):329–37.PubMedCrossRef

64.

Ellis GI, Reneer MC, Velez-Ortega AC, et al. Generation of induced regulatory T cells from primary human naive and memory T cells. J Vis Exp. 2012;(62).

65.

Flores-Borja F, Bosma A, Ng D, et al. CD19 + CD24hiCD38hi B cells maintain regulatory T cells while limiting TH1 and TH17 differentiation. Sci Transl Med. 2013;5(173):173ra23.PubMedCrossRef

66.

Park MJ, Park HS, Cho ML, et al. Transforming growth factor beta-transduced mesenchymal stem cells ameliorate experimental autoimmune arthritis through reciprocal regulation of Treg/Th17 cells and osteoclastogenesis. Arthritis Rheum. 2011;63(6):1668–80.PubMedCrossRef

67.

• Gonzalez-Rey E, Gonzalez MA, Varela N, et al. Human adipose-derived mesenchymal stem cells reduce inflammatory and T cell responses and induce regulatory T cells in vitro in rheumatoid arthritis. Ann Rheum Dis. 2010;69(1):241–8. Using an in vitro model, this paper shows how RA T-cell pathogenic responses can be modulated and Treg populations expanded.PubMedCrossRef

68.

Carranza F, Falcon CR, Nunez N, et al. Helminth antigens enable CpG-activated dendritic cells to inhibit the symptoms of collagen-induced arthritis through Foxp3+ regulatory T cells. PLoS One. 2012;7(7):e40356.PubMedCrossRef

69.

Kleijwegt FS, Laban S, Duinkerken G, et al. Critical role for TNF in the induction of human antigen-specific regulatory T cells by tolerogenic dendritic cells. J Immunol. 2010;185(3):1412–8.PubMedCrossRef

70.

Haque R, Lei F, Xiong X, et al. FoxP3 and Bcl-xL cooperatively promote regulatory T cell persistence and prevention of arthritis development. Arthritis Res Ther. 2010;12(2):R66.PubMedCrossRef

71.

Wright GP, Notley CA, Xue SA, et al. Adoptive therapy with redirected primary regulatory T cells results in antigen-specific suppression of arthritis. Proc Natl Acad Sci U S A. 2009;106(45):19078–83.PubMedCrossRef

72.

Furuzawa-Carballeda J, Macip-Rodriguez P, Galindo-Feria AS, et al. Polymerized-type I collagen induces upregulation of Foxp3-expressing CD4 regulatory T cells and downregulation of IL-17-producing CD4(+) T cells (Th17) cells in collagen-induced arthritis. Clin Dev Immunol. 2012;2012:618608.PubMedCrossRef

73.

Sun J, Li R, Guo J, et al. Superior molecularly altered influenza virus hemagglutinin peptide 308–317 inhibits collagen-induced arthritis by inducing CD4+ Treg cell expansion. Arthritis Rheum. 2012;64(7):2158–68.PubMedCrossRef

74.

Dominguez Mdel C, Lorenzo N, Barbera A, et al. An altered peptide ligand corresponding to a novel epitope from heat-shock protein 60 induces regulatory T cells and suppresses pathogenic response in an animal model of adjuvant-induced arthritis. Autoimmunity. 2011;44(6):471–82.PubMedCrossRef

75.

Chen G, Hao J, Xi Y, et al. The therapeutic effect of vasoactive intestinal peptide on experimental arthritis is associated with CD4 + CD25+ T regulatory cells. Scand J Immunol. 2008;68(6):572–8.PubMedCrossRef

76.

Deng S, Xi Y, Wang H, et al. Regulatory effect of vasoactive intestinal peptide on the balance of Treg and Th17 in collagen-induced arthritis. Cell Immunol. 2010;265(2):105–10.PubMedCrossRef

77.

Srivastava RK, Tomar GB, Barhanpurkar AP, et al. IL-3 attenuates collagen-induced arthritis by modulating the development of Foxp3+ regulatory T cells. J Immunol. 2011;186(4):2262–72.PubMedCrossRef

78.

Arce F, Breckpot K, Stephenson H, et al. Selective ERK activation differentiates mouse and human tolerogenic dendritic cells, expands antigen-specific regulatory T cells, and suppresses experimental inflammatory arthritis. Arthritis Rheum. 2011;63(1):84–95.PubMedCrossRef

79.

Solt LA, Kumar N, He Y, et al. Identification of a selective RORgamma ligand that suppresses T(H)17 cells and stimulates T regulatory cells. ACS Chem Biol. 2012;7(9):1515–9.PubMedCrossRef

80.

Duarte J, Agua-Doce A, Oliveira VG, et al. Modulation of IL-17 and Foxp3 expression in the prevention of autoimmune arthritis in mice. PLoS One. 2010;5(5):e10558.PubMedCrossRef

81.

Notley CA, McCann FE, Inglis JJ, Williams RO. ANTI-CD3 therapy expands the numbers of CD4+ and CD8+ Treg cells and induces sustained amelioration of collagen-induced arthritis. Arthritis Rheum. 2010;62(1):171–8.PubMedCrossRef

82.

Capini C, Jaturanpinyo M, Chang HI, et al. Antigen-specific suppression of inflammatory arthritis using liposomes. J Immunol. 2009;182(6):3556–65.PubMedCrossRef

83.

Weng L, Williams RO, Vieira PL, et al. The therapeutic activity of low-dose irradiation on experimental arthritis depends on the induction of endogenous regulatory T cell activity. Ann Rheum Dis. 2010;69(8):1519–26.PubMedCrossRef

84.

Saouaf SJ, Li B, Zhang G, et al. Deacetylase inhibition increases regulatory T cell function and decreases incidence and severity of collagen-induced arthritis. Exp Mol Pathol. 2009;87(2):99–104.PubMedCrossRef

85.

Huang L, Lemos HP, Li L, et al. Engineering DNA nanoparticles as immunomodulatory reagents that activate regulatory T cells. J Immunol. 2012;188(10):4913–20.PubMedCrossRef

Titel: Treg Cells in Rheumatoid Arthritis: An Update
verfasst von: Faye A. H. Cooles
John D. Isaacs
Amy E. Anderson
Publikationsdatum: 01.09.2013
Verlag: Springer US
Erschienen in: Current Rheumatology Reports / Ausgabe 9/2013
Print ISSN: 1523-3774
Elektronische ISSN: 1534-6307
DOI: https://doi.org/10.1007/s11926-013-0352-0

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2013

Top 10 Developments in Lupus Nephritis

Cardiovascular Risk in the Rheumatic Disease Patient Undergoing Orthopedic Surgery

Interstitial Lung Disease in Inflammatory Myopathies: Clinical Phenotypes and Prognosis

2013 Update: Hopkins Lupus Cohort

Genetics and Epigenetics of Systemic Lupus Erythematosus