Multipl skleroz ve otoimmünite üzerine cinsiyet faktörünün etkisi

Yıl 2016, Cilt: 2 Sayı: 2, 158 - 164, 01.06.2016

Bilge Piri Çınar , Halil Güllüoğlu Yüksel Güven Yorgun

Öz

Otoimmün bir hastalık olan multipl sklerozun (MS) etyopatogenezi tam aydınlatılamamış olsa da T ve B lenfositlerin, doğal öldürücü (NK) hücrelerin,makrofajların ve sitokinlerin atak-remisyon dönemlerinde ve progresyonda önemli rolü olduğu bilinmektedir. Kadınlarda otoimmün hastalık gelişmeriski erkeklere oranla daha fazladır. Multipl sklerozda yardımcı T 1 hücre (Th1) aktivitesi ön plandadır ve kadınlarda Th1 hücre yanıtı erkeklerden dahabaskındır. Bu durum MS gibi diğer otoimmün hastalıkların kadınlarda neden daha sık olduğunu kısmen açıklamaktadır. Düşük östrojen düzeyleri Th1tipi proenflamatuar yanıtı artırırken, yüksek östrojen ve progesteron düzeyleri Th2 tipi yanıtı artırır. Kadınlarda menstrüasyon döneminden önce MSataklarında alevlenme olduğu ve östrojen ve progesteron düzeylerinin çok düşük olduğu saptanmıştır. Progesteron ve östrojenin çok yüksek olduğugebeliğin son trimesterinde atak oranı anlamlı olarak azalırken, doğum sonrası dönemde atak sıklığı ve şiddeti artmaktadır. Progestreron reaktifgliozisi düşürür, remiyelinizasyonu artırır ve mikroglial enflamatuar aktivasyonu azaltır. Östrojen proenflamatuar sinyalleri azaltmaktadır. Kadınlarda,tekrarlayan ve düzelen MS tipi daha sık görülmekle birlikte, erkeklerde daha ciddi düzeyde disabilite ve daha kısa sürede progresif forma geçişsaptanmaktadır. Manyetik rezonans görüntülemelerde erkeklerde daha az enflamatuvar aktivite gözlenirken, aksonal kayıp ve nörodejenerasyonungöstergesi olan kara delik görüntüsüne daha sık rastlanmaktadır. Bu klinik ve radyolojik farklılıklar, seks hormonlarının MS patolojisi üzerine olan etkisiolduğu düşüncesini desteklemektedir.

Anahtar Kelimeler

Autoimmunity, gender, multiple sclerosis

Kaynakça

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