Atopik Dermatit’in Patogenezinde İmmunolojik Mekanizmalar

Yıl 2004, Cilt: 2 Sayı: 1, 6 - 14, 01.03.2004

Mübeccel Akdiş Cezmi A.akdiş

Öz

Aktive T-hücreleri ve ürünleri, psöriasis ve atopik dermatit AD gibi birçok cilt hastalığının patogenezinde önemli bir rol oynarlar. Aktivasyonu takiben, periferik kandaki T hücrelerinin derideki selektif yerleşimi ve efektör işlevleri, patogenezdeki immunolojik olaylar dizinini temsil eder. Kutanöz lenfositle ilişkili antijen CLA , bellek/efektör T hücresinin deriye migrasyonunda rol oynayan bir yerleşim reseptörüdür. CLA, farklılaşma sürecinde Th1 hücreleri üzerinde belirir ve Th2 hücreleri üzerinde de bakteriyel super antigen ve/veya IL-12 uyarısıyla indüklenebilir. Muhtemelen, deriye özgü yerle- şim, işlevsel ve fenotipik T hücre subsetleri ile sı- nırlı değildir. Bazı T hücre reseptörlerinde değişken β zinciri ekspresyonu veya IL-12Rβ ekspresyonu ile karakterize IL-12 ve/veya süperantijen yanıtı, T hücreleri üzerindeki CLA ekspresyonunu kontrol eden faktörlerdir. CLA taşıyan CD4 ve CD8 T hücreleri, AD hastalarının periferik kanındaki aktive bellek/efektör T hücre subsetlerini temsil eder. Bunlar, IgE’yi IL-13 aracılığıyla uyarırlar ve eosinofil ya- şam süresini de IL-5 aracılığıyla uzatırlar. Atopik hastalıklardaki periferik Th2 yanıtının bir mekanizması olarak, dolaşımdaki aktive bellek/efektör Th1 hücreleri selektif olarak aktivasyon ile indüklenen hücre ölümüne uğrayarak, immün yanıtı hayatta kalan Th2 hücrelerinden yana kaydırır. Atopik dermatitde, T hücreleri, dendritik hücreler ve keratinositlerden oluşan bir kemokin ağı, inflamatuvar hücrelerin deriye infiltrasyonunu kontrol eder. Aktive olan bu T hücreleri, Fas bağımlı bir yol ile keratinosit apoptozisini indükler ki bu spongiosis ve ekzematöz lezyonların oluşumunda önemli bir patogenetik faktördür.

Kaynakça

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