INTESTINE Vol.13 No.1(7)

特集名 Intestineの時代到来 -- 今,解決しなければならないIBDの諸問題
題名 VII. 潰瘍性大腸炎に対する免疫統御療法の進歩
発刊年月 2009年 01月
著者 緒方 晴彦 慶應義塾大学病院内視鏡センター
著者 日比 紀文 慶應義塾大学病院医学部消化器内科
【 要旨 】 難治性潰瘍性大腸炎に対する免疫統御療法には,寛解導入療法としてcyclospotin Aやtacrolimus,寛解維持療法としてのazathloprine / 6-mercaptopurineを用いた免疫調節剤がある.また最近では抗TNF-alpha剤を中心とした生物学的製剤による分子標的治療が登場した.さらに,わが国においては白血球除去療法が加わる,これら各種治療法を駆使することにより多くの症例の寛解導入・維持が可能になった.
Theme Now is the time for the "Intestine" -- updates and problems raised to be solved in IBD
Title Advances in immunoregulatory therapies of ulcerative colitis
Author Haruhiko Ogata Division of Endoscopy, School of Medicine, Keio University
Author Toshifumi Hibi Department of Internal Medicine, School of Medicine, Keio University
[ Summary ] The first medications for ulcerative colitis (UC) were 5-aminosalicylate, and corticosteroids. Use of those medications began more than 50 years ago, and were followed by immunosuppressive therapies such as cyclosporin A / tacrolimus for induction therapy and azathioprine / 6-mercaptopurine for maintenance therapy. Recent advances in molecular biology have provided new therapeutic strategies for refractory UC, using biological products for molecular target therapy indicated by anti-TNF-alpha antibodies. Furthermore, in Japan, leucocytapheresis has emerged as an immunoregulatory therapeutic option for refractory cases. By using the therapeutics, many of the patients have been successfully induced or maintained remission. There have been more trials and approaches based on pathophysiological evidence to develop novel therapeutic strategies for UC. Although some of these strategies still require further confirmatory studies, these therapies will provide new insights into cell-based and gene-based treatment for UC in the near future.