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La Revue de médecine interne, v.23 suppl.4, 2002년, pp.501S - 510S
Papo, T. (Auteur correspondant.)
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AbstractPurpose.-To assess the role of endogenous interferon alpha (IFN) in auto-immune experimental models and human diseases, and toevaluate its iatrogenic potential as a therapeutic agent.Main points.-IFN is a cytokine involved in cellular immunity, that promotes both differentiation of dendritic...
RésuméPropos.-L'objectif de ce travail est l'analyse du potentiel iatrogène de l'interféron (IFN) alpha exogene, et, en amont, du rôle de l'IFN alpha endogene en pathologie auto-immune dans les modèles expérimentaux et dans les maladies humaines spontanées.Actualités et points forts.-L'IFN alpha apparaît surtout comme un promoteur de l'immunité cellulaire, en favorisant la filierelymphocytaire T de type auxiliaire TH1 ou la differentiation des cellules dendritiques. L'utilisation thérapeutique de l'IFN alpha recombinant s'accompagne d'effets latéraux auto-immuns, hautement dependants de la dose administrée et du contexte pathologique. Le spectre des manifestations auto-immunes observées sous IFN s'dtend de l'apparition isolée d'auto-anticorps chez un patient asymptomatique à la survenue d'une maladie auto-immune parfois severe, comme par exemple un lupus systdmique. La cible antigénique des auto-anticorps est varide : cellules sanguines (leucocytes, hématies, plaquettes), facteurs de la coagulation (facteur VIII, antiprothrombinase), immunoglobulines (activité rhumatoide avec ou sans cryoglobulinémie), composants intra-cellulaires (noyau, enzymes), hormones (insuline, thyroidiennes), facteur intrinséque, épiderme La pathologie la plus fréquemment induite ou favorisée par l'IFN est une thyroïdite, sous trois formes : hypothyroïdie, hyperthyroïdie ou dysthyroïdie biphasique. En fait, l'incidence reelle en est discutée ; elle apparaît faible lors de l'utilisation de l'IFN à faible dose en situation hépatologique, inférieure à 1 % dans une étude récente. La possibilité d'auto-immunité liée à la pathologie traitée avant tout traitement par IFN rend l'interprétation des phénomènes plus complexe : la forte prévalence des FAN ou des anti-DNA dans la leucémie myéloïde chronique ou les auto-anticorps anti-muscle lisse ou anti-LKM daps l'hépatite C en sont des exemples.Perspectives et projets.-L'IFN alpha est plus probablement un agent favorisant qu'un inducteur de novo de pathologie auto-immune. Son utilisation thérapeutique future comme immunomodulateur doit donc faire l'objet de protocoles ≪prudents≫
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