Die Pathogenese der Großgefäßvaskulitiden

Zusammenfassung

Vaskulitiden der großen Gefäße, wie die Riesenzellarteriitis (RZA) und die Takayasu-Arteriitis sind durch zelluläre Infiltrate in vaskulären Läsionen und dem Fehlen von Autoantikörpern gekennzeichnet. Bei der RZA wird vermutet, dass die durch Bakterien und/oder Viren ausgelöste Reifung von dendritischen Zellen eine Störung der Immuntoleranz verursacht. In Folge werden CD4+-T-Zellen und Makrophagen rekrutiert, wodurch es zu einer Zerstörung glatter Muskelzellen und der Membrana elastica interna kommt. Die nachfolgenden Reparationsprozesse mit Intimahyperplasie führen zu einem zunehmenden Lumenverschluss der betroffenen Gefäße. Im Unterschied zur RZA sind bei der Takayasu-Arteriitis CD8+-T-Zellen die dominierende Zellpopulation. Neben der antigenvermittelten Aktivierung werden diese Zellen auch antigenunabhängig über natürliche Killer-Zell-Rezeptoren stimuliert und verursachen durch Sekretion von Perforin direkt eine Schädigung der Gefäßwand.

Summary

Large vessel vasculitides including giant cell arteritis (GCA) and Takayasu arteritis are characterised by cellular infiltrates in the vessel wall and the absence of autoantibodies. Infectious agents are considered to cause maturation of vascular dendritic cells leading to the breakdown of immune tolerance. Consequently, CD4+T-cells and macrophages are recruited to the vascular lesion leading to the destruction of smooth muscle cells and the internal elastic lamina. In response to the injury, the artery generates intimal hyperplasia leading to luminal occlusion and subsequent tissue ischemia. Inflammatory lesions of patients with Takayasu arteritis are dominated by CD8+ T-cell infiltrates. These T-cells are activated by antigen dependent and independent stimuli and they directly contribute to vessel wall damage by the secretion of perforin.

Schlüsselwörter

Vaskulitis - Arteriitis temporalis - Polymyalgia rheumatica

Keywords

Vasculitis - temporal arteritis - polymyalgia rheumatica

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