nefrНефрологияNephrology (Saint-Petersburg)1561-62742541-9439Pavlov First Saint-Petersburg State Medical University10.36485/1561-6274-2020-24-5-9-17nefr-1878Research ArticleОБЗОРЫ И ЛЕКЦИИREVIEWS AND LECTURESФакторы иммунной защиты в патогенезе инфекций мочевыводящих путей (обзор литературы)Factors of immune protection in the pathogenesis of urinary infections (literature review)https://orcid.org/0000-0002-5754-4418КрутиковЕ. С.KrutikovE. S.

Проф. Крутиков Евгений Сергеевич, д-р мед. наук

Кафедра пропедевтики внутренней медицины

295006, Республика Крым, г. Симферополь, бул. Ле­нина, д. 5/7. Тел.: (3652)554-911

Prof. Evgeniy S. Krutikov, MD, PhD, DMedSci

Department of Propedeutics of Internal Medicine

Affiliations: 295006, Russia, Crimea, Simferopol, blvd. Lenin, 5/7

 

nephrostar@yandex.ruhttps://orcid.org/0000-0002-1772-6399ЖитоваВ. А.ZhitovaV. A.

Житова Виктория Андреевна

Кафедра пропедевтики внутренней медицины

297501, Республика Крым, Симферопольский р-н, пгт Молодежное, ул. Вишневая, д. 3. Тел.: (978)835-00-18 

Viktoriya A. Zhitova

Department of Propedeutics of Internal Medicine

Affiliations: 297501, Russia, Crimea, Simferopol district, Molo- dezhnoye, st. Vishnevaya 3. Phone: (978)835-00-18

viki.jitowa@yandex.ruМедицинская академия имени С.И. Георгиевского, Крымский федеральный университет имени В.И. ВернадскогоРоссияMedical Academy named after S.l. Georgievsky, Crimean Federal University named after V.l. VernadskyRussian Federation202031082020245917Copyright © Крутиков Е.С., Житова В.А., 20202020Крутиков Е.С., Житова В.А.Krutikov E.S., Zhitova V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nephrolog.ru/jour/article/view/1878

За последние годы представления о патогенезе инфекций мочевыводящих путей значительно изменились. Открыты различные факторы патогенности микроорганизмов и новые механизмы защиты от них. Значительную часть патоге­нов инактивирует первая линия защиты - врожденный иммунитет, куда относятся эпителиальные барьеры (слизи­стые), клеточные (фагоциты, дендритные клетки, NK-кпетки) и гуморальные (хемокины, цитокины, комплемент) ком­поненты, а также антимикробные протеины. Второй и более специфической линией защиты является приобретенный (адаптивный) иммунитет - гуморальный (В-кпетки, антитела) и клеточный (Т-клетки). Но важную роль в иммунном ответе играют эпителиоциты, которые взаимодействуют с компонентами как врожденного иммунитета, так и при­обретенного. Антимикробные протеины являются одними из самых древних и примитивных компонентов иммунной системы и очень широко встречаются в природе. Описано более 800 антимикробных протеинов, из которых не менее 100 найдены в организме человека. Механизм работы данных белков заключается, главным образом, в нарушении целостности бактериальной мембраны. Но некоторые белки могут ингибировать синтез белка и/или ДНК. Самый рас­пространенный белок в моче - уромодулин (белок Тамма-Хорсфалла), синтезируемый в толстом восходящем отделе петли Генле. Уромодулин не обладает прямой антимикробной активностью, но он задействован в патогенезе многих воспалительных заболеваний почек. Кроме того, уромодулин, действуя через TLR-4-сигнальный путь, способствует созреванию дендритных клеток, тем самым дополнительно активирует врожденный и приобретенный иммунитет. В настоящее время активно изучается роль антимикробных протеинов и дендритных клеток в патогенезе инфекционно­го процесса, что может иметь высокую практическую значимость. Таким образом, развитие инфекций мочевыводя­щих путей является процессом конкурирующего взаимодействия уропатогена и макроорганизма. Лечение данных за­болеваний (особенно хронических) не должно ограничиваться применением антибактериальных препаратов. Важным компонентом эрадикации возбудителя является повышение активности собственных защитных механизмов.

In recent years, ideas about the pathogenesis of urinary tract infections have been changed significantly. Various pathogenetic factors of microorganisms and new defense mechanisms against them have been discovered. A significant part of pathogens is inactivated by the first line of defense - innate immunity which includes epithelial barriers (mucous membranes), cellular (phagocytes, dendritic cells, NK-cells) and humoral (chemokines, cytokines, complement) components, as well as antimi­crobial proteins). The second and more specific line of defense is the acquired (adaptive) immune system - humoral (B-cells, antibodies) immunity and cellular (T-cells) immunity. However, epithelial cells play an important role in the immune response. These cells interact with the components of both innate immunity and acquired one. Antimicrobial proteins are one of the most ancient and primitive components of the immune system and they are very widely spread in nature. More than 800 antimicro­bial proteins have been described and more than 100 of them have been found in the human body. The mechanism of these proteins is mainly connected with the violation of the bacterial membrane integrity. Nevertheless, some proteins can inhibit protein and/or DNA synthesis. The most common protein in the urine is uromodulin (Tamm-Horsfall protein), synthesized in the thick ascending section of the Henle loop. Uromodulin does not have direct antimicrobial activity, but it is involved in the pathogenesis of many inflammatory kidney diseases. In addition, uromodulin acting through the TLR4 signaling pathway pro­motes the maturation of dendritic cells, thereby further activating innate and acquired immunity. Currently, the role of antimi­crobial proteins and dendritic cells in the pathogenesis of the infectious process is being actively studied. It will probably have a significant practical value. Thus, the development of urinary tract infections is the process of competing for the interaction of the uropathogenic and the macroorganism. The treatment of these diseases (especially chronic) should not be limited to the use of antibacterial drugs. An important component of the pathogen eradication is to increase the activity of its own protective mechanisms.

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The authors declare that there are no conflicts of interest present.