Reshaping neuroimmunology: diagnosis and treatment in the era of precision medicine

Giordani Rodrigues dos Passos; Tarso Adoni; Maria Fernanda Mendes; Douglas Kazutoshi Sato

doi:10.1055/s-0043-1777752

Arquivos de Neuro-Psiquiatria, Table of Contents

CC BY 4.0 · Arq Neuropsiquiatr 2023; 81(12): 1125-1133
DOI: 10.1055/s-0043-1777752

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Reshaping neuroimmunology: diagnosis and treatment in the era of precision medicine

Remodelando a neuroimunologia: diagnóstico e tratamento na era da medicina de precisão

Authors

Giordani Rodrigues dos Passos

¹Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina e Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.
Tarso Adoni

²Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
Maria Fernanda Mendes

³Santa Casa de São Paulo, Faculdade de Ciências Médicas, São Paulo SP, Brazil.
Douglas Kazutoshi Sato

¹Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina e Instituto do Cérebro do Rio Grande do Sul, Porto Alegre RS, Brazil.

Abstract

Precision medicine has revolutionized the field of neuroimmunology, with innovative approaches that characterize diseases based on their biology, deeper understanding of the factors leading to heterogeneity within the same disease, development of targeted therapies, and strategies to tailor therapies to each patient. This review explores the impact of precision medicine on various neuroimmunological conditions, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), optic neuritis, autoimmune encephalitis, and immune-mediated neuropathies. We discuss advances in disease subtyping, recognition of novel entities, promising biomarkers, and the development of more selective monoclonal antibodies and cutting-edge synthetic cell-based immunotherapies in neuroimmunological disorders. In addition, we analyze the challenges related to affordability and equity in the implementation of these emerging technologies, especially in situations with limited resources.

Resumo

A medicina de precisão está revolucionando o campo da neuroimunologia, com uma abordagem inovadora caracterizada pela classificação de doenças com base em sua biologia, compreensão mais profunda dos fatores que levam à heterogeneidade dentro da mesma doença, desenvolvimento de terapias com alvos específicos e estratégias para adaptar as terapias a cada paciente. Esta revisão explora o impacto da medicina de precisão em várias condições neuroimunológicas, incluindo esclerose múltipla (EM), distúrbio do espectro da neuromielite óptica (NMOSD), doença associada ao anticorpo anti-glicoproteína da mielina do oligodendrócito (MOGAD), neurites ópticas, encefalites autoimunes e neuropatias imunomediadas. Discutimos avanços na subclassificação de doenças, reconhecimento de novas entidades, biomarcadores promissores e desenvolvimento de anticorpos monoclonais mais seletivos e imunoterapias de ponta baseadas em células sintéticas para as condições acima. Além disso, analisamos os desafios relacionados com acessibilidade e equidade na implementação dessas tecnologias emergentes, especialmente em ambientes com recursos limitados.

Keywords

Precision Medicine - Autoimmune Diseases of the Nervous System - Multiple Sclerosis - Neuromyelitis Optica - Biomarkers - Immunomodulation - Pharmacogenetics

Palavras-chave

Medicina de Precisão - Doenças Autoimunes do Sistema Nervoso - Esclerose Múltipla - Neuromielite Óptica - Biomarcadores - Imunomodulação - Farmacogenética

Full Text

References

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