Рак и туберкулез легких: обзор ключевых особенностей молекулярных механизмов сочетанной патологии

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Аннотация

Рак легкого и туберкулез органов дыхания являются значимыми проблемами для мирового здравоохранения, занимая лидирующие позиции по заболеваемости и смертности как в развитых, так и в развивающихся странах. Клинико-экспериментальные исследования позволили подробно изучить механизмы развития патологических процессов, лежащих в основе обоих заболеваний, влияние болезней на макроорганизм, различные варианты лекарственной терапии. По данным популяционных исследований, взаимовлияние двух процессов не вызывает никаких сомнений – в равной степени как активный туберкулез и посттуберкулезные изменения являлись факторами риска возникновения неопластического процесса, так и злокачественная опухоль создавала благоприятные условия и предпосылки к развитию микобактериальной инфекции. Однако вопросы механизмов взаимодействия этих двух заболеваний при их сочетании остаются открытыми и недостаточно изученными. В представленном обзоре литературы подробно описаны варианты сочетания рака легкого и туберкулеза легких, патофизиологические основы взаимовлияния инфекционного и неопластического процессов: модуляция иммунного ответа Mycobacterium tuberculosis и опухоли легкого; сигнальные пути онкогенеза, активируемые туберкулезной инфекцией; механизмы эпителиально-мезенхимального перехода в посттуберкулезных рубцовых изменениях и его роль в формировании так называемой “скарциномы”; взаимосвязь опухоль-опосредованной и туберкулез-ассоциированной иммуносупрессии; роль сигнального пути PD-1:PD-L и влияние современных видов противоопухолевой иммунотерапии на течение данных патологических процессов. В заключительной части обзора представлены собственные данные экспериментальных исследований сочетания рака и туберкулеза на лабораторной модели, обозначены перспективные направления изучения данного вопроса.

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Г. М. Агафонов

ФГБУ “Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии” Минздрава России; ФГБОУ ВО “Санкт-Петербургский государственный университет”

Автор, ответственный за переписку.
Email: g.agafonov.98@gmail.com
Россия, 191036, Санкт-Петербург; 199034, Санкт-Петербург

Г. Г. Кудряшов

ФГБУ “Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии” Минздрава России

Email: g.agafonov.98@gmail.com
Россия, 191036, Санкт-Петербург

Ю. С. Крылова

ФГБУ “Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии” Минздрава России

Email: g.agafonov.98@gmail.com
Россия, 191036, Санкт-Петербург

Т. С. Зубарева

ФГБУ “Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии” Минздрава России

Email: g.agafonov.98@gmail.com
Россия, 191036, Санкт-Петербург

И. М. Кветной

ФГБУ “Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии” Минздрава России; ФГБОУ ВО “Санкт-Петербургский государственный университет”

Email: g.agafonov.98@gmail.com
Россия, 191036, Санкт-Петербург; 199034, Санкт-Петербург

П. К. Яблонский

ФГБУ “Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии” Минздрава России; ФГБОУ ВО “Санкт-Петербургский государственный университет”

Email: g.agafonov.98@gmail.com
Россия, 191036, Санкт-Петербург; 199034, Санкт-Петербург

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