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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">mimmun</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинская иммунология</journal-title><trans-title-group xml:lang="en"><trans-title>Medical Immunology (Russia)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1563-0625</issn><issn pub-type="epub">2313-741X</issn><publisher><publisher-name>SPb RAACI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15789/1563-0625-2016-4-317-330</article-id><article-id custom-type="elpub" pub-id-type="custom">mimmun-1054</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS</subject></subj-group></article-categories><title-group><article-title>ДИАБЕТ-АССОЦИИРОВАННЫЙ ОСТЕОАРТРИТ – СИНТРОПИЯ?</article-title><trans-title-group xml:lang="en"><trans-title>DIABETES-ASSOCIATED OSTEOARTHRITIS: A SYNTROPY?</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Казыгашева</surname><given-names>Е. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Kazygasheva</surname><given-names>E. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>младший научный сотрудник лаборатории клинической иммунофармакологии,</p><p>630047, г. Новосибирск, ул. Ядринцевская, 14</p></bio><bio xml:lang="en"><p>Junior Research Associate, Laboratory of Clinical Immunopharmacology,</p><p>630047, Novosibirsk, Yadrintsevskaya, 14</p></bio><email xlink:type="simple">elena.kazygasheva@mail.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ширинский</surname><given-names>В. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Shirinsky</surname><given-names>V. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д.м.н., профессор, заведующий лабораторией клинической иммунофармакологии</p></bio><bio xml:lang="en"><p>PhD, MD (Medicine), Professor, Head, Laboratory of Clinical Immunopharmacology</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ширинский</surname><given-names>И. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Shirinsky</surname><given-names>I. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д.м.н., ведущий научный сотрудник лаборатории клинической иммунофармакологии</p></bio><bio xml:lang="en"><p>PhD, MD (Medicine), Leading Research Associate, Laboratory of Clinical Immunopharmacology</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБНУ «Научно-исследовательский институт фундаментальной и клинической иммунологии»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>Research Institute of Fundamental and Clinical Immunology</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2016</year></pub-date><pub-date pub-type="epub"><day>22</day><month>08</month><year>2016</year></pub-date><volume>18</volume><issue>4</issue><fpage>317</fpage><lpage>330</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Казыгашева Е.В., Ширинский В.С., Ширинский И.В., 2016</copyright-statement><copyright-year>2016</copyright-year><copyright-holder xml:lang="ru">Казыгашева Е.В., Ширинский В.С., Ширинский И.В.</copyright-holder><copyright-holder xml:lang="en">Kazygasheva E.V., Shirinsky V.S., Shirinsky I.V.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.mimmun.ru/mimmun/article/view/1054">https://www.mimmun.ru/mimmun/article/view/1054</self-uri><abstract><p>В обзоре данных литературы и материалах собственных исследований анализируются ряд предрасполагающих и патогенетических факторов в развитии распространенной коморбидной патологии – диабет-ассоциированного остеоартрита (ДАОА). Поскольку у исследователей и клиницистов пока не сложилось четкого представления о ДАОА как отдельном клиническом варианте ОА, авторам не удалось найти в литературе работ, посвященных изучению роли генетических факторов в развитии именно этого варианта болезни. Особое внимание обращено на исследования, посвященные поиску перекрестных генов – кандидатов риска развития как СД 2 типа, так и ОА: PPARγ, FTO, ADIPOQ, RAGE, которые экспрессируют белки, потенциально способные участвовать в патогенезе как ОА, так и СД. Немногочисленные данные оказались противоречивы: в некоторых работах показана ассоциация перечисленных генов с развитием диабета и остеоартрита, в других исследованиях таких связей не выявлено. Рассмотрены работы, посвященные описанию клинической характеристики ОА, ассоциированного с СД. Показана патогенетическая роль хронической гипергликемии, инсулино-резистентности, конечных продуктов гликирования (advanced glycation age products, AGE) в развитии ОА и осложнений СД. Обсуждаются механизмы развития воспаления, гуморального и клеточного иммунного ответа к компонентам хряща, участие этих механизмов в прогрессии ОА. Подчеркивается сходство механизмов вялотекущего воспаления у больных ОА и сосудистых осложнений сахарного диабета. Заключается, что ДАОА не является простым механическим сочетанием двух заболеваний. ОА и СД имеют некоторые сходные генетические, патогенетические механизмы, особый фенотип болезни и нацеливают врача, ученого на новый, холистический (персонифицированный) подход к профилактике, диагностике, лечению и прогнозу этой коморбидной патологии. Рассматриваются возможности фармакотерапии ДАОА, учитывающей ключевую характеристику коморбидных заболеваний – эмерджентность (возникающие свойства). Предполагается, что изучение универсальных сетевых взаимодействий, происходящих на геномном, молекулярном, клеточном уровнях, которые приводят к поражению различных органов-мишеней, позволит успешно использовать подход «сетевой фармакологии» в терапии коморбидных заболеваний. Приводятся примеры успешного использования такого лечения при некоторых полипатиях (фармакологический агонист PPARα фенофибрат, ингибитор ГМГ-КоА редуктазы симвастатин при ОА, РА и псориазе). Обсуждается реальность этих подходов в терапии ДАОА. В частности, приводится пример использования в пилотных исследованиях донатора метильной группы адеметионина.</p></abstract><trans-abstract xml:lang="en"><p>This review presents our own and literature data dedicated to predisposing and pathogenetic factors involved in development of a common comorbidity, diabetes-associated osteoarthritis (DAOA). So far, there is no wide-accepted clinical or scientific viewing of DAOA as a distinct clinical phenotype of osteoarthritis (OA). To our knowledge, the role of genetic factors in DAOA development was not discussed in details. Therefore, we have drawn attention to the cross-acting genes involved in both OA and diabetes, i.e., PPARγ, FTO, ADIPOQ, and AGE. These genes encode proteins which can contribute to the pathogenesis of both OA and diabetes. However, some controversies exist about genetic predisposal for OA and diabetes. We review the studies which concern various clinical characteristics of DAOA. We describe a role of chronic hyperglycemia, insulin resistance, advanced glycation end-products (AGE) in development of OA and micro- and macrovascular complications of diabetes. The mechanisms of low-grade inflammation, humoral and cellular immune responses to cartilage antigens, and their role in OA progression are discussed. We underline a similarity of low-grade inflammation in OA and microvascular complications in diabetes. In conclusion, OA and diabetes comorbidity is not a mere coincidence of these diseases. They share some common genetic and pathogenetic factors, a distinct phenotype, and may change thinking of physicians and scientists towards a holistic (personalized) approach to prevention, diagnosis, treatment and prognosis of this comorbidity. We discuss opportunities of DAOA pharmacotherapy based on the key comorbidity feature, i.e., emergence of a new disease property by coexistence of several diseases. One may hypothesize that studying genetic, molecular, and cellular networks in comorbidities may lead to new treatment strategies (‘network pharmacology”) based on targeting the network hubs. We provide examples of such approach in some polypathies (e.g., phenofibrate, a PPARα agonist; simvastatin, a GMGCoA reductase in OA, rheumatoid arthritis and psoriasis), and its potential discuss usefulness is discussed for DAOA. In particular, we provide an example of a pilot study of ademethionine, a methyl group donator.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>диабет-ассоциированный остеоартрит</kwd><kwd>коморбидность</kwd><kwd>сахарный диабет 2 типа</kwd><kwd>остеоартрит</kwd><kwd>генетика</kwd><kwd>иммунопатогенез</kwd></kwd-group><kwd-group xml:lang="en"><kwd>diabetes-associated osteoarthritis</kwd><kwd>comorbidity</kwd><kwd>type 2 diabetes</kwd><kwd>osteoarthritis</kwd><kwd>genetics</kwd><kwd>immunopathogenesis</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Алексеева Л.И., Зайцева Е.М. 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