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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-PAO-2042</article-id><article-id custom-type="elpub" pub-id-type="custom">mimmun-2042</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>Полиморбидность, старение иммунной системы и системное вялотекущее воспаление – вызов современной медицине</article-title><trans-title-group xml:lang="en"><trans-title>Polymorbidity, ageing of immune system and low-grade systemic inflammation: a challenge for modern medicine</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4922-9303</contrib-id><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>Валерий Степанович Ширинский - доктор медицинских наук, профессор, главный научный сотрудник лаборатории клинической иммунофармакологии.</p><p>Новосибирск</p></bio><bio xml:lang="en"><p>Shirinsky Valery S. - PhD, MD (Medicine), Professor, Main Research Associate, Laboratory of Clinical Immunopharmacology.Novosibirsk</p></bio><email xlink:type="simple">valery.shirinsky@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-8603-3406</contrib-id><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>Ширинский Иван Валерьевич - доктор медицинских наук, врач-ревматолог, ведущий научный сотрудник,  заведующий  лабораторией клинической иммунофармакологии.</p><p>630047, Новосибирск, ул. Залесского, 6, Тел.: 8 (923) 107-51-00, Факс: 8 (383) 228-25-47</p></bio><bio xml:lang="en"><p>Shirinsky Ivan V. - PhD, MD (Medicine), Clinical Rheumatologist, Leading Research Associate, Head, Laboratory of Clinical Immunopharmacology.</p><p>630047, Novosibirsk, Zalessky str., 6. Phone: 7 (923) 107-51-00, Fax: 7 (383) 228-25-47</p></bio><email xlink:type="simple">ishirinsky@mail.ru</email><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>2020</year></pub-date><pub-date pub-type="epub"><day>03</day><month>08</month><year>2020</year></pub-date><volume>22</volume><issue>4</issue><fpage>609</fpage><lpage>624</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Ширинский В.С., Ширинский И.В., 2020</copyright-statement><copyright-year>2020</copyright-year><copyright-holder xml:lang="ru">Ширинский В.С., Ширинский И.В.</copyright-holder><copyright-holder xml:lang="en">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/2042">https://www.mimmun.ru/mimmun/article/view/2042</self-uri><abstract><p>В обзоре анализируются данные литературы, посвященной характеристике полиморбидности, ее взаимосвязи со старением иммунной системы и низкоуровневым воспалением старения, механизмам их развития и путям поиска методов профилактики и лечения возраст-ассоциированных заболеваний. Прослежена эволюция понятий «коморбидность» и «полиморбидность», дано  современное определение полиморбидности, показано, что распространенность полиморбидности растет во всем мире и в настоящее время достигает 23-25% общего числа населения и до 98% – у людей в возрасте 65 лет и старше. Анализируются факторы риска развития полиморбидности, ее социальное бремя, которое определяется высокой нагрузкой на учреждения здравоохранения, повышенной частотой летальных исходов, избыточным лечением, обусловленным участием специалистов разного профиля. Приводятся доказательства того, что старение и полиморбидность связывают сходные молекулярные и клеточные механизмы, объединенные понятием “inflammaging” (инфламэйджинг – ИЭ), которое представляет собой  вялотекущее хроническое системное воспаление при  старении. Представлены данные, свидетельствующие о том,  что в развитии ИЭ  принимают участие  стареющие клетки врожденного и адаптивного иммунитета, различные про и противовоспалительные медиаторы, пожизненная антигенная нагрузка. Анализируются сведения о функциональных и структурных изменениях врожденной и адаптивной иммунной системы при  старении, роли  этих  изменений в персистенции ИЭ  и возникновении полиморбидных заболеваний. Показано, что существует сложная взаимосвязь между старением всего организма и старением иммунной системы, механизмы которых в ряде случаев почти идентичны, в других сильно отличаются, возникают совместно, взаимно влияя друг на друга. С течением возраста, при наличии факторов риска, измененный адптивный иммунитет большинства людей  не способен полноценно справляться с хронической антигенной нагрузкой, что увеличивает риск развития болезней. С другой стороны, у многих пожилых людей эти изменения компенсируются постоянной активацией клеток врожденного иммунитета. Подчеркивается, что процесс старения и возникновение болезни (полиморбидности) нельзя рассматривать как  отдельные явления, поскольку они, существенно отличаясь по своей  природе, могут  взаимодействовать. В перспективе следует сосредоточить усилия на выяснении молекулярных и клеточных механизмов этих  взаимодействий, решении задач,  направленных на разработку таких вмешательств, которые были бы способны уменьшать  вредные последствия старения и использовать полезные эффекты для сохранения здоровья и достижения максимальной продолжительности жизни.</p></abstract><trans-abstract xml:lang="en"><p>The  review  article  considers the  data  from  literature that  concern polymorbidity aspects,  its interrelations with ageing of immune system and lo-grade immune ageing, mechanisms of genesis, approaches to its prevention and treatment. Evolution of “comorbidity” and “polymorbidity” terms is traced, an updated definition of polymorbidity is proposed. The  world-wide incidence of polymorbidity is increased and  now it reaches  23-25%  in general  population, and up to 98%, in elderly people  (&gt; 65 years old).  The risk factors  of polymorbidity are considered, like as its social burden due to high costs for healthcare, high mortality rates, excessive treatment provided by multidisciplinary specialists.  We present  evidence  for common molecular and cellular  mechanisms involved  in ageing and polymorbidity, being unified  by the term  “inflammaging” which represents a low-grade chronic systemic  inflammation associated with  ageing.  The  data  are  presented that concern the “inflammaging” development with involvement of ageing cells from innate and adaptive immunity systems,  different   pro and  anti-inflammatory mediators, lifelong  antigenic load.  The  data  are  analyzed concerning functional and  structural changes  in the  inborn and  adaptive  immune system  in ageing,  role of these changes  in “inflammaging” persistence and development of polymorbid conditions. There  are complex interactions shown between  the bodily senescence and immune ageing, with similar underlying mechanisms in some cases, however, being quite different  in other  instances. With age, upon  existing risk factors,  the changed adaptive  immunity in most people  is not able to full-scale  coping  with chronic antigenic load,  thus increasing the risk of diseases. Moreover, in many elderly people these changes are compensated by steady activation of the innate immunity cells. It is noted  that the aging events and development of disease (polymorbidity) cannot be considered distinct entities, since they can interact, being, however, basically different in their nature. In future, one should concentrate our efforts on elucidation of molecular and cellular mechanisms of these interactions, solution of the  tasks  oriented for development of such  interventions that  could  be able  to  reduce  harmful consequences of ageing and to use useful effects for health  maintenance and reaching maximal longevity.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>полиморбидность</kwd><kwd>старение</kwd><kwd>инфламэйджинг</kwd><kwd>врожденный иммунитет</kwd><kwd>адаптивный иммунитет</kwd><kwd>хроническая антигенная нагрузка</kwd></kwd-group><kwd-group xml:lang="en"><kwd>polymorbidity</kwd><kwd>ageing</kwd><kwd>inflammaging</kwd><kwd>innate immunity</kwd><kwd>adaptive immunity</kwd><kwd>chronic antigen load</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">Арутюнов А.Г., Драгунов Д.О., Арутюнов Г.П., Рылова А.К., Пашкевич Д.Д., Витер К.В., Деревянченко М.В., Инина Л.И., Соловьева О.Е., Стаценко М.Е. 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