Роль рецепторов врожденного иммунитета в развитии инфекционного процесса, обусловленного Mycobacterium tuberculosis

Согласно данным Всемирной организации здравоохранения, ежегодно во всем мире регистрируется свыше 10 млн новых случаев туберкулеза. В Российской Федерации, по данным Федеральной службы государственной статистики, в 2017 г. на 100 тыс. населения зарегистрировано 109,8 случаев активного туберкулеза, из которых 41,3% имели запущенную форму заболевания. Повсеместная распространенность заболевания независимо от климатических условий обусловлена не только высокой выживаемостью Mycobacterium tuberculosis, но и способностью возбудителя длительно персистировать в организме человека и реактивироваться через неограниченный период времени. Итог инфицирования в значительной степени определяется иммунореактивностью самого организма-хозяина и его готовностью к развитию протективного иммунного ответа. Кроме того, уже после развития болезни состояние иммунной системы определяет и течение туберкулеза: либо в виде ограниченной формы, либо с обширным поражением легких и даже других органов, что наблюдается при генерализованной инфекции. В последние десятилетия большое внимание исследователей было направлено на изучение механизмов клеточного адаптивного иммунитета в патогенезе туберкулезной инфекции. Безусловно, адаптивный иммунитет является мощной защитой, обеспечивающей целенаправленный специфический иммунный ответ, однако в настоящее время становится понятным, что он является лишь эффекторным звеном врожденного иммунитета. Врожденный иммунитет — филогенетически более древняя, наследственно закрепленная система, основной задачей которой является обеспечение быстрой элиминации патогена и предотвращение развития инфекции на ранних стадиях, когда механизмы адаптивного иммунитета отсутствуют. Механизмы врожденного иммунитета представлены клетками, разнообразными рецепторами, молекулами и их комплексами, присутствующими на разных клетках и имеющими одинаковое предназначение. Активация врожденного иммунитета начинается с распознавания одинаковых групп молекул, присутствующих у различных патогенов, — патоген-ассоциированных молекулярных паттернов (pathogen-accociated molecular patterns — PAMPs), осуществляемого с помощью паттерн-распознающих рецепторов (pathogen recognition receptops — PRRs). В обзоре приводятся данные о роли рецепторов врожденного иммунитета в распознавании PAMPs, присущих Mycobacterium tuberculosis, в продукции иммунорегуляторных цитокинов и в активации сигнальных путей, играющих критическую роль в регуляции некроптоза, апоптоза и аутофагии инфицированных макрофагов. Рассматривается значение факторов врожденного мукозального иммунитета в реализации иммунного ответа на M. tuberculosis. Описано участие Toll-подобных и скавенджер-рецепторов, манноз-ного рецептора, DC-SIGN и других в развитии иммунитета против M. tuberculosis. Представлены данные о полиморфных вариантах генов врожденного иммунитета, формирующих предрасположенность к туберкулезу и оказывающих влияние на характер его течения.

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