神経性食欲不振症における治療抵抗性(シンポジウム:摂食障害研究の最前線,2008年,第49回日本心身医学会総会(札幌))  [in Japanese] Treatment-resistance in Anorexia Nervosa(Symposium/The Forefront of Eating Disorder Research)  [in Japanese]

Anorexia nervosa(AN)の治療においてはrefeedingに伴う「治療抵抗性」をはじめとしてintrinsic/extrinsic risk factorsを無視できない局面がある.Food regulatory systemは,ANにおいてはmixed signalingを呈しており,食欲調節のみならず情動調節においてもそのambivalentな病態と密接な関連があると考えられているが,いまだANの中核病態にかかわるkey mediatorを見出せてはいない.Food regulatory systemを軸としてさらなるintrinsic/extrinsic risk factorsの探索を進めていく必要があるが,中でもalarmin systemは栄養・炎症・免疫と密接に関連したhomeostatic regulatorであり,特にANにおいては「治療抵抗性」との密接な関連が示唆される.今後は有機的な治療構造の確立のためにもintrinsic/extrinsic risk factorsの観点に立ち,特にfood regulatory systemとalarmin systemの crosstalkを中心にANの病態解析を進めていく必要があるものと思われる.

Treatment of patients with anorexia nervosa (AN) involves serious difficulties such as "treatment-resistance" during refeeding that need careful consideration of psychopathology of AN from intrinsic/extrinsic risk factors. A lot of literature on AN has revealed that, mixed signaling in the food regulatory system which appears to mirror not only energy intake but also emotions, may underlie characteristic ambivalent eating behaviors in this disorder; however, the key mediator relevant to core psychopathology of AN has not yet to be determined. Further investigations exploring new intrinsic/extrinsic risk factors of pathogenesis of AN are required, and the alarmin system, a homeostatic regulator relevant to nutrition, inflammation, and immune system, is especially noteworthy because of its close association with "treatment-resistance" in AN. We believe that elucidation of pathogenesis of AN from the view of intrinsic/extrinsic risk factors, specifically crosstalk between food regulatory and alarmin systems, is needed to take advantage of possible therapeutic applications in this serious disorder.