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2023
ВЕСТНИК САНКТ-ПЕТЕРБУРГСКОГО УНИВЕРСИТЕТА МЕДИЦИНА
Т. 18. Вып. 4
ВНУТРЕННИЕ БОЛЕЗНИ
UDC 615.2:616.72-002.77
S-adenosylmethionine therapy in rheumatic and related autoimmune diseases*
J. F. de Carvalho1, L. P. Churilov2,3, A. Lerner4,5, P. A. Sobolevskaia2, A. A. Basina2, N. Yu. Gavrilova2,6
1 Núcleo de Pesquisa em Doen^as Crónicas nao Transmissíveis (NUPEN), Rua Augusto Viana, Palácio da Reitoria, Canela, Salvador, 40110-909, Brazil
2 St. Petersburg State University,
7-9, Universitetskaya nab., St. Petersburg, 199034, Russian Federation
3 St. Petersburg Research Institute of Phthisiopulmonology, 2-4, Ligovskiy pr., St. Petersburg, 191036, Russian Federation
4 The Zabludowicz Research Center for Autoimmune Diseases, 2, Derech Sheba, Ramat Gan, 52621, Israel
5 Ariel University,
65, ul. Ramat HaGolan, Ariel, 40700, Israel
6 St. Petersburg University's N. I. Pirogov Clinic of High Medical Technologies, 154, nab. r. Fontanki, St. Petersburg, 190103, Russian Federation
For citation: de Carvalho J. F., Churilov L. P., Lerner A., Sobolevskaia P. A., Basina A. A., Gavrilova N. Yu. S-adenosylmethionine therapy in rheumatic and related autoimmune diseases. Vestnik of Saint Petersburg University. Medicine, 2023, vol. 18, issue 4, pp. 348-360. https://doi.org/10.21638/spbu11.2023.401
S-adenosylmethionine has been used to treat neuropsychiatric diseases, including those accompanied with depression. These entities often are comorbid with rheumatic and thyroid pathology, and in the COVID-19 pandemic and post-pandemic periods, there was a growing number of such cases. That's why the article evaluates the experience and perspectives of S-ad-enosylmethionine therapy in osteoarthritis and a few rheumatic and comorbid thyroid diseases (fibromyalgia, systemic sclerosis, gout and autoimmune thyroiditis). PubMed/MEDLINE, EMBASE, elibrary.ru and Scielo databases were searched for targeted topic between 1966 and 2023. 15 articles were depicted to fulfill the inclusion criteria, 13 in Latin and 2 in Cyrillic scripts, including 1,499 patients (1,383 in osteoarthritis and 116 in other rheumatic diseases). The dosage varied from 200 mg to 1,200 mg/day. The follow-up ranged from 3 weeks to 24 months. Almost all studies (13/15) showed at least one benefit after S-adenosylmethionine
* The research is supported by Russian Science Foundation (RSF) grant no. 22-15-00113, agreement of May 13, 2022.
© St. Petersburg State University, 2023
therapy supplementation, including 2 papers documented positive effect in vitro achieved upon the cells taken from patients. Most side effects were mild, one study showed borderline moderate/severe adverse effects. Only pre-clinical/experimental studies of S-adenosylmethio-nine therapy effects on thyroid regulation were revealed. S-adenosylmethionine is a promising and safe element of complex therapy for some rheumatic diseases.
Keywords: S-adenosylmethionine, SAMe, methylation, rheumatic diseases, rheumatoid arthritis, systemic sclerosis, osteoarthritis, fibromyalgia, thyroid gland.
Introduction
S-adenosylmethionine (SAMe) was discovered in 1952, and it is an amino acid metabolite and enzyme co-substrate involved in multiple biochemical pathways, including the neurotransmitters and hormones production [1]. Deficiencies of vitamin B12 and folic acid, which are important co-factors for SAMe synthesis, may account for decreased SAMe levels. In addition, reduction of SAMe levels in cerebrospinal fluid has been also observed in patients with rare inherited defects in folate and methionine metabolism [2], and in more common diseases such as depressive disorders, Alzheimer's disease, and Parkinson's disease [3].
SAMe has been used in psychiatric and medical disorders in Europe. The supplement has been reported to exert clinically significant anti-inflammatory and analgesic effects [4]. In Russia there is some experience of its successful application in liver diseases and in experimental hepatic encephalopathy [5, 6]. While the mechanism remains unclear, SAMe does not appear to alter the eicosanoid system like non-steroidal anti-inflammatory drugs (NSAID) but may enhance proteoglycan biosynthesis and secretion [7]. Recently it has been shown that it may regulate the process of autophagy, thus influencing autoim-munity and inflammation. An additional mechanism may be regulation of gene methyla-tion/activity [8, 9]. Systemic blood concentration of SAMe is regarded as an indicator of enhanced global transmethylation [10]. In several randomized controlled studies, including many patients, SAMe was as effective as NSAIDs in relieving pain in osteoarthritis (OA) [11-19].
Therefore, it is reasonable to systematically review the articles that evaluate SAMe therapy in various rheumatic diseases and co-morbid autoimmune pathology.
Methods
A systematic search of articles published in PubMed/MEDLINE, EMBASE, elibrary. ru and Scielo from 1966 to March 2023 using the following MeSH entry terms: "SAMe" OR "S-adenosylmethionine" and "rheumatic" OR "rheumatologic" OR "systemic lupus erythematosus" OR "lupus" OR "fibromyalgia" OR "rheumatoid arthritis" OR "spondy-loarthritis" OR "Sjogren's syndrome" OR "myositis" OR "systemic sclerosis" OR "vasculitis" OR "Takayasu disease" OR "Wegener's disease" OR "granulomatosis with polyangiitis" OR "Kawasaki's disease" OR "polyarteritis nodosa" OR "Livedoid vasculitis" OR Churg-Strauss" OR "eosinophilic granulomatosis with polyangiitis" OR "osteoarthritis" OR "gout" OR "thyroid". The search had no language restrictions. The reference lists of the selected articles were analyzed to identify additional publications.
Three authors (JFC, AL and LPC) initially performed the literature search and independently selected the study abstracts. Then, in the second stage, the same reviewers
independently read the full-text articles selected by abstracts. Again, the authors followed PRISMA guidelines [20]. Finally, a standardized form was designed to extract the information from relevant articles, including authors, year of publication, number of patients studied, demographic data, disease duration, study follow-up, SAMe posology, outcomes, and side effects. The same work for Cyrillic script sources was performed by Russian part of the team (PAS, AAB, NYG and LPC).
Results
Table 1 summarizes the search results on SAMe treatment in OA. There are 8 articles in this field, including 1,383 patients. The countries that produced those articles were Germany (n = 3), Italy (n = 3), Argentina (n = 1), Korea (n = 1), and the United States (n = 1). Most studies performed a double-blind clinical trial as a study design (n = 8), and only one was an open trial. Age varied from 40 to 64.37 years old, and female gender ranged from 22.2 to 84 %. Disease duration went from 4.5 to 11.7 years. The SAMe dosage varied from 600 mg to 1,200 mg/day. The study time follow-up ranged from 3 weeks to 24 months.
All articles demonstrated improvements in diverse OA parameters. Pain intensity, patient's and physician's global assessments of response to therapy, and WOMAC index scores compared to placebo improved. When SAMe was compared to NSAID, no difference was observed, attesting to the fact that the supplement is as good as the pharmaceutical therapy of NSAID. No significant side effect was detected; however, mild gastrointestinal symptoms were the most common.
Table 2 shows the search results for the other rheumatic diseases [21-25]: three trials in fibromyalgia, 1 in systemic sclerosis, and 1 in gout with 110 patients. Concerning study design, most of them were double-blinded trials (n = 3), followed by case series (n = 1) and case report (n = 1). Italy was ahead by the number of studies (n = 2), followed by Denmark (n = 1), Germany (n = 1), and Malaysia (n = 1). In those studies, females predominated (from 20 to 82 %); age varied from 5.6 to 49 years old, and disease duration from 3.6 to 11 years. The study follow-up ranged from 3 weeks to 1 year. The SAMe dosage varied from 200 to 800 mg/day.
Regarding outcome, 4 out of 5 studies showed the benefits of SAMe in rheumatic diseases. The patients observed improved pain, functional parameters, fatigue, mood, and sleep. On the contrary, only one fibromyalgia study did not follow changes after supplementation. However, a trend was observed regarding pain, stiffness, and fatigue [21]. The other two studies verified improved systemic sclerosis parameters [25], and the patients with Lesch-Nyhan and gout get better neurological conditions [24]. Furthermore, in 4/5 of the studies, no side effects were observed, while in one study, moderate to severe reactions were seen, such as an anaphylactic reaction [21] (Table 2).
Two Russian language articles revealed both were biomedical and dedicated to pre-clinical SAMe use in rheumatoid arthritis (RA) [26, 27]. Using synovial cells from 6 patients with active RA, Russian authors have demonstrated that SAMe in vitro significantly increased the methylation of DNA in these target cells, also the production of pro-inflammatory cytokines in vitro by these cells could be noticeably decreased by SAMe in all cases. SAMe also decreased in vitro osteoprotegrin biosynthesis and migration/invasive-ness of RA synovial cells.
Table 1. Studies of SAMe in osteoarthritis
Author, reference Study design Country No. Age (years old), gender Disease duration SAMe dose Follow-up Outcome Side effects
Kim et al., 2009 [11] Multicenter, Randomized, Double- Blind, Double- Dummy, Phase IV Study Korea 134 63.9 ± 8.2, 84 % females 7.9 ± 6.3 years 400 mg TID weeks After 8 weeks, SAMe improved compared to baseline: — pain intensity; — although SAMe and ibuprofen were similar. Physician and patient's global assessment of response to therapy and WOMAC index scores did not differ SAMe: 35.8 % vs. nabumetone 31.3 %, p = NS
Najm et al., 2004 [12] Randomized double-blind cross-over trial; 20 weeks The United States 61 53, 70 % females 11.7 ± 10.1 years 1,200 mg 16 weeks In the first month of Phase 1, celecoxib showed significantly more reduction in pain than SAMe (p = 0.024). By the second month of Phase 1, both groups had no significant difference (p < 0.01) Gastrointestinal and psychiatric mild side effects were the most common
Caruso & Pietrogrande, 1987 [13] Double-Blind Multicenter Italy 734 58.4 (27-75), 74 % females 6.1 years 1,200 mg 4 weeks After 30 days, SAMe improved compared to the placebo: — standing up from a seat; — walking on a plane; — going upstairs; — diurnal pain; — functional limitation; — although SAMe and naproxen were similar SAME had fewer side effects than naproxen, and they were equal to the placebo
Muller-Fassbender, 1987 [14] Double-Blind Clinical Trial Germany 36 54(37-70), 22.2 % females 55 months 1,200 mg 4 weeks SAMe improved compared to baseline: global clinical score; — total score ofknee OA; — total score ofhip OA; — total score of spine OA. Although SAMe and ibuprofen were similar Well tolerated
Author, reference Study design Country No. Age (years old), gender Disease duration SAMe dose Follow-up Outcome Side effects
König, 1987 [15] Long-term multicenter, open trial Germany 108 62 ±9, 55 % females 70 ±61 months 600 mg for 2 weeks later supporting 40 mg 24 months 90 % of the physicians and > 85% of the patients assessed the efficacy of SAMe as being "very good" or "good". 18/97 became asymptomatic. The complaint score dropped from 20.3 to 4.5. Score of the mental state rating (feelings) dropped from 31.7 to 16.1 None
Macagno et al., 1987 [16] Double-Blind Clinical Trial Argentina 48 64.361 1.6; 68 % females Not available 1,200 mg 12 weeks Both SAMe and piroxicam improved: total pain score after 28 days of treatment; morning stiffness; the distance walked before the onset of pain, and active and passive motility improved about day 58 in both groups 4 patients in SAMe and 9 in the piroxicam group reported side effects. The adverse effects were mainly related to gastric intolerance
Vetter, 1987 [17] Double-Blind Comparative Clinical Trial Germany 36 64 ±37 56 % females 73 ± 5.9 months 1,200 mg 4 weeks SAMe improved compared to baseline: — global clinical score; — total score of knee OA; — total score of hip OA; — total score of spine OA. Although SAMe and indomethacin were similar 2 patients in the SAMe group had slight náusea. 11 % in SAMe vs. 3 % in the indomethacin group
Montrone et al., 1985 [18] Double-Blind Clinical Trial Italy 76 Not available Not available 1,200 mg 3 weeks SAMe improved compared to placebo: nigh pain, loading pain, pain poll, going upstairs and downstairs, standing up from a chair. Getting out of bed. "Difficulty in specific activity" pool Gastrointestinal side effects were experienced in 3 patients receiving SAMe and in 6 of the placebo
Glorioso et al. 1985 [19] Double-blind multicentre Italy 150 Not available Not available 400 mg thrice daily 30 days SAMe exhibited a slightly more marked activity than the reference drug in managing the various painful manifestations Minor side-effects: in 5 patients (SAMe) and 16 (ibuprofen)
Table 2. Studies in SAMe use in fibromyalgia, gout, and systemic sclerosis
Author, reference Study design Country No., age, gender Rheumatic disease Disease duration SAMe dose (mg/day) Follow-up Outcome Side effects
Volkmann et al., 1997 [21] Prospective, randomized, double-blind, cross-over, placebo- controlled Germany 34, 49 ± 10, not available Fibromyalgia 11 (2-42) years 600 mg i.v. or placebo daily for 10 days in a cross-over trial 30 days No significant difference in improvement in tender point Count. There was a tendency towards statistical significance in favor of SAMe on the subjective perception of pain at rest (p=0.08), pain on movement (p=0.11), and overall well-being (p=0.17), and slight improvement only on fatigue, quality of sleep, morning stiffness, and on the Fibromyalgia Impact Questionnaire for pain 4 patients (SAMe) withdrew: 2 severe nausea/vomiting and diarrhea; 1 anaphylactic reaction. Most patients had mild effects equal to a placebo
Jacob sen et al., 1991 [22] Double-Blind Clinical Trial Denmark 44, 49.8, 82 % females Fibromyalgia 4.5 years 800 mg 16 weeks SAMe improved: — clinical disease activity; — pain experienced during the last week; — fatigue; — morning stiffness; — mood evaluated by Face Scale Equal to a placebo
Author, reference Study design Country No., age, gender Rheumatic disease Disease duration SAMe dose (mg/day) Follow-up Outcome Side effects
Tavoni et al., 1987 [23] Ddouble-blind crossover trial Italy 17, 44.5, not available Fibromyalgia 7 years 200 mg or placebo for 21 days by intramuscular administration and then, after a 2 weeks wash-out period, therapy was switched to the agent 3 weeks SAMe caused a significant decrease in pain, evaluated as the number of trigger points plus painful anatomic sites. Hamilton and the SAD (Scala di Autovalutazi-one per la Depression) scales decreased significantly after Apart from the abscesses at the injection sites, no significant side effects were noted during the study
Chen et al., 2014 [24] Case series Malaysia 5, 5.6, 80 % males Gout secondary to Lesch-Nyhan disease 3.6 years 21 to 38 mg/kg/ day 1 year Dramatic reductions of self-injury and aggressive behavior, as well as a milder reduction of dystonia was observed in all 5 patients. No description of uric acid evolution Not available
Oriente et al., 1985 [25] Case report Italy 10, not available, 100 % females Systemic sclerosis (6 systemic sclerosis, 3 morphea, and 1 sclero-dactyly) Not available 600 mg daily i.v. in the first two months, subsequently 400 mg 3 times daily per os 6 months After 4 months: 5 patients (3 with PSS, 2 with morphea) exhibited significant improvement in their indurative skin. 5 other patients (3 PSS, 1 morphea, 1 sclerodac-tyly) did not present any significant increase in cutaneous elasticity after 6 months' medication None
No clinical papers on SAMe use in autoimmune thyroid disease was found. Although few pre-clinical and experimental biomedical findings allowing to relate SAMe and pathogenesis of these diseases exist. Thus, SAMe increased affinity of thyrotropin receptor to its ligand in vitro [28]. Anti-thyroid inhibitor thiouracil increases the SAMe level [29].
Discussion
This is the first study to systematically review the therapeutic effects of SAMe in many rheumatic and related autoimmune diseases.
In a biochemical basis, SAMe is involved in three main metabolic routes: 1) methyla-tion, it is the main font of methyl groups in the human body; 2) trans-sulfuration, while SAMe forms S-adenosylhomocysteine and then homocysteine which can be converted to cystathionine then to cysteine and the sulfate that is available to other metabolic routes; 3) aminopropylation, while SAMe participates in the synthesis of polyamines which can eventually recycle as methionine [30, 31].
The specific mechanism of action of SAMe in reducing pain in OA patients needs to be discover. There is hypothesis that SAMe may be a COX-2 inhibitor. Furthermore, in vitro studies in chondrocytes have demonstrated increased levels of proteoglycan production and proliferation rates [32, 33]. In addition, SAMe may reduce inflammatory mediators, including tumor necrosis factor (TNF)-alpha and fibronectin [34]. In turn, SAMe-dependent polyamines also may render some anti-inflammatory effects [35].
Regarding SAMe in OA, the benefits of this supplementation in this degenerative disorder are evident. Almost all articles demonstrated efficacy similar to NSAIDs with minor side effects. Concerning SAMe mechanism of action in OA, studies in animals and in vitro suggested that SAMe reduces inflammation and induces proteoglycan synthesis [34].
Randomized, double-blind clinical trials have been conducted evaluating SAMe, and most of them compared SAMe to NSAIDs [11-16, 36, 37]. The studies revealed similar effects on pain reduction and function improvement when SAMe was comapred with NSAIDs. Although, SAMe groups had much less adverse events.
Interestingly, two meta-analyses concluded that the pain and functional improvements caused by SAMe were similar to those of NSAIDs [36, 37].
This review has some strengths that are: 1) the inclusion of studies with patients fulfilling the international criteria for rheumatic diseases; 2) the inclusion of all kinds of study designs using SAMe in rheumatic diseases, except reviews, animal studies, and in vitro studies. Applying the inclusion criteria, it is assumed that all published articles of SAMe in rheumatic patients were collected. Not only Latin script written, but also Cyrillic script written sources were covered.
Some limitations were seen in this study. No comparison between classical pharmacological therapies commonly used in rheumatic diseases was available for conditions other than OA. In addition, with the exception of OA studies, the number of participants was low, and the follow-up was short for the investigated diseases. Therefore, new studies should include larger patient samples with a more long-term observation, enabling a better understanding of SAMe therapy in rheumatic conditions.
Careful consideration of pursuing treatment with SAMe, as opposed to a registered NSAID or antidepressant, is required by the clinician and the patient. Clinicians
recommending SAMe must inform their patients that this compound has not been tested as rigorously as its counterparts approved by Federal Drug Administration (FDA) or analogous national services of other countries. As such, its relative efficacy cannot be guaranteed. However, the risks of SAMe are still generally speaking lower when compared with the NSAIDs (with their gastrointestinal bleeding, renal failure, etc.) and antidepressants, particularly in SAMe in which sexual dysfunction or weight gain, are not seen. No cases of death by SAMe overdose have been reported. In a mouse study, a lethal oral dose of SAMe was equivalent to over 400,000 mg in a 70 kg man (National Library of Medicine, 1999 RTECS (Registry of Toxic Effects of Chemical Substances), Bethesda, MD, Record Nos. 7176, 7177). At the same time, various comorbidities and specifics of individual anamnesis should always be taken into account when SAMe treatment is considered. Thus, it is known that fibromyalgia, rheumatic and related autoimmunity conditions may be provoked in many individuals by COVID-19 [38]. SAMe, although therapeutically effective in these disorders, at the same time was shown to be positively related to COVID-19 lung involvement severity, because transmethylation is essential for SARS-CoV-2 replication [10, 39]. It means that SAMe therapy is possible for such patients only after elimination of acute viral infection, in appropriate patterns of post-COVID syndrome, but in virus-negative state.
Although the cost of SAMe is not covered by insurance companies, compared with the high co-payments on many prescriptions, it may be a reasonable expense. Patients should be discouraged from self-medicating their diseases and encouraged to seek professional evaluation before starting any treatment.
Conclusion
A few articles evaluated the effects of SAMe in rheumatological diseases, and only four conditions (OA, fibromyalgia, scleroderma, and Lesch-Nyhan) were addressed in the literature. Nevertheless, almost all analyzed studies demonstrated that SAMe use is efficacious in treating rheumatic diseases, with rare and mild side effects. Therefore, it can be concluded that SAMe emerges as an exciting option to be explored in rheumatological conditions.
Highlight key points:
1. S-adenosylmethionine (SAMe) has been used to treat some rheumatic disorders.
2. This article systematically reviews the use of SAMe in osteoarthritis (OA), fibromyalgia, systemic sclerosis, and gout.
3. Almost all studies demonstrated at least one benefit after SAMe supplementation: pain intensity, fatigue, and functional parameters.
4. Most side effects were mild or absent.
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Received: October 2, 2023 Accepted: December 10, 2023
Authors' information:
Jozélio Freire de Carvalho — MD, Professor; jotafc@gmail.com jotafc@gmail.com
Leonid P. Churilov — MD, PhD in Medicine, Associate Professor; l.churilov@spbu.ru, elpach@mail.ru
Aaron Lerner — MD, Professor, Senior Scientist; aaronlerner1948@gmail.com
Polina A. Sobolevskaya — Researcher; dr.polinasobolevskaia@bk.ru
Alena A. Basina — Student; a.a.lamova@mail.ru
Natalia Yu. Gavrilova — MD, PhD in Medicine; fromrussiawithlove_nb@mail.ru
Лечение ревматических и связанных с ними аутоиммунных заболеваний с применением S-аденозилметионина*
Ж. Ф. де Карвальо1, Л. П. Чурилов2,3, А. Лернер4,5, П. А. Соболевская2, А. А. Басина2, Н. Ю. Гаврилова2,6
1 Научный центр хронических неинфекционных заболеваний (NUPEN), Бразилия, 40110-909, Сальвадор, Канела, Паласио да Рейториа, Руа Аугусто Виана
2 Санкт-Петербургский государственный университет,
Российская Федерация, 199034, Санкт-Петербург, Университетская наб., 7-9
3 Санкт-Петербургский научно-исследовательский институт фтизиопульмонологии, Российская Федерация, 191036, Санкт-Петербург, Лиговский пр., 2-4
4 Исследовательский центр аутоиммунных заболеваний им. П. Заблудовича, Израиль, 52621, Рамат Ган, Дерех Шиба, 2
5 Ариэльский университет,
Израиль, 40700, Ариэль, ул. Рамат ха-Голан, 65
6 Клиника высоких медицинских технологий им. Н. И. Пирогова Санкт-Петербургского государственного университета,
Российская Федерация, 190103, Санкт-Петербург, наб. реки Фонтанки, 154
Для цитирования: de Carvalho J. F., Churilov L. P., Lerner A., Sobolevskaia P. A., Basina А. А., Gavrilova N. Yu. S-adenosylmethionine therapy in rheumatic and related autimmune diseases // Вестник Санкт-Петербургского университета. Медицина. 2023. Т. 18. Вып. 4. С. 348-360. https://doi.org/10.21638/spbu11.2023.401
S-аденозилметионин (SAMe) использовался для лечения нервных и психиатрических заболеваний, включая сопровождаемые депрессией. Эти нарушения нередко сочетаются с ревматологической и тиреоидной патологией, причем данные коморбидные поражения в период и после пандемии COVID-19 наблюдаются все чаще, в связи с чем была произведена оценка применения S-аденозилметионина для лечения ревматологических заболеваний и сопутствующих тиреопатий. Был проведен систематический обзор использования S-аденозилметионина для ревматических заболеваний, таких как остеоартрит, фибромиалгия, системная склеродермия и подагра; изучен описанный в специализированных источниках опыт применения S-аденозилметионина при лечении аутоиммунных заболеваний щитовидной железы, часто сочетающихся с ревматическими. В наукометрических базах данных PubMed/MEDLINE, EMBASE, elibrary.ru и Scielo был произведен поиск статей о применении S-аденозилметионина при ревматических заболеваниях и сопутствующей патологии щитовидной железы в период с 1966 по март 2023 г. 15 статей соответствовали критериям включения, 13 из них написаны на латинице, 2 — на кириллице, суммарно они содержали сведения о 1499 пациентах. Дозировка S-аденозилметионина варьировала от 200 до 1200 мг в сутки. Период наблюдения составлял от 3 недель до 24 месяцев. Почти все исследования (13/15) показали по крайней мере одно преимущество после приема добавок S-аденозилметионина: снижение интенсивности боли, утомляемости и улучшение функциональных параметров, включая две работы, в которых был задокументирован положительный эффект in vitro с клетками, взятыми у пациентов с ревматоидным артритом. Хотя большинство побочных эффектов были умеренными, одно исследование зафиксировало пограничные с тяжелыми побочные эффекты. Клинический опыт применения S-аденозилметионина при аутоиммунных заболеваниях щитовидной железы не описан в литературе, хотя существуют преклинические/экспериментальные
* Исследование выполнено при финансовой поддержке Российского научного фонда (РНФ) № 22-15-00113, договор от 13 мая 2022 г.
исследования влияния 8-аденозилметионина на регуляцию функций щитовидной железы. Настоящий систематический обзор показывает, что 8-аденозилметионин может служить многообещающим и безопасным элементом комплексного лечения при некоторых ревматических заболеваниях. Однако требуется большее количество данных, полученных в более обширных, хорошо спланированных и контролируемых исследованиях.
Ключевые слова: 8-аденозилметионин, 8ЛМе, метилирование, ревматические заболевания, ревматоидный артрит, системный склероз, остеоартрит, фибромиалгия, щитовидная железа.
Статья поступила в редакцию 2 октября 2023 г.; рекомендована к печати 10 декабря 2023 г.
Контактная информация:
де Карвальо Жозелио Фрейре — д-р мед. наук, проф.; jotafc@gmail.com Чурилов Леонид Павлович — канд. мед. наук, доц.; elpach@mail.ru Лернер Аарон — д-р мед. наук, проф.; aaronlerner1948@gmail.com Соболевская Полина Анатольевна — науч. сотр.; dr.polinasobolevskaia@bk.ru Басина Алёна Алексеевна — студент; a.a.lamova@mail.ru Гаврилова Наталия Юрьевна — канд. мед. наук; fromrussiawithlove_nb@mail
