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Book Review Targeted Therapies in Rheumatology Josef S. Smolen and Peter E. Lipsky, Editors, New York, USA, London, UK: Martin Dunitz, 2003, 729 pages, price: $130.00 US. This comprehensive text focuses on newly emerging pathophysiologic targets and novel emerging targeted therapies for rheumatic diseases. It comprises 8 sections and 43 chapters covering reviews of basic science and clinical relevance of these topics. In Section I, the roles of all cell types, including T and B cells, dendritic cells, mast cells, macrophages and fibroblast-like synoviocytes and cell surface receptors with their inherent pathways relevant to rheumatic disorders are reviewed. What is known of pathogenetic and pharmacologic concepts from the known basic science is discussed. In addition to chapters on the roles of chemokines and cytokines such as tumor necrosis factor-a, the pertinent interleukins, and osteoprotegerin, Section II reviews their effector molecules and the roles they play in the immune response of rheumatic diseases. Their functions are analyzed in terms of the Th1/Th2 and pro-/anti-inflammatory balance in both experimental models and human disease. Using both models, Section III goes on to explore the physiology and roles for the transcription factors nuclear factor-kB, STATs, and JAKs (Janus kinase and signal transducer and activator of transcription), the signaling factors inducible nitric oxide synthase, cyclooxygenase, inhibitors of complement, and matrix metalloproteinases. In Section IV, the knowledge of the response to biotherapeutics is explored in a spectrum of rheumatic disease including rheumatoid arthritis, early rheumatoid arthritis, juvenile arthritis, psoriatic arthritis, systemic lupus erythematosus, myositis, and vasculitis. Additional chapters are devoted to ethical issues in rheumatologic investigation and practice, randomized controlled trials, longterm observational controlled trials, and regulatory issues. This work is of sufficient scope to be recommended for those wanting a review of the basic science behind biotherapeutics, for translational researchers bringing targeted therapies to human rheumatic diseases, and for interested clinicians using them in practice. Vivian P. Bykerk, BSc (Hons), MD, FRCPC, Assistant Professor of Medicine, University of Toronto, Consultant, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5 |