Vas V, Pálóczi K, Uher F
Országos Haematológiai és Immunológiai Intézet, Budapest.
Orv Hetil. 2001 Jan 28;142(4):163-7.
Despite B-cell counts and serum immunoglobulin levels usually normalized by one year, humoral immunity and the incidence of bacterial infections continue to be abnormal even after years following bone marrow transplantation. This immunodeficiency could be partially caused by B-cell repertoire restriction similar to that observed early in ontogeny. Immune reconstitution after haematopoietic stem cell transplantation really follows many established ontogenetic patterns relating to the appearance of particular membrane markers, immunoglobulin classes and subclasses, and onset of antigen receptor rearrangements. The sequence of events that occur during successful bone marrow transplantation can be regarded as a blueprint for immune reconstitution in other clinical settings as well. However, the repertoire does not resemble a fetal one, because it displays adult-size IgH CDR3s, adult-type immunoglobulin gene utilization and no evidence of bias towards any particular VH-gen family. Therefore, in the description and interpretation of these events, it is important to realize that immune reconstitution does not appear to recapitulate human fetal ontogeny. In terms of B lymphocyte diversity, the inadequacy of the recovering immune system is more likely to be explained by a combination of other factors--such as clonal dominance and the delayed occurrence of somatic hypermutation.
尽管B细胞计数和血清免疫球蛋白水平通常在一年内恢复正常，但即使在骨髓移植数年之后，体液免疫和细菌感染的发生率仍持续异常。这种免疫缺陷可能部分是由类似于个体发育早期所观察到的B细胞库受限引起的。造血干细胞移植后的免疫重建确实遵循许多既定的个体发育模式，这些模式与特定膜标志物的出现、免疫球蛋白类别和亚类以及抗原受体重排的发生有关。成功的骨髓移植过程中发生的一系列事件也可被视为其他临床环境中免疫重建的蓝图。然而，这个库并不类似于胎儿的库，因为它显示出成人大小的IgH CDR3、成人型免疫球蛋白基因利用情况，并且没有偏向任何特定VH基因家族的证据。因此，在描述和解释这些事件时，重要的是要认识到免疫重建似乎不会重现人类胎儿的个体发育过程。就B淋巴细胞多样性而言，恢复中的免疫系统的不足更可能是由其他因素共同作用导致的，如克隆优势和体细胞超突变的延迟发生。
