Sedlackova Lucie, Sedlacek Petr, Hromadnikova Ilona
Department of Pediatrics, Cell Biology Laboratory, 2nd Medical Faculty, Charles University, Prague, Czech Republic.
Pediatr Transplant. 2006 Mar;10(2):178-86. doi: 10.1111/j.1399-3046.2005.00420.x.
GVHD is a major complication after allogeneic SCT. Etiology of GVHD is multifactorial. Known role of hSPS in antigen presentation could suggest their potential role in the alloreactive process that leads to aGVHD. HSPS represent major immunodominant antigens in a wide spectrum of microbial pathogens. Bacterial and fungal colonization, infection and sepsis are frequent in immunocompromised patients with various malignant and non-malignant diseases. We studied PBMC responses to recombinant human hsp60 (rh-hsp60), rh-hsp70 and Mycobacterium bovis hsp65 (M. bovis hsp65) in relation to aGVHD and infection in 34 pediatric patients with various lympho-hemopoietic malignancies as well as non-malignant disorders subjected to SCT. PBMC of patients before initiation of preparative regimen as well as after engraftment were stimulated with hSPS (1 microg/mL/well, 7-day cultivation). PHA was used as a control of the stimulation ability. Cell responses were measured after the incorporation of 3H-thymidin (pulsing with 1 microCi/well) and were expressed as stimulation indexes (SI). We demonstrated significantly high proliferative response to rh-hsp60 as well as M. bovis hsp65 in a cohort of pretransplant patients with anamnestic and/or actual infection when compared with a cohort of patients without infection and healthy individuals. Strong PBMC cell responses to hSPS were found in patients who were at present colonized with Escherichia coli and Klebsiella pneumoniae or had previously K. pneumoniae infection with subsequent sepsis. Our findings support various studies dealing with immunodominant hSPS in connection with several pathogens and infectious diseases. Although no statistical difference for proliferative response to PHA was observed, PBMC responses against all tested hSPS comparing a cohort of patients with aGVHD and that with no sign of GVHD resulted in significantly lower SI for all tested hSPS in patients with aGVHD. Lower stimulation with hSPS during aGVHD might be explained by the stress-induced upregulation of self-hSPS synthesis that might lead to the inhibition of self-hSPS reactive T-cell response. Vice versa, we hypothesize that increased hsp-specific stimulation may reflect the presence of protecting regulatory T cells preventing the development of Th1-mediated diseases involving aGVHD.
移植物抗宿主病(GVHD)是异基因造血干细胞移植(SCT)后的主要并发症。GVHD的病因是多因素的。热休克蛋白(hSPS)在抗原呈递中的已知作用可能提示它们在导致急性移植物抗宿主病(aGVHD)的同种异体反应过程中的潜在作用。热休克蛋白在多种微生物病原体中代表主要的免疫显性抗原。在患有各种恶性和非恶性疾病的免疫受损患者中,细菌和真菌定植、感染和败血症很常见。我们研究了34例患有各种淋巴造血系统恶性肿瘤以及接受SCT的非恶性疾病的儿科患者的外周血单个核细胞(PBMC)对重组人热休克蛋白60(rh-hsp60)、rh-hsp70和牛分枝杆菌热休克蛋白65(牛分枝杆菌hsp65)的反应,这些反应与aGVHD和感染有关。在开始预处理方案之前以及植入后,用热休克蛋白(1微克/毫升/孔,培养7天)刺激患者的PBMC。用植物血凝素(PHA)作为刺激能力的对照。在加入3H-胸腺嘧啶核苷(以1微居里/孔脉冲)后测量细胞反应,并表示为刺激指数(SI)。我们证明,与没有感染的患者队列和健康个体相比,在有既往感染和/或实际感染的移植前患者队列中,对rh-hsp60以及牛分枝杆菌hsp65有显著高增殖反应。在目前被大肠杆菌和肺炎克雷伯菌定植或先前有肺炎克雷伯菌感染并随后发生败血症的患者中发现了PBMC对热休克蛋白的强烈细胞反应。我们的发现支持了各种关于免疫显性热休克蛋白与几种病原体和传染病相关的研究。尽管未观察到对PHA增殖反应的统计学差异,但比较有aGVHD的患者队列和没有GVHD迹象的患者队列,PBMC对所有测试热休克蛋白的反应导致aGVHD患者中所有测试热休克蛋白的刺激指数显著降低。aGVHD期间热休克蛋白刺激较低可能是由于应激诱导的自身热休克蛋白合成上调,这可能导致自身热休克蛋白反应性T细胞反应受到抑制。反之,我们假设热休克蛋白特异性刺激增加可能反映了保护性调节性T细胞的存在,从而预防涉及aGVHD的Th1介导疾病的发展。