João Cristina
Internal Medicine Department-Hematology Division, Mayo Clinic, Stabile building, 6th floor, 200th Street SW, Rochester, MN, USA.
Med Hypotheses. 2007;68(1):158-61. doi: 10.1016/j.mehy.2006.05.062. Epub 2006 Aug 4.
Paradoxically, human B cell immune deficiencies are associated with increased susceptibility to viral and fungi infections, which are T cell immunity related infections. Also, some viral infections occurring in immune depressed patients such as cytomegalovirus infections are recommended to be treated with intravenous immunoglobulin (IVIg) in combination with antiviral therapy. This fact has no clear biological explanation but it has been shown to be successful. Recently, B cells and immunoglobulin were identified as essential elements driving T cell receptor (TCR) diversity generation. Idiotype peptides of B cell immunoglobulin may be the driving force for the antigen presenting function of B cells and other antigen presenting cells to influence the T cell repertoire. This seems to be another relevance of Jerne's idiotypic network and another function of immunoglobulin. Since T cells function depends on the diversity of the TCR repertoire, means to increase the diversity of the T cell repertoire may improve T cell function in situations characterized by a contracted TCR repertoire, such as AIDS, primary immunodeficiency, cancer, autoimmunity and following chemotherapy and hematopoietic precursors transplantation. The clinical hypothesis here put forward is that B cells and/or immunoglobulin may be used therapeutically aiming to increase and potentially to restore T cell repertoire diversity improving T cell function in situations implicating a contracted T cell repertoire. The fact that immunoglobulin influence the composition of T cell repertoire by increasing its diversity allows a much wider application of this molecule in the clinical practice. Here is presented a novel reasoning for the use of IVIg in humans, which should be explored. All the situations where immune reconstitution occurs are potentially a target for this therapeutically mechanism, aiming to fast and improve the diversity of the reconstituted immune repertoires. This new role of Ig molecule, an old and widely therapeutically used molecule, may help to explain several effects that IVIg have in the T cell compartment, such as modulation of the activation and function of effectors T cells. The idea that immunoglobulin is essential in the generation and maintenance of a diverse compartment of T cells, affecting T cell function via that mechanism suggests a promising approach to medical conditions involving immune reconstitution. Furthermore, it represents a new paradigm of understanding the immune system as a complex, interdependent web of cells/cell products that inter-affect each other generation, function and survival.
矛盾的是,人类B细胞免疫缺陷与对病毒和真菌感染的易感性增加有关,而这些感染是与T细胞免疫相关的感染。此外,对于免疫功能低下患者中发生的一些病毒感染,如巨细胞病毒感染,建议采用静脉注射免疫球蛋白(IVIg)联合抗病毒治疗。这一事实尚无明确的生物学解释,但已证明这种治疗方法是成功的。最近,B细胞和免疫球蛋白被确定为驱动T细胞受体(TCR)多样性产生的关键因素。B细胞免疫球蛋白的独特型肽可能是B细胞和其他抗原呈递细胞发挥抗原呈递功能、影响T细胞库的驱动力。这似乎是耶尔内独特型网络的另一个关联,也是免疫球蛋白的另一个功能。由于T细胞功能依赖于TCR库的多样性,在TCR库收缩的情况下,如艾滋病、原发性免疫缺陷、癌症、自身免疫以及化疗和造血前体细胞移植后,增加TCR库多样性的方法可能会改善T细胞功能。这里提出的临床假设是,B细胞和/或免疫球蛋白可用于治疗,旨在增加并可能恢复T细胞库多样性,从而在T细胞库收缩的情况下改善T细胞功能。免疫球蛋白通过增加T细胞库的多样性来影响其组成,这一事实使得该分子在临床实践中有更广泛的应用。本文提出了一种关于在人类中使用IVIg的新推理,值得进一步探索。所有发生免疫重建的情况都可能是这种治疗机制的目标,旨在快速提高重建免疫库的多样性。Ig分子这一古老且广泛应用于治疗的分子的这一新作用,可能有助于解释IVIg在T细胞区室中的几种作用,如调节效应T细胞的激活和功能。免疫球蛋白在T细胞库的产生和维持中至关重要,并通过该机制影响T细胞功能,这一观点为涉及免疫重建的医学状况提供了一种有前景的方法。此外,它代表了一种理解免疫系统的新范式,即免疫系统是一个由细胞/细胞产物组成的复杂、相互依存的网络,它们在生成、功能和存活方面相互影响。