Allergy and Immunology Section, Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Tex 77030, USA.
J Allergy Clin Immunol. 2012 Feb;129(2):342-8. doi: 10.1016/j.jaci.2011.11.047. Epub 2011 Dec 28.
Investigations of basic immunologic mechanisms and clinical studies of primary immunodeficiencies were most prevalent in 2011. Significant progress was achieved in the characterization of T(H)17 cell differentiation and associated cytokines in the setting of inflammatory disorders, HIV infection, and immunodysregulation disorders. The role of transmembrane activator and calcium modulator and cyclophilin ligand interactor (TACI) mutations in the pathogenesis of CVID was further described and reported to be likely mediated by impaired TACI expression affecting B-cell function. The frequency of autoimmunity in patients with partial DiGeorge syndrome was estimated at 8.5%, predominantly resulting in blood cytopenias and hypothyroidism. Several reports emphasized the presentation of neoplasias, most often lymphomas, as the first manifestation of several primary immunodeficiencies. Novel strategies for newborn screening of B-cell lymphopenia by measuring immunoglobulin κ chain-deletion recombinant excision circles and for adenosine deaminase deficiency using tandem mass spectrometry were demonstrated to be feasible at a large scale. Progress in the treatment of primary immunodeficiencies included increased success with unrelated HLA-compatible donors for hematopoietic stem cell transplantation and the development of new gene therapy approaches with improved safety features. Induced pluripotent stem cells were developed from patients with primary immunodeficiencies, providing a virtually unlimited resource for pathophysiology and gene correction studies. New findings in several of the uncommon immunodeficiencies, such as the increased susceptibility to severe viral infections caused by defects in the activation of the Toll-like receptor 3 pathway, overall contributed to the understanding of their immunologic basis and provided for the design of effective diagnostic and therapeutic strategies.
2011 年,基础免疫学机制研究和原发性免疫缺陷的临床研究最为盛行。在炎症性疾病、HIV 感染和免疫失调性疾病中,T(H)17 细胞分化及其相关细胞因子的特征得到了显著进展。跨膜激活剂和钙调节剂及环孢素配体相互作用蛋白(TACI)突变在 CVID 发病机制中的作用进一步得到描述,并报告称可能是通过影响 B 细胞功能的 TACI 表达受损介导的。部分 DiGeorge 综合征患者自身免疫的频率估计为 8.5%,主要导致血液细胞减少症和甲状腺功能减退。有几份报告强调了几种原发性免疫缺陷症的表现为肿瘤,最常见的是淋巴瘤。通过测量免疫球蛋白 κ 链缺失重组切除环和串联质谱法对腺苷脱氨酶缺乏症进行 B 细胞淋巴细胞减少症的新生儿筛查的新策略已被证明在大规模上是可行的。原发性免疫缺陷症的治疗进展包括增加了与 HLA 相容无关供体的造血干细胞移植成功率,以及开发具有改进的安全性特征的新基因治疗方法。从原发性免疫缺陷症患者中开发出诱导多能干细胞,为病理生理学和基因纠正研究提供了几乎无限的资源。在几种罕见的免疫缺陷症中发现了新的发现,例如,由于 Toll 样受体 3 途径激活缺陷导致严重病毒感染的易感性增加,这些发现总体上有助于理解其免疫学基础,并为设计有效的诊断和治疗策略提供了依据。