Mueller-Loebnitz Christoph, Ostermann Helmut, Franzke Anke, Loeffler Juergen, Uharek Lutz, Topp Max, Einsele Hermann
Medical Writer, Goldammerweg 4, 91301 Forchheim, Germany.
Interdiscip Perspect Infect Dis. 2013;2013:102934. doi: 10.1155/2013/102934. Epub 2013 Jan 21.
Patients with allogeneic stem cell transplantation (SCT) have a high risk of invasive fungal infections (IFIs) even after neutrophil regeneration. Immunological aspects might play a very important role in the IFI development in these patients. Some data are available supporting the identification of high-risk patients with IFI for example patients receiving stem cells from TLR4 haplotype S4 positive donors. Key defense mechanisms against IFI include the activation of neutrophils, the phagocytosis of germinating conidia by dendritic cells, and the fight of the cells of the innate immunity such as monocytes and natural killer cells against germlings and hyphae. Furthermore, immunosuppressive drugs interact with immune effector cells influencing the specific fungal immune defense and antimycotic drugs might interact with immune response. Based on the current knowledge on immunological mechanism in Aspergillus fumigatus, the first approaches of an immunotherapy using human T cells are in development. This might be an option for the future of aspergillosis patients having a poor prognosis with conventional treatment.
异基因干细胞移植（SCT）患者即使在中性粒细胞再生后仍有较高的侵袭性真菌感染（IFI）风险。免疫因素在这些患者IFI的发生发展中可能起着非常重要的作用。现有一些数据支持对IFI高危患者的识别，例如接受来自TLR4单倍型S4阳性供体干细胞的患者。抵御IFI的关键防御机制包括中性粒细胞的激活、树突状细胞对萌发分生孢子的吞噬作用，以及单核细胞和自然杀伤细胞等固有免疫细胞对抗芽管和菌丝的作用。此外，免疫抑制药物与免疫效应细胞相互作用，影响特异性真菌免疫防御，抗真菌药物可能与免疫反应相互作用。基于目前对烟曲霉免疫机制的认识，使用人T细胞的免疫治疗的初步方法正在研发中。对于传统治疗预后较差的曲霉病患者来说，这可能是未来的一种选择。
