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抗白细胞介素-17A 自身抗体可能与 APECED 患者黏膜皮肤念珠菌病的严重程度相关。

Autoantibodies to IL-17A may be correlated with the severity of mucocutaneous candidiasis in APECED patients.

机构信息

Department of Infectious and Pediatric Immunology, University of Debrecen, Medical and Health Science Center, Nagyerdei Krt. 98, 4032, Debrecen, Hungary.

出版信息

J Clin Immunol. 2014 Feb;34(2):181-93. doi: 10.1007/s10875-014-9987-5. Epub 2014 Feb 4.

Abstract

The relative roles of various autoantibodies against IL-17-type cytokines in susceptibility to chronic mucocutaneous candidiasis (CMC) in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) remain poorly defined. The purpose of this longitudinal study was to analyze the relationship between the occurrence of mucocutaneous candidiasis and levels of anti-IL-17A, anti-IL-17F and anti-IL-22 autoantibodies. We studied six APECED patients from four families with various disease manifestations. Clinical data were collected during regular follow-up. Anti-endocrine organ antibody levels and clinical chemistry and immunology parameters were determined in routine laboratory assays on freshly isolated serum. Levels of autoantibodies against IL-17A, IL-17F, IL-22, IFN-α, IFN-ω and TNF-α, and cytokine release by Candida-exposed blood cells were determined by ELISA. Mutations were analyzed by sequencing genomic DNA. Four patients carried the germline c.769C > T homozygous nonsense mutation, which results in R257X truncation of the AIRE protein, and two patients from the same family were compound heterozygous for the c.769C > T/c.1344delC mutation. We found persistently high levels of antibodies against IL-17A in the serum samples of one patient presenting CMC since infancy and low or undetectable anti-IL-17A antibody levels in the sera of five patients with no candidiasis or without severe candidiasis. By contrast, levels of autoantibodies against IL-17F and IL-22 were higher in all patients than in healthy controls. Release of IL-17-type cytokines by Candida-exposed blood mononuclear cells was low or negligible in all patients tested. We suggest that anti-IL-17A antibodies may play an important role in the predisposition to candidiasis of APECED patients. However, the lack of severe CMC in APECED patients with high levels of IL-17F and anti-IL-22 autoantibodies clearly calls into question the role of these antibodies as the principal cause of cutaneous and mucosal candidiasis in at least some APECED patients. These data also suggest that the impaired release of IL-17-type cytokines by blood cells may be an element of the immunopathology of CMC in APECED patients.

摘要

自身免疫性多内分泌腺病-念珠菌病-外胚层营养不良(APECED)患者发生慢性黏膜皮肤念珠菌病(CMC)的易感性与各种针对白细胞介素 17 型细胞因子的自身抗体的相对作用仍不清楚。本纵向研究的目的是分析黏膜皮肤念珠菌病的发生与抗白细胞介素 17A、抗白细胞介素 17F 和抗白细胞介素 22 自身抗体水平之间的关系。我们研究了来自四个家族的六名具有不同疾病表现的 APECED 患者。在常规随访期间收集临床数据。在新鲜分离的血清中通过常规实验室检测确定针对内分泌器官的抗体水平以及临床化学和免疫学参数。通过 ELISA 测定针对白细胞介素 17A、白细胞介素 17F、白细胞介素 22、IFN-α、IFN-ω 和 TNF-α 的自身抗体水平以及经念珠菌暴露的血细胞的细胞因子释放。通过测序基因组 DNA 分析突变。四名患者携带纯合胚系 c.769C>T 无义突变,导致 AIRE 蛋白的 R257X 截断,两名来自同一家庭的患者为 c.769C>T/c.1344delC 突变的复合杂合子。我们发现,一名自婴儿期起即出现 CMC 的患者的血清样本中持续存在高水平的抗白细胞介素 17A 抗体,而五名无念珠菌病或无严重念珠菌病的患者的血清中抗白细胞介素 17A 抗体水平较低或无法检测到。相比之下,所有患者的针对白细胞介素 17F 和白细胞介素 22 的自身抗体水平均高于健康对照组。所有接受检测的患者经念珠菌暴露的血单核细胞释放的白细胞介素 17 型细胞因子水平较低或可忽略不计。我们认为抗白细胞介素 17A 抗体可能在 APECED 患者易患念珠菌病方面发挥重要作用。然而,在高水平的白细胞介素 17F 和抗白细胞介素 22 自身抗体的 APECED 患者中缺乏严重的 CMC,这显然质疑了这些抗体作为至少某些 APECED 患者皮肤和黏膜念珠菌病主要原因的作用。这些数据还表明,血细胞释放白细胞介素 17 型细胞因子的能力受损可能是 APECED 患者 CMC 免疫病理学的一个要素。

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