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自身免疫性葡萄膜炎的免疫治疗策略。

Immunotherapeutic strategies in autoimmune uveitis.

机构信息

Hospital Israelita Albert Einstein, Av. Albert Einstein 627-701, 2-SS Bloco A, 05651-901 São Paulo, Brazil.

Hospital Israelita Albert Einstein, Av. Albert Einstein 627-701, 2-SS Bloco A, 05651-901 São Paulo, Brazil; Instituto de Investigação em Imunologia, Instituto Nacional de Ciência e Tecnologia (iii-INCT), Brazil.

出版信息

Autoimmun Rev. 2014 Sep;13(9):909-16. doi: 10.1016/j.autrev.2014.05.003. Epub 2014 May 12.

Abstract

Autoimmune uveitis is an organ-specific disorder characterized by irreversible lesions to the eye that predominantly affect people in their most productive years and is among the leading causes of visual deficit and blindness. Currently available therapies are effective in the treatment of a wide spectrum of uveitis, but are often associated with severe side effects. Here, we review ongoing research with promising immunomodulatory therapeutic strategies, describing their specific features, interactions and the responses triggered by the targeted immune molecules that aim to minimize clinical complications and the likelihood of disease relapse. We first review the main features of the disease, diagnostic tools, and traditional forms of therapy, as well as the animal models predominantly used to understand the pathogenesis and test the novel intervention approaches aiming to control the acute immune and inflammatory responses and to dampen chronic responses. Both exploratory research and clinical trials have targeted either the blockade of effector pathways or of their companion co-stimulatory molecules. Examples of targets are T cell receptors (CD3), their co-stimulatory receptors (CD28, CTLA-4) and corresponding ligands (B7-1 and B7-2, also known as CD80 and CD86), and cytokines like IL-2 and their receptors. Here, we summarize the available evidence on effectiveness of these treatments in human and experimental uveitis and highlight a novel CD28 antagonist monovalent Fab' antibody, FR104, which has shown preclinical efficacy suppressing effector T cells while enhancing regulatory T cell function and immune tolerance in a humanized graft-versus-host disease (GVHD) mice model and is currently being tested in a mouse autoimmune uveitis model with encouraging results.

摘要

自身免疫性葡萄膜炎是一种器官特异性疾病,其特征为眼睛的不可逆转损伤,主要影响到生产力最高的年龄段人群,是导致视力缺陷和失明的主要原因之一。目前可用的疗法对广泛谱的葡萄膜炎治疗有效,但通常与严重的副作用相关。在此,我们综述了具有前景的免疫调节治疗策略的研究进展,描述了它们的特定特征、相互作用以及靶向免疫分子所引发的反应,旨在最小化临床并发症和疾病复发的可能性。我们首先综述了疾病的主要特征、诊断工具和传统治疗形式,以及主要用于了解发病机制和测试新型干预方法的动物模型,这些方法旨在控制急性免疫和炎症反应,并抑制慢性反应。探索性研究和临床试验均靶向于效应途径或其协同共刺激分子的阻断。靶点的例子包括 T 细胞受体 (CD3)、其协同刺激受体 (CD28、CTLA-4) 及其相应配体 (B7-1 和 B7-2,也称为 CD80 和 CD86),以及细胞因子如 IL-2 及其受体。在此,我们总结了这些治疗方法在人类和实验性葡萄膜炎中的有效性的现有证据,并强调了一种新型 CD28 拮抗剂单价 Fab'抗体 FR104,该抗体在人源化移植物抗宿主病 (GVHD) 小鼠模型中已显示出抑制效应 T 细胞而增强调节性 T 细胞功能和免疫耐受的临床前疗效,目前正在进行一项自身免疫性葡萄膜炎的小鼠模型测试,结果令人鼓舞。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/37b5/4181827/f9605a7010f1/gr1.jpg

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