Takeuchi Yasuo, Takeuchi Emiko, Ishida Takashi, Onodera Masafumi, Nakauchi Hiromitsu, Otsu Makoto
Division of Nephrology, Department of Internal Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
Int J Hematol. 2015 Jul;102(1):111-20. doi: 10.1007/s12185-015-1799-8. Epub 2015 Apr 29.
Chronic granulomatous disease (CGD) is a primary immunodeficiency disorder characterized by defective microbial killing in phagocytes. Long-term prognosis for CGD patients is generally poor, highlighting the need to develop minimally toxic, curative therapeutic approaches. We here describe the establishment of a mouse model in which X-linked CGD can be cured by allogeneic bone marrow transplantation. Using a combination of non-myeloablative-dose total body irradiation and a single injection of anti-CD40 ligand monoclonal antibody, transplantation of whole bone marrow cells achieved long-lasting mixed chimerism in X-linked CGD mice in a haploidentical transplantation setting. Stable mixed chimerism was maintained for up to 1 year even at a low range (<20 % donor cells), indicating induction of donor-specific tolerance. The regimen induced mild myelosuppression without severe acute complications. Stable chimerism was therapeutic, as it suppressed cutaneous granuloma formation in an in vivo test suited for evaluation of treatment efficacy in murine CGD models. These results warrant future development of a simplified allogeneic hematopoietic cell transplantation regimen that would benefit CGD patients by allowing the use of haploidentical donor grafts without serious concerns of severe treatment-related toxicity.
慢性肉芽肿病(CGD)是一种原发性免疫缺陷疾病,其特征是吞噬细胞杀灭微生物的功能存在缺陷。CGD患者的长期预后通常较差,这凸显了开发毒性最小的治愈性治疗方法的必要性。我们在此描述了一种小鼠模型的建立,在该模型中,X连锁CGD可通过同种异体骨髓移植治愈。通过联合使用非清髓剂量的全身照射和单次注射抗CD40配体单克隆抗体,在单倍体相合移植环境下,全骨髓细胞移植在X连锁CGD小鼠中实现了持久的混合嵌合状态。即使在低比例(<20%供体细胞)情况下,稳定的混合嵌合状态也能维持长达1年,这表明诱导了供体特异性耐受。该方案诱导了轻度骨髓抑制,但无严重急性并发症。稳定的嵌合状态具有治疗作用,因为在适合评估小鼠CGD模型治疗效果的体内试验中,它抑制了皮肤肉芽肿的形成。这些结果为未来简化同种异体造血细胞移植方案的开发提供了依据,该方案将使CGD患者受益,因为它允许使用单倍体相合供体移植物,而无需严重担心与治疗相关的严重毒性。