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依库珠单抗治疗母亲后脐血中膜攻击复合物形成减少:一例报告。

Reduced membrane attack complex formation in umbilical cord blood during Eculizumab treatment of the mother: a case report.

机构信息

Department of Nephrology, Odense University Hospital, 5000, Odense C, Denmark.

Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.

出版信息

BMC Nephrol. 2019 Aug 7;20(1):307. doi: 10.1186/s12882-019-1469-9.

DOI:10.1186/s12882-019-1469-9
PMID:31390992
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6686417/
Abstract

BACKGROUND

Atypical hemolytic uremic syndrome (aHUS) is a disorder of the microvasculature with hemolytic anemia, thrombocytopenia and acute kidney injury. Nowadays, aHUS is successfully treated with eculizumab, a humanized, chimeric IgG2/4 kappa antibody, which binds human complement C5 and blocks generation of C5a and membrane-attack-complex.

CASE PRESENTATION

A 25-year-old woman with end stage renal disease due to relapsing atypical hemolytic uremic syndrome had a relapse of the disease during pregnancy. She was treated with eculizumab. We measured reduced formation of the membrane-attack complex in newborn's umbilical cord vein blood using the sensitive and specific Palarasah-Nielsen-ELISA.

CONCLUSIONS

Eculizumab treatment of the mother with end stage renal disease may cause reduced innate immunity which could render newborns more susceptible to infections.

摘要

背景

非典型溶血性尿毒症综合征(aHUS)是一种微血管疾病,伴有溶血性贫血、血小板减少和急性肾损伤。如今,aHUS 可以通过依库珠单抗成功治疗,这是一种人源化、嵌合 IgG2/4 kappa 抗体,可结合人补体 C5,阻止 C5a 和膜攻击复合物的生成。

病例介绍

一位 25 岁女性因反复发作的非典型溶血性尿毒症综合征导致终末期肾病,在怀孕期间疾病复发。她接受了依库珠单抗治疗。我们使用敏感且特异的 Palarasah-Nielsen-ELISA 测量新生儿脐静脉血中膜攻击复合物形成减少的情况。

结论

患有终末期肾病的母亲接受依库珠单抗治疗可能导致先天免疫能力降低,使新生儿更容易感染。

相似文献

1
Reduced membrane attack complex formation in umbilical cord blood during Eculizumab treatment of the mother: a case report.依库珠单抗治疗母亲后脐血中膜攻击复合物形成减少:一例报告。
BMC Nephrol. 2019 Aug 7;20(1):307. doi: 10.1186/s12882-019-1469-9.
2
Alternative complement pathway hemolytic assays reveal incomplete complement blockade in patients treated with eculizumab.替代补体途径溶血试验显示,接受依库珠单抗治疗的患者存在补体阻断不完全的情况。
Clin Immunol. 2017 Oct;183:1-7. doi: 10.1016/j.clim.2017.06.007. Epub 2017 Jun 21.
3
Eculizumab-C5 complexes express a C5a neoepitope in vivo: Consequences for interpretation of patient complement analyses.依库珠单抗 - C5复合物在体内表达C5a新表位:对患者补体分析解读的影响。
Mol Immunol. 2017 Sep;89:111-114. doi: 10.1016/j.molimm.2017.05.021. Epub 2017 Jun 10.
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Efficacy and Safety of Eculizumab in Kidney Transplant Patients With Primary Atypical Hemolytic-Uremic Syndrome.依库珠单抗治疗原发性非典型溶血尿毒综合征肾移植患者的疗效和安全性。
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Eculizumab in pregnancy: a narrative overview.妊娠期间使用依库珠单抗:叙事性综述。
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A patient with a homozygous diacylglycerol kinase epsilon (DGKE) gene mutation with atypical haemolytic uraemic syndrome and low C3 responded well to eculizumab: a case report.携 DGKE 基因纯合突变的非典型溶血尿毒综合征伴低补体 C3 患者对依库珠单抗治疗反应良好:一例报告。
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Tailored eculizumab therapy in the management of complement factor H-mediated atypical hemolytic uremic syndrome in an adult kidney transplant recipient: a case report.成人肾移植受者中补体因子H介导的非典型溶血性尿毒症综合征管理中的个性化依库珠单抗治疗:一例报告
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本文引用的文献

1
Living Donor Kidney Transplantation in Atypical Hemolytic Uremic Syndrome: A Case Series.活体供肾移植治疗非典型溶血尿毒综合征:病例系列研究。
Am J Kidney Dis. 2017 Dec;70(6):770-777. doi: 10.1053/j.ajkd.2017.06.024. Epub 2017 Aug 16.
2
Outcomes of patients with atypical haemolytic uraemic syndrome with native and transplanted kidneys treated with eculizumab: a pooled post hoc analysis.伴有和不伴有移植物的非典型溶血性尿毒综合征患者使用依库珠单抗治疗的结局:一项汇总的事后分析。
Transpl Int. 2017 Dec;30(12):1275-1283. doi: 10.1111/tri.13022. Epub 2017 Sep 8.
3
Long lasting neutralization of C5 by SKY59, a novel recycling antibody, is a potential therapy for complement-mediated diseases.
新型循环抗体 SKY59 可持久中和 C5,有望成为补体介导疾病的潜在治疗方法。
Sci Rep. 2017 Apr 24;7(1):1080. doi: 10.1038/s41598-017-01087-7.
4
Eculizumab Dosing Regimen in Atypical HUS: Possibilities for Individualized Treatment.依库珠单抗剂量方案在非典型溶血尿毒综合征中的应用:实现个体化治疗的可能。
Clin Pharmacol Ther. 2017 Oct;102(4):671-678. doi: 10.1002/cpt.686. Epub 2017 May 26.
5
Atypical haemolytic uraemic syndrome and pregnancy: outcome with ongoing eculizumab.非典型溶血尿毒综合征与妊娠:持续使用依库珠单抗的结局。
Nephrol Dial Transplant. 2016 Dec;31(12):2122-2130. doi: 10.1093/ndt/gfw314. Epub 2016 Sep 1.
6
Blood SC5b-9 complement levels increase at parturition during term and preterm labor.足月和早产分娩时,血液中SC5b-9补体水平会升高。
J Reprod Immunol. 2015 Jun;109:24-30. doi: 10.1016/j.jri.2015.02.008. Epub 2015 Apr 2.
7
Efficacy and safety of eculizumab in atypical hemolytic uremic syndrome from 2-year extensions of phase 2 studies.依库珠单抗治疗非典型溶血性尿毒症综合征的疗效及安全性:来自2期研究2年延长期的结果
Kidney Int. 2015 May;87(5):1061-73. doi: 10.1038/ki.2014.423. Epub 2015 Feb 4.
8
Eculizumab treatment during pregnancy does not affect the complement system activity of the newborn.孕期使用依库珠单抗治疗不会影响新生儿的补体系统活性。
Immunobiology. 2015 Apr;220(4):452-9. doi: 10.1016/j.imbio.2014.11.003. Epub 2014 Nov 13.
9
Anticomplement C5 therapy with eculizumab for the treatment of paroxysmal nocturnal hemoglobinuria and atypical hemolytic uremic syndrome.依库珠单抗抗补体 C5 治疗阵发性睡眠性血红蛋白尿症和非典型溶血尿毒综合征。
Transl Res. 2015 Feb;165(2):306-20. doi: 10.1016/j.trsl.2014.10.010. Epub 2014 Oct 20.
10
Atypical hemolytic uremic syndrome.非典型溶血尿毒综合征。
Semin Nephrol. 2013 Nov;33(6):508-30. doi: 10.1016/j.semnephrol.2013.08.003.