Division for Allergy, Pneumology and Cystic Fibrosis, Department for Children and Adolescence, Goethe-University, Frankfurt, Germany.
Division of Nephrology, Department of Internal Medicine III, Goethe-University, Frankfurt, Germany.
Front Immunol. 2019 Nov 27;10:2785. doi: 10.3389/fimmu.2019.02785. eCollection 2019.
Ataxia-telangiectasia (A-T) is a multisystem disorder with progressive cerebellar ataxia, immunodeficiency, chromosomal instability, and increased cancer susceptibility. Cellular immunodeficiency is based on naïve CD4 and CD8 T-cell lymphopenia. Hematopoietic stem cell transplantation (HSCT) offers a potential to cure immunodeficiency and cancer due to restoration of the lymphopoietic system. The aim of this investigation was to analyze the effect of HSCT on naïve CD4 as well as CD8 T-cell numbers in A-T. We analyzed total numbers of peripheral naïve (CD45RACD62L) and memory (CD45ROCD62L) CD4 and CD8 T-cells of 32 A-T patients. Naïve (CD62LCD44) and memory (CD62LCD44) T-cells were also measured in Atm-deficient mice before and after HSCT with GFP-expressing bone marrow derived hematopoietic stem cells. In addition, we analyzed T-cells in the peripheral blood of two A-T patients after HLA-identic allogeneic HSCT. Like in humans, naïve CD4 as well as naïve CD8 lymphocytes were decreased in -deficient mice. HSCT significantly inhibited thymic lymphomas and increased survival time in these animals. Donor cell chimerism increased up to more than 50% 6 months after HSCT accompanied by a significant increase of naïve CD4 and CD8 T-cell subpopulations, but not of memory T-cells. This finding was also identified in the blood of the A-T patients after HSCT. HSCT seems to be a feasible strategy to overcome immunodeficiency and might be a conceivable strategy to avoid T-cell driven cancer in A-T at higher risk for malignancy. Naïve CD4 and CD8 T-cells counts are suitable markers for monitoring immune reconstitution post-HSCT. However, risks and benefits of HSCT in A-T have to be properly weighted.
共济失调毛细血管扩张症(A-T)是一种多系统疾病,具有进行性小脑共济失调、免疫缺陷、染色体不稳定和癌症易感性增加。细胞免疫缺陷基于幼稚 CD4 和 CD8 T 细胞淋巴细胞减少症。造血干细胞移植(HSCT)通过恢复淋巴造血系统,为治愈免疫缺陷和癌症提供了一种可能。本研究旨在分析 HSCT 对 A-T 中幼稚 CD4 以及 CD8 T 细胞数量的影响。我们分析了 32 名 A-T 患者外周血幼稚(CD45RACD62L)和记忆(CD45ROCD62L)CD4 和 CD8 T 细胞的总数。在 HSCT 前后,我们还使用表达 GFP 的骨髓来源造血干细胞测量了 Atm 缺陷小鼠中的幼稚(CD62LCD44)和记忆(CD62LCD44)T 细胞。此外,我们分析了两名 HLA 相同同种异体 HSCT 后 A-T 患者的外周血 T 细胞。与人类一样,-缺陷小鼠中的幼稚 CD4 以及幼稚 CD8 淋巴细胞减少。HSCT 显著抑制了这些动物的胸腺淋巴瘤并延长了其存活时间。供体细胞嵌合度在 HSCT 后 6 个月内增加到 50%以上,伴随着幼稚 CD4 和 CD8 T 细胞亚群的显著增加,但记忆 T 细胞没有增加。这一发现也在 HSCT 后的 A-T 患者的血液中得到了证实。HSCT 似乎是克服免疫缺陷的可行策略,并且可能是避免 A-T 中 T 细胞驱动的癌症的一种可行策略,因为 A-T 患者的恶性肿瘤风险较高。幼稚 CD4 和 CD8 T 细胞计数是监测 HSCT 后免疫重建的合适标志物。然而,HSCT 在 A-T 中的风险和益处必须得到适当权衡。