Division of Allergy and Clinical Immunology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Division of Allergy and Immunology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Clin Invest. 2020 Sep 1;130(9):4759-4770. doi: 10.1172/JCI138448.
No known therapies can prevent anaphylaxis. Bruton's tyrosine kinase (BTK) is an enzyme thought to be essential for high-affinity IgE receptor (FcεRI) signaling in human cells. We tested the hypothesis that FDA-approved BTK inhibitors (BTKis) would prevent IgE-mediated responses including anaphylaxis. We showed that irreversible BTKis broadly prevented IgE-mediated degranulation and cytokine production in primary human mast cells and blocked allergen-induced contraction of isolated human bronchi. To address their efficacy in vivo, we created and used what we believe to be a novel humanized mouse model of anaphylaxis that does not require marrow ablation or human tissue implantation. After a single intravenous injection of human CD34+ cells, NSG-SGM3 mice supported the population of mature human tissue-resident mast cells and basophils. These mice showed excellent responses during passive systemic anaphylaxis using human IgE to selectively evoke human mast cell and basophil activation, and response severity was controllable by alteration of the amount of allergen used for challenge. Remarkably, pretreatment with just 2 oral doses of the BTKi acalabrutinib completely prevented moderate IgE-mediated anaphylaxis in these mice and also significantly protected against death during severe anaphylaxis. Our data suggest that BTKis may be able to prevent anaphylaxis in humans by inhibiting FcεRI-mediated signaling.
尚无已知疗法可预防过敏反应。布鲁顿酪氨酸激酶(BTK)被认为是人类细胞中高亲和力 IgE 受体(FcεRI)信号传导所必需的酶。我们测试了以下假设:已批准用于治疗的 BTK 抑制剂(BTKi)可预防 IgE 介导的反应,包括过敏反应。我们发现,不可逆的 BTKi 可广泛抑制原代人肥大细胞中的 IgE 介导的脱颗粒和细胞因子产生,并阻断过敏原诱导的人支气管收缩。为了在体内评估其疗效,我们创建并使用了一种我们认为是新型的过敏反应人源化小鼠模型,该模型不需要骨髓消融或人组织植入。在单次静脉注射人 CD34+细胞后,NSG-SGM3 小鼠支持成熟的人组织驻留肥大细胞和嗜碱性粒细胞的群体。这些小鼠在使用人 IgE 选择性引发人肥大细胞和嗜碱性粒细胞激活的被动全身性过敏反应中表现出出色的反应,并且通过改变用于挑战的过敏原量来控制反应严重程度。值得注意的是,仅用 2 剂口服 BTKi 阿卡替尼预处理即可完全预防这些小鼠中度 IgE 介导的过敏反应,并在严重过敏反应中也显著保护免于死亡。我们的数据表明,BTKi 通过抑制 FcεRI 介导的信号传导,可能能够预防人类的过敏反应。