Department of Pediatric Hematology and Oncology, Cell and Gene Therapy, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.
Pediatr Blood Cancer. 2021 Apr;68(4):e28900. doi: 10.1002/pbc.28900. Epub 2021 Jan 23.
Interferon-gamma (IFN-γ) plays a key role in the pathophysiology of hemophagocytic lymphohistiocytosis (HLH), and available evidence also points to a role in other conditions, including aplastic anemia (AA) and graft failure following allogeneic hematopoietic stem cell transplantation. Recently, the therapeutic potential of IFN-γ inhibition has been documented; emapalumab, an anti-IFN-γ monoclonal antibody, has been approved in the United States for treatment of primary HLH that is refractory, recurrent or progressive, or in patients with intolerance to conventional therapy. Moreover, ruxolitinib, an inhibitor of JAK/STAT intracellular signaling, is currently being investigated for treating HLH. In AA, IFN-γ inhibits hematopoiesis by disrupting the interaction between thrombopoietin and its receptor, c-MPL. Eltrombopag, a small-molecule agonist of c-MPL, acts at a different binding site to IFN-γ and is thus able to circumvent its inhibitory effects. Ongoing trials will elucidate the role of IFN-γ neutralization in secondary HLH and future studies could explore this strategy in controlling hyperinflammation due to CAR T cells.
干扰素-γ (IFN-γ) 在噬血细胞性淋巴组织细胞增生症 (HLH) 的病理生理学中发挥关键作用,现有证据也表明其在其他疾病中发挥作用,包括再生障碍性贫血 (AA) 和异基因造血干细胞移植后的移植物失败。最近,IFN-γ 抑制的治疗潜力已得到证实;抗 IFN-γ 单克隆抗体 emapalumab 已获美国批准用于治疗难治性、复发性或进行性原发性 HLH,或用于不耐受常规治疗的患者。此外,JAK/STAT 细胞内信号通路抑制剂 ruxolitinib 目前正在研究用于治疗 HLH。在 AA 中,IFN-γ 通过破坏血小板生成素与其受体 c-MPL 之间的相互作用来抑制造血。Eltrombopag 是 c-MPL 的小分子激动剂,与 IFN-γ 的结合位点不同,因此能够规避其抑制作用。正在进行的试验将阐明 IFN-γ 中和在继发性 HLH 中的作用,未来的研究可能会探索这种策略来控制 CAR T 细胞引起的过度炎症。
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