Braun Lukas M, Zeiser Robert
Department of Medicine I, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
Faculty of Biology, University of Freiburg, Germany.
Hemasphere. 2021 Jun 1;5(6):e581. doi: 10.1097/HS9.0000000000000581. eCollection 2021 Jun.
Allogeneic hematopoietic stem cell transplantation (allo-HCT) is a potentially curative therapy for patients suffering from hematological malignancies, and its therapeutic success is based on the graft-versus-leukemia (GvL) effect. Severe acute and chronic graft-versus-host disease (GvHD) are life-threatening complications after allo-HCT. To date, most of the approved treatment strategies for GvHD rely on broadly immunosuppressive regimens, which limit the beneficial GvL effect by reducing the cytotoxicity of anti-leukemia donor T-cells. Therefore, novel therapeutic strategies that rely on immunomodulatory rather than only immunosuppressive effects could help to improve patient outcomes. Treatments should suppress severe GvHD while preserving anti-leukemia immunity. New treatment strategies include the blockade of T-cell activation via inhibition of dipeptidyl peptidase 4 and cluster of differentiation 28-mediated co-stimulation, reduction of proinflammatory interleukin (IL)-2, IL-6 and tumor necrosis factor-α signaling, as well as kinase inhibition. Janus kinase (JAK)1/2 inhibition acts directly on T-cells, but also renders antigen presenting cells more tolerogenic and blocks dendritic cell-mediated T-cell activation and proliferation. Extracorporeal photopheresis, hypomethylating agent application, and low-dose IL-2 are powerful approaches to render the immune response more tolerogenic by regulatory T-cell induction. The transfer of immunomodulatory and immunosuppressive cell populations, including mesenchymal stromal cells and regulatory T-cells, showed promising results in GvHD treatment. Novel experimental procedures are based on metabolic reprogramming of donor T-cells by reducing glycolysis, which is crucial for cytotoxic T-cell proliferation and activity.
异基因造血干细胞移植(allo-HCT)是治疗血液系统恶性肿瘤患者的一种潜在治愈性疗法,其治疗成功基于移植物抗白血病(GvL)效应。严重的急性和慢性移植物抗宿主病(GvHD)是allo-HCT后的危及生命的并发症。迄今为止,大多数已获批的GvHD治疗策略依赖于广泛的免疫抑制方案,这通过降低抗白血病供体T细胞的细胞毒性来限制有益的GvL效应。因此,依赖免疫调节而非仅免疫抑制作用的新型治疗策略可能有助于改善患者预后。治疗应在保留抗白血病免疫力的同时抑制严重的GvHD。新的治疗策略包括通过抑制二肽基肽酶4和分化簇28介导的共刺激来阻断T细胞活化,减少促炎白细胞介素(IL)-2、IL-6和肿瘤坏死因子-α信号传导,以及激酶抑制。Janus激酶(JAK)1/2抑制不仅直接作用于T细胞,还使抗原呈递细胞更具耐受性,并阻断树突状细胞介导的T细胞活化和增殖。体外光化学疗法、应用低甲基化剂和低剂量IL-2是通过诱导调节性T细胞使免疫反应更具耐受性的有效方法。包括间充质基质细胞和调节性T细胞在内的免疫调节和免疫抑制细胞群体的转移在GvHD治疗中显示出有希望的结果。新的实验程序基于通过减少糖酵解对供体T细胞进行代谢重编程,糖酵解对细胞毒性T细胞的增殖和活性至关重要。
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