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自身免疫性肝炎中的免疫功能失调:从发病机制到新疗法。

Dysfunctional Immune Regulation in Autoimmune Hepatitis: From Pathogenesis to Novel Therapies.

机构信息

Department of Anesthesia, Critical Care & Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.

Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.

出版信息

Front Immunol. 2021 Sep 28;12:746436. doi: 10.3389/fimmu.2021.746436. eCollection 2021.

Abstract

Autoimmune hepatitis (AIH) is a chronic inflammatory disorder characterized by hypergammaglobulinemia, presence of serum autoantibodies and histological features of interface hepatitis. AIH therapeutic management still relies on the administration of corticosteroids, azathioprine and other immunosuppressants like calcineurin inhibitors and mycophenolate mofetil. Withdrawal of immunosuppression often results in disease relapse, and, in some cases, therapy is ineffective or associated with serious side effects. Understanding the mechanisms underlying AIH pathogenesis is therefore of paramount importance to develop more effective and well tolerated agents capable of restoring immunotolerance to liver autoantigens. Imbalance between effector and regulatory cells permits liver damage perpetuation and progression in AIH. Impaired expression and regulation of CD39, an ectoenzyme key to immunotolerance maintenance, have been reported in Tregs and effector Th17-cells derived from AIH patients. Interference with these altered immunoregulatory pathways may open new therapeutic avenues that, in addition to limiting aberrant inflammatory responses, would also reconstitute immune homeostasis. In this review, we highlight the most recent findings in AIH immunopathogenesis and discuss how these could inform and direct the development of novel therapeutic tools.

摘要

自身免疫性肝炎(AIH)是一种慢性炎症性疾病,其特征是高丙种球蛋白血症、血清自身抗体存在和界面肝炎的组织学特征。AIH 的治疗管理仍然依赖于皮质类固醇、硫唑嘌呤和其他免疫抑制剂的应用,如钙调神经磷酸酶抑制剂和霉酚酸酯。免疫抑制的停药常常导致疾病复发,在某些情况下,治疗无效或伴有严重的副作用。因此,了解 AIH 发病机制的机制对于开发更有效和耐受良好的药物以恢复对肝自身抗原的免疫耐受至关重要。效应细胞和调节细胞之间的失衡允许肝损伤在 AIH 中持续和进展。已经在 AIH 患者来源的调节性 T 细胞(Tregs)和效应 Th17 细胞中报道了 CD39 的表达和调节受损,CD39 是维持免疫耐受的关键外切酶。干扰这些改变的免疫调节途径可能会开辟新的治疗途径,除了限制异常炎症反应外,还可以重建免疫稳态。在这篇综述中,我们强调了 AIH 免疫发病机制的最新发现,并讨论了这些发现如何为新型治疗工具的开发提供信息和指导。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/fde3/8510512/dfba34277108/fimmu-12-746436-g001.jpg

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