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多发性硬化症患者自体造血干细胞移植后炎症和神经退行性生物标志物的动态变化。

Dynamics of Inflammatory and Neurodegenerative Biomarkers after Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis.

机构信息

Neuroimmunology and Multiple Sclerosis Research, Neurology Clinic, University Hospital Zurich, University Zurich, Frauenklinikstrasse 26, 8091 Zurich, Switzerland.

Department of Clinical Research, Neurology Clinic, University Hospital Basel, Schanzenstrasse 55, 4031 Basel, Switzerland.

出版信息

Int J Mol Sci. 2022 Sep 19;23(18):10946. doi: 10.3390/ijms231810946.

Abstract

Autologous hematopoietic stem cell transplantation (aHSCT) is a highly efficient treatment of multiple sclerosis (MS), and hence it likely normalizes pathological and/or enhances beneficial processes in MS. The disease pathomechanisms include neuroinflammation, glial cell activation and neuronal damage. We studied biomarkers that in part reflect these, like markers for neuroinflammation (C-X-C motif chemokine ligand (CXCL) 9, CXCL10, CXCL13, and chitinase 3-like 1 (CHI3L1)), glial perturbations (glial fibrillary acidic protein (GFAP) and in part CHI3L1), and neurodegeneration (neurofilament light chain (NfL)) by enzyme-linked immunosorbent assays (ELISA) and single-molecule array assay (SIMOA) in the serum and cerebrospinal fluid (CSF) of 32 MS patients that underwent aHSCT. We sampled before and at 1, 3, 6, 12, 24 and 36 months after aHSCT for serum, as well as before and 24 months after aHSCT for CSF. We found a strong increase of serum CXCL10, NfL and GFAP one month after the transplantation, which normalized one and two years post-aHSCT. CXCL10 was particularly increased in patients that experienced reactivation of cytomegalovirus (CMV) infection, but not those with Epstein-Barr virus (EBV) reactivation. Furthermore, patients with CMV reactivation showed increased Th1 phenotype in effector memory CD4+ T cells. Changes of the other serum markers were more subtle with a trend for an increase in serum CXCL9 early post-aHSCT. In CSF, GFAP levels were increased 24 months after aHSCT, which may indicate sustained astroglia activation 24 months post-aHSCT. Other CSF markers remained largely stable. We conclude that MS-related biomarkers indicate neurotoxicity early after aHSCT that normalizes after one year while astrocyte activation appears increased beyond that, and increased serum CXCL10 likely does not reflect inflammation within the central nervous system (CNS) but rather occurs in the context of CMV reactivation or other infections post-aHSCT.

摘要

自体造血干细胞移植 (aHSCT) 是多发性硬化症 (MS) 的一种高效治疗方法,因此它可能使 MS 中的病理和/或有益过程正常化。疾病的发病机制包括神经炎症、胶质细胞激活和神经元损伤。我们研究了部分反映这些过程的生物标志物,如神经炎症标志物 (C-X-C 基序趋化因子配体 (CXCL) 9、CXCL10、CXCL13 和几丁质酶 3 样蛋白 1 (CHI3L1))、神经胶质细胞扰动标志物 (胶质纤维酸性蛋白 (GFAP) 和部分 CHI3L1) 和神经退行性标志物 (神经丝轻链 (NfL)),通过酶联免疫吸附测定 (ELISA) 和单分子阵列测定 (SIMOA) 在 32 名接受 aHSCT 的 MS 患者的血清和脑脊液 (CSF) 中进行检测。我们在 aHSCT 前和 aHSCT 后 1、3、6、12、24 和 36 个月采集血清样本,并在 aHSCT 前和 aHSCT 后 24 个月采集 CSF 样本。我们发现,移植后一个月,血清中 CXCL10、NfL 和 GFAP 水平显著升高,aHSCT 后 1 年和 2 年时恢复正常。在巨细胞病毒 (CMV) 感染再激活的患者中,CXCL10 尤其升高,而 EBV 再激活的患者则没有。此外,CMV 再激活的患者在效应记忆 CD4+T 细胞中表现出 Th1 表型增加。其他血清标志物的变化较为微妙,aHSCT 后早期血清 CXCL9 呈上升趋势。在 CSF 中,GFAP 水平在 aHSCT 后 24 个月升高,这可能表明 aHSCT 后 24 个月时星形胶质细胞持续激活。其他 CSF 标志物基本保持稳定。我们得出结论,MS 相关生物标志物表明 aHSCT 后早期存在神经毒性,1 年后恢复正常,而星形胶质细胞激活似乎在此之后增加,血清 CXCL10 增加可能不反映中枢神经系统 (CNS) 内的炎症,而是发生在 aHSCT 后 CMV 再激活或其他感染的背景下。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e77a/9503241/ea977d1429f7/ijms-23-10946-g001.jpg

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