Huang Jingyu, Zhang Wei, Xiang Rong, Tan Lu, Liu Peiqiang, Tao Zezhang, Deng Yuqin, Tong Huan, Xu Yu
Department of Rhinology and Allergy, Otolaryngology-Head and Neck Surgery Center, Renmin Hospital of Wuhan University, Wuhan, China.
Research Institute of Otolaryngology-Head and Neck Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
World Allergy Organ J. 2023 Sep 6;16(8):100811. doi: 10.1016/j.waojou.2023.100811. eCollection 2023 Aug.
Allergen immunotherapy is the only etiological treatment for allergic rhinitis.
To analyze the efficacy, safety, and mechanism of subcutaneous immunotherapy (SCIT).
The efficacy, safety, and serum immunological changes of 3 modes of subcutaneous immunotherapy were compared. Peripheral blood mononuclear cells (PBMC) transcriptome changes were obtained on the Illumina sequencing platforms. We confirmed differentially expressed genes (DEGs) by quantitative real-time polymerase chain reaction (PCR). The DEGs were analyzed by gene ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG), and protein-protein interaction (PPI) networks. The correlation between the common DEGs and clinical indicators was analyzed by Origin 2022.
The 3 SCITs were all effective after 1 year. The Combined Symptom and Medication Score (CSMS) and Visual Analog Score (VAS) in rush immunotherapy (RIT) are lowest after 24 and 48 weeks of treatment among the 3 groups. After treatment, the levels of sIgE, sIgE/tIgE, Th2 cytokines, Th17 cytokines, and percentage of peripheral eosinophils (EOS%) decreased significantly (P＜0.05), while the levels of Th1 type cytokines did not change significantly. Transcriptome analysis identified 24, 24, and 91 DEGs at W3 and 42, 52, 175 DEGs at W7 in conventional immunotherapy (CIT), cluster immunotherapy (CLIT), and RIT groups, respectively. The pathways and functions involved in SCIT include secretion of Th1/2 cytokines, immune cell differentiation. Unlike CIT and CLIT, DEGs are also involved in T cell tolerance induction, T cell anergy, and lymphocyte anergy in RIT. CXCR1, CXCR2, and IER3 had a specific effect on reflecting the improvement of symptoms in allergic rhinitis patients with SCIT.
The clinical efficacy of RIT appeared earlier than CIT and CLIT. Clinicians can use the highly conserved gene expression profile to evaluate responses to immunotherapy.
变应原免疫疗法是变应性鼻炎唯一的病因治疗方法。
分析皮下免疫疗法（SCIT）的疗效、安全性及作用机制。
比较3种皮下免疫疗法的疗效、安全性及血清免疫学变化。在Illumina测序平台上获取外周血单个核细胞（PBMC）转录组变化。通过定量实时聚合酶链反应（PCR）确认差异表达基因（DEG）。利用基因本体论（GO）、京都基因与基因组百科全书（KEGG）和蛋白质-蛋白质相互作用（PPI）网络对DEG进行分析。通过Origin 2022分析常见DEG与临床指标之间的相关性。
3种SCIT治疗1年后均有效。在3组中，快速免疫疗法（RIT）在治疗24周和48周后的联合症状与药物评分（CSMS）和视觉模拟评分（VAS）最低。治疗后，特异性免疫球蛋白E（sIgE）、sIgE与总免疫球蛋白E（tIgE）的比值、辅助性T细胞2（Th2）细胞因子、辅助性T细胞17（Th17）细胞因子水平及外周血嗜酸性粒细胞百分比（EOS%）显著降低（P＜0.05）,而辅助性T细胞1（Th1）型细胞因子水平无明显变化。转录组分析显示，常规免疫疗法（CIT）组、集群免疫疗法（CLIT）组和RIT组在第3周分别有24、24和91个DEG，在第7周分别有42、52、175个DEG。SCIT涉及的途径和功能包括Th1/2细胞因子分泌、免疫细胞分化。与CIT和CLIT不同，RIT中的DEG还参与T细胞耐受性诱导、T细胞无反应性和淋巴细胞无反应性。CXC趋化因子受体1（CXCR1）、CXC趋化因子受体2（CXCR2）和早老素反应蛋白3（IER3）对反映接受SCIT治疗变应性鼻炎患者的症状改善有特异性作用。
RIT的临床疗效出现早于CIT和CLIT。临床医生可利用高度保守的基因表达谱评估免疫治疗反应。
