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靶向耗竭 TRBV9 T 细胞作为一名强直性脊柱炎患者的免疫疗法。

Targeted depletion of TRBV9 T cells as immunotherapy in a patient with ankylosing spondylitis.

机构信息

Pirogov Russian National Research Medical University, Moscow, Russia.

Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Moscow, Russia.

出版信息

Nat Med. 2023 Nov;29(11):2731-2736. doi: 10.1038/s41591-023-02613-z. Epub 2023 Oct 23.

Abstract

Autoimmunity is intrinsically driven by memory T and B cell clones inappropriately targeted at self-antigens. Selective depletion or suppression of self-reactive T cells remains a holy grail of autoimmune therapy, but disease-associated T cell receptors (TCRs) and cognate antigenic epitopes remained elusive. A TRBV9-containing CD8 TCR motif was recently associated with the pathogenesis of ankylosing spondylitis, psoriatic arthritis and acute anterior uveitis, and cognate HLA-B27-presented epitopes were identified. Following successful testing in nonhuman primate models, here we report human TRBV9 T cell elimination in ankylosing spondylitis. The patient achieved remission within 3 months and ceased anti-TNF therapy after 5 years of continuous use. Complete remission has now persisted for 4 years, with three doses of anti-TRBV9 administered per year. We also observed a profound improvement in spinal mobility metrics and the Bath Ankylosing Spondylitis Metrology Index (BASMI). This represents a possibly curative therapy of an autoimmune disease via selective depletion of a TRBV-defined group of T cells. The anti-TRBV9 therapy could potentially be applicable to other HLA-B27-associated spondyloarthropathies. Such targeted elimination of the underlying cause of the disease without systemic immunosuppression could offer a new generation of safe and efficient therapies for autoimmunity.

摘要

自身免疫是由记忆性 T 和 B 细胞克隆异常靶向自身抗原所驱动的。选择性耗尽或抑制自身反应性 T 细胞仍然是自身免疫治疗的圣杯,但与疾病相关的 T 细胞受体(TCR)和同源抗原表位仍然难以捉摸。最近,一个含有 TRBV9 的 CD8 TCR 基序与强直性脊柱炎、银屑病关节炎和急性前葡萄膜炎的发病机制有关,并鉴定出相应的 HLA-B27 呈递的表位。在非人类灵长类动物模型中成功测试后,我们在这里报告了强直性脊柱炎中人类 TRBV9 T 细胞的消除。患者在 3 个月内达到缓解,并在连续使用 5 年后停止使用抗 TNF 治疗。目前已经持续缓解了 4 年,每年接受 3 次抗 TRBV9 治疗。我们还观察到脊柱活动度指标和 Bath 强直性脊柱炎计量指数(BASMI)的显著改善。这代表了通过选择性耗尽 TRBV 定义的 T 细胞群来治疗自身免疫疾病的一种可能的治愈疗法。抗 TRBV9 疗法可能适用于其他 HLA-B27 相关的脊柱关节病。这种对疾病根本原因的靶向消除而不进行全身免疫抑制,可能为自身免疫提供新一代安全有效的治疗方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b4a5/10667094/f16ac913eb3e/41591_2023_2613_Fig1_HTML.jpg

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