Longhi Maria Serena, Zhang Lina, Mieli-Vergani Giorgina, Vergani Diego
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA; School of Arts and Sciences, Tufts University, Medford, MA, USA.
Autoimmun Rev. 2024 Jul-Aug;23(7-8):103591. doi: 10.1016/j.autrev.2024.103591. Epub 2024 Aug 6.
Autoimmune hepatitis (AIH) is a severe hepatopathy characterized by hypergammaglobulinemia, presence of serum autoantibodies and histological appearance of interface hepatitis. Liver damage in AIH is initiated by the presentation of a liver autoantigen to uncommitted Th0 lymphocytes, followed by a cascade of effector immune responses culminating with the production of inflammatory cytokines, activation of cytotoxic cells and subsequent hepatocyte injury. B cells actively participate in AIH liver damage by presenting autoantigens to uncommitted T lymphocytes. B cells also undergo maturation into plasma cells that are responsible for production of immunoglobulin G and autoantibodies, which mediate antibody dependent cell cytotoxicity. Perpetuation of effector immunity with consequent progression of liver damage is permitted by impairment in regulatory T cells (Tregs), a lymphocyte subset central to the maintenance of immune homeostasis. Treg impairment in AIH is multifactorial, deriving from numerical decrease, reduced suppressive function, poor response to IL-2 and less stable phenotype. In this review, we discuss the role of B and T lymphocytes in the pathogenesis of AIH. Immunotherapeutic strategies that could limit inflammation and halt disease progression while reconstituting tolerance to liver autoantigens are also reviewed and discussed.
自身免疫性肝炎(AIH)是一种严重的肝病,其特征为高球蛋白血症、血清自身抗体的存在以及界面性肝炎的组织学表现。AIH中的肝损伤始于肝脏自身抗原呈递给未分化的Th0淋巴细胞,随后是一系列效应免疫反应,最终产生炎性细胞因子、激活细胞毒性细胞并导致肝细胞损伤。B细胞通过将自身抗原呈递给未分化的T淋巴细胞,积极参与AIH肝损伤。B细胞还会成熟为浆细胞,浆细胞负责产生免疫球蛋白G和自身抗体,介导抗体依赖性细胞毒性作用。调节性T细胞(Tregs)功能受损会使效应免疫持续存在,从而导致肝损伤进展,Tregs是维持免疫稳态的核心淋巴细胞亚群。AIH中Treg功能受损是多因素的,源于数量减少、抑制功能降低、对白细胞介素-2反应不佳以及表型稳定性较差。在本综述中,我们讨论了B淋巴细胞和T淋巴细胞在AIH发病机制中的作用。还对可以限制炎症、阻止疾病进展并同时重建对肝脏自身抗原耐受性的免疫治疗策略进行了综述和讨论。