基因治疗在肿瘤过继性免疫治疗中的应用

过继性输注肿瘤浸润性淋巴细胞(TILs)能可靠地治疗转移性黑色素瘤,并使其有效率稳定在50%左右.但由于受TIL来源的限制,大多数非黑色素瘤病人无法使用过继性免疫治疗.使用抗肿瘤抗原TCR修饰的T淋巴细胞成功用于黑色素瘤病人的治疗为非黑色素瘤癌症病人的过继性免疫治疗提供了方向.本综述介绍了近几年来肿瘤特异性过继免疫治疗的进展,重点介绍基因修饰的T淋巴细胞的应用及存在的问题,并展望了发展前景.     

骨髓间充质干细胞对致脑脊髓炎性MBP68-86特异性T淋巴细胞的调节作用

目的 探讨骨髓间充质干细胞(MSCs)对致脑脊髓炎性MBP68-86-特异性T淋巴细胞的抑制和激活作用.方法 全骨髓贴壁法提取、培养Lewis大鼠股骨、胫骨内的MSCs;建立实验性自身免疫性脑脊髓炎(EAE)动物模型,对照组大鼠仅免疫完全弗氏佐剂(CFA);EAE大鼠免疫10～11 d后,MBP68-86特异性T淋巴细胞被取出进行体外T淋巴细胞增值试验.从Lewis大鼠中得到的间质干细胞分别按下列要求预培养:在24孔板中与T细胞比值:1:1(1×106骨髓基质细胞/T细胞1×106)1:5、1:10、1:50或1:100;ELISA方法检测淋巴细胞培养上清液.结果 同种同基因的MSCs以MSCs与效应T细胞比例为1:1、1:5、1:10时共培养能够显著抑制MBP68-86特异性T淋巴细胞的增殖能力,与没有加入MSCs的单独MBP68-86特异性T淋巴细胞组相比差异具有统计学意义(P＜0.01).结论 MSCs在高密度(MSCs/T细胞数比≥1:10)的情况下,对MBP68-86-特异性T细胞表现为抑制作用;在较低的密度(≤1:50)时,表现为刺激的作用.     

过继肿瘤特异性淋巴细胞联合mIL-21瘤苗抗肿瘤效应研究

目的 在环磷酰胺(Cy)所致小鼠淋巴细胞急剧减少状态下,过继mIL-21转染的瘤苗细胞(mIL-21-Sp2/0)免疫致敏的同系小鼠淋巴细胞,联合mIL-21-Sp2/0瘤苗免疫,探讨过继免疫抗瘤效应机制.方法 用Cy 100 mg/kg预处理BALB/c小鼠2 d后,以灭活mIL-21瘤苗免疫的同系小鼠脾及淋巴结的淋巴细胞作为肿瘤抗原特异性淋巴细胞过继给Cy预处理鼠,同时用mIL-21瘤苗免疫,7 d后以野生型Sp2/0细胞攻击,观察小鼠的肿瘤生长情况.流式细胞仪(FCM)分析CD4+、CD8+、CD4+CD25+T细胞等亚群的变化,分别以CFSE和7-AAD标记,FCM检测淋巴细胞增殖能力和效应细胞的细胞毒活性,用ELISPOT检测分泌IFN-γ的淋巴细胞数量.结果 与对照组相比,Cy预处理小鼠接受过继效应细胞及mIL-21瘤苗免疫后,可有效地抵抗野生型Sp2/0细胞的攻击.过继的肿瘤特异性淋巴细胞的体内增殖能力和体外杀伤活性显著增强,分泌IFN-γ效应细胞的数量显著增高.结论 在小鼠淋巴细胞减少期,过继mIL-21瘤苗免疫致敏的肿瘤抗原特异性淋巴细胞并同时给予mIL-21瘤苗免疫,利于输入的效应细胞及自身免疫细胞的增殖和特异性抗肿瘤功能的形成与维持.     

过继免疫疗法在异基因造血干细胞移植中的应用

近年来免疫识别等方面取得的一些研究进展为克服或逆转异基因造血干细胞移植（Allo－HSCT）的主要伴发症——继发性免疫缺陷和移植物抗宿病（GVHD）提供了新思路：如过继输注病毒特异性T淋巴细胞,重建移植病人的特异性免疫功能;Allo-HSCT后行供体淋巴细胞输入（DLI）延长病人的缓解期,以及诱导移植物抗白血病（GVL）效应等。因此,本文就近几年来异基因造血干细胞移植中过继免疫疗法的某些研究进展进行综述。     

同种特异T细胞疫苗诱导移植物存活期延长的研究——Ⅰ.同种特异T细胞疫苗诱导的细胞免疫水平低下

在体外实验中观察了同种特异T细胞疫苗（TCV）免疫鼠T淋巴细胞对同种抗原和有丝分裂原（ConA）的反应能力。B6同种抗原特异TCV免疫的BALB/c小鼠对B6同种抗原的反应（MLR）能力明显变抑制,对无关第三者同种抗原AKR的反应能力也显著下降,表明存在抗原非特异性的抑制作用。在BALB/c同种抗原特异TCV免疫的B6小鼠中,获得一致的结果。在观察两组TCV免疫动物T细胞对Cond诱导的淋巴细胞增殖实验中,与正常小鼠 T细胞反应性比较,TCV免疫动物 T细胞的增殖能力显著下降,表现为抗原非特异作用。此与MLR中ConA-T细胞免疫动物的结果相一致。在CML实验里,同种抗原特异TCV免疫小鼠的脾细胞体外诱导同种CTL活性明显受到抑制,CTL 活性十分低下。体外实验结果表明:同种特异TCV免疫小鼠可诱发同种抗原反应和对ConA诱发的增殖反应能力显著低下,表现为抗原非特异性作用。     

自身免疫肝炎研究进展

自身免疫性肝炎是伴随肝细胞慢性进行性破坏与肝功能受损，表现为慢性活动性肝炎的一种自身免疫性肝疾病。其具体的发病机制虽不清楚，但循环自身抗体的不断发现，自身反应性肝浸润型Ｔ淋巴细胞的存在，ＨＬＡⅡ类抗原异常表达以及伴发其他自身免疫病和对免疫抑制剂治疗有效等诸多特征提示为自身免疫发生过程。近年来，对其遗传机制，尤其是易感基因的免疫遗传学研究作了大量的探讨。     

自身免疫肝炎研究进展

自身免疫性肝炎是伴随肝细胞慢性进行性破坏与肝功能受损，表现为慢性活动性肝炎的一种自身免疫性肝疾病。其具体的发病机制虽不清楚，但循环自身抗体的不断发现，自身反应性肝浸润型Ｔ淋巴细胞的存在，ＨＬＡⅡ类抗原异常表达以及伴发其他自身免疫病和对免疫抑制剂治疗有效等诸多特征提示为自身免疫发生过程，近年来，对其遗传机制，尤其是易感基因的免疫遗传学研究作了大量的探讨。     

HLA-肽四聚体和过继性免疫疗法与巨细胞病毒疾病(英文)

背景:抗病毒药物能减少早期的巨细胞病毒疾病,但有较强的毒性和引起晚期巨细胞病毒疾病发生的可能。为了更好地防治巨细胞病毒疾病,研究细胞毒性T淋巴细胞控制巨细胞病毒再活化的作用是很关键的,荧光HLA-肽四聚体是一个很好的工具,被用来监测移植受者的巨细胞病毒特异细胞毒性T淋巴细胞的恢复。目的:探讨HLA-肽四聚体和过继性免疫疗法在治疗巨细胞病毒疾病中的作用。方法:由第一、二作者检索2003/2009PubMed数据库及万方数据库有关移植后巨细胞病毒特异细胞毒性T淋巴细胞检测、抗病毒药物应用、HLA肽四聚体应用、过继性免疫治疗作用的文献,英文检索词为"HLA-peptide tetramers,cytomegalovirus,specific CTL,adoptive immunotherapy",中文检索词为"HLA-肽四聚体,巨细胞病毒,特异细胞毒性T淋巴细胞,过继性免疫治疗"。排除重复性研究,纳入29篇归纳总结。结果与结论:用巨细胞病毒特异细胞毒性T淋巴细胞进行的过继性免疫治疗是非常完美的策略,然而,产生这些细胞是昂贵和耗时的,因此治疗不是在每个移植中心都能进行。用HLA-肽四聚体从巨细胞病毒血清阳性供者外周血中选择巨细胞病毒特异细胞毒性T淋巴细胞是非常有希望的策略,使过继性免疫疗法更容易进行。     

068 实验性自身免疫性甲状腺炎动物模型的建立

自身免疫性甲状腺炎是一种常见的器官特异性自身免疫性疾病,其病理特征是甲状腺组织内淋巴细胞和单核细胞浸润.实验性自身免疫性甲状腺炎(EAT)动物模型是研究自身免疫性甲状腺炎的重要工具.目前已经建立的EAT模型可分为自发产生的EAT,运用T细胞减除法产生的EAT,以及免疫方法诱导产生的EAT等几类.     

经导管动脉栓塞化疗联合射频消融和细胞因子诱导的杀伤细胞输注治疗小肝癌

目的 探讨经导管动脉栓塞化疗(TACE)联合射频消融(RFA)后行自体细胞因子诱导的杀伤细胞(CIK)输注治疗对小肝癌的疗效.评价CIK细胞过继免疫治疗后患者免疫指标的变化.方法 2004年2月至2006年2月本院收治的小肝癌患者43例,分为两组,所有患者均行TACE联合RFA治疗.其中研究组患者21例,均完成4次以上自体CIK细胞输注治疗,每次回输CIK细胞的数量为(1.1～1.5)×1010m,检测研究组患者在CIK治疗前后外周血T淋巴细胞亚群及NK细胞水平的变化;对照组患者22例,未行CIK细胞过继免疫治疗.两组患者均每1～2个月评价肿瘤情况.结果 (1)对照组治疗后第1、2和3年的肝内累积复发率分别为9.1%、22.3%和27.3%;术后1、2和3年的生存率分别为95.5%、81.8%和68.2%.研究组第1、2和3年的肝内累积复发率分别是9.5%、14.3%和19.0%;术后1、2和3年的生存率分别为95.2%、85.7%和76.2%.两组生存率差异无统计学意义(P=0.558).(2)研究组CIK细胞治疗前后外周血T淋巴细胞亚群检测显示CD3+、CD4+、CD56+(NK)效应细胞的比例和CD4+/CD8+比值显著上升(P<0.05),CD8+和CD3+CD56+效应细胞比例下降(P<0.05).结论 TACE序贯联合RFA和CIK细胞过继免疫细胞治疗小肝癌可以提高患者的机体免疫水平,可能对降低肿瘤复发,延长小肝癌患者的生存期有一定作用.     

Liver cell surface localization of hepatitis B antigen and of immunoglobulins in acute and chronic hepatitis and in liver cirrhosis.

This paper describes immunofluorescence studies on liver cell surface localization of hepatitis B surface antigen (HBsAg) and of IgG in acute and chronic hepatitis and in cirrhosis. In acute hepatitis B, HBsAg was found at the surface of hepatocytes in an early phase of the disease, but not during the recovery. This finding is consistent with the hypothesis that immune reactions to HBsAg may be responsible for the liver cell lysis. In HBsAg-positive chronic hepatitis and cirrhosis the antigen was found in the cytoplasm, but not on the surface of the hepatocytes, while in HBsAg-negative cases the antigen could not be detected in the liver cells. Both in HBsAg-positive and in HBsAg-negative chronic active hepatitis (CAH) and cryptogenic cirrhosis IgG bound to the membrane of the hepatocytes could be detected, suggesting a role of antibodies in the pathogenesis of the disease.     

Interleukin-6 (IL-6) serum concentrations in dogs with hepatitis and hepatic tumours compared with those with extra-hepatic inflammation and tumours

Cytokines are part of pathogenesis in many diseases. Their measurement could be interesting for diagnostic purposes. One cytokine which participates in different inflammatory and neoplastic diseases is interleukin-6 (IL-6). The aim of this study was to investigate the IL-6 serum concentration in dogs with different liver diseases to show if there is any association between the cytokine serum level and the disease aetiology or the degree of the disease. IL-6 was measured in dogs with acute hepatitis, chronic hepatitis of different degrees and primary and secondary liver tumours. The data were compared with clinically healthy dogs and dogs with extra-hepatic diseases. For measurement, a commercial ELISA Kit (R&D Systems) was used. Compared with clinically healthy dogs and dogs with diabetes mellitus, all dogs with an intra- or extra-hepatic inflammatory or neoplastic disease have increased serum levels of IL-6. Dogs with acute hepatitis have significantly increased IL-6 serum concentrations compared with dogs with chronic hepatitis (P?<?0.05). No significant difference between mild and moderate chronic hepatitis exists (P?>?0.05). Dogs with secondary liver tumours have significantly increased IL-6 serum concentrations in comparison to dogs with primary liver tumours (P?<?0.01), but both groups have comparable IL-6 serum concentration to dogs with extra-hepatic tumours. Measurement of IL-6 serum concentration may help differentiate between acute and chronic hepatitis and between primary and secondary liver tumours. Further information about the aetiology of the liver disease cannot be obtained by measuring IL-6 in the serum.     

An inhibitor of interleukin‐6 trans‐signalling,sgp130, contributes to impaired acute phase response in human chronic liver disease

In chronic liver disease, high circulating interleukin (IL)‐6 contrasts with a poor acute phase response. We evaluated the impact of liver and circulating IL‐6‐receptor (IL‐6R) forms on IL‐6 bioactivity in chronic liver disease. IL‐6, soluble IL‐6‐receptor and sgp130 levels were assayed in plasma from 45 patients with alcoholic liver disease, 84 with hepatitis C virus (HCV) infection undergoing transjugular liver biopsies and 15 healthy subjects. IL‐6R mRNA was quantified on liver extracts from 54 patients with alcoholic liver disease with or without cirrhosis and 18 HCV‐infected patients. The effect of gp130–Fc on fibrinogen secretion induced by IL‐6 trans‐signalling was evaluated on hepatocyte cultures. Levels of plasma IL‐6 and sgp130, but not soluble IL‐6R, increased with the stage of chronic liver disease, and correlated significantly with disease severity. Alcoholic liver disease patients had higher plasma IL‐6 levels than hepatitis C, but lower liver IL‐6R expression. In alcoholic and HCV‐related liver diseases, liver IL‐6R expression decreased with advanced fibrosis stage. In vitro, on hepatocytes, gp130–Fc blunted the acute phase response while soluble IL‐6R enhanced IL‐6 stimulation. In advanced chronic liver disease, high plasma IL‐6 is associated with low liver IL‐6R expression. This situation enables high plasma sgp130 to act as a major negative regulator of liver IL‐6 trans‐signalling, as demonstrated functionally here on hepatocytes. This might explain the poor acute phase response induced by IL‐6 in chronic liver disease.     

Serum interleukin-6 and interferon-gamma levels in patients with hepatitis B-associated chronic liver disease

Hepatitis B virus (HBV) infection can elicit a variety of clinical sequelae ranging from acute self-limited hepatitis to hepatocellular carcinoma, which are not attributable to a direct cytopathic effect of the virus but rather to the individual host's immune response. Cytokines, low-molecular-weight proteins with a broad range of activity, have been shown to be involved in the regulation of hepatocyte functions, as well as in the pathogenesis leading to liver damage. In the present study, we investigated the correlation between serum interleukin 6 (IL-6) and interferon gamma (IFN-gamma) in altogether 75 patients chronically infected with HBV. They comprised 15 asymptomatic carriers, 15 chronic persistent hepatitis (CPH) and 15 chronic active hepatitis (CAH) patients, 15 cases of cirrhosis and 15 patients with hepatocellular carcinoma (HCC) previously diagnosed by serology and histology, respectively. IL-6 and IFN-gamma levels in their sera were determined using a commercially available kit. Our results showed various concentrations of serum IL-6 detectable in 6.7% of asymptomatic carriers, 13.3% of patients with CPH, 20% of patients with CAH, 33.3% in cirrhotic patients and 66.7% in HCC. In contrast, serum IFN-gamma was only found in 13.3% of asymptomatic carriers and CAH, but could not be detected in the other groups. Our data demonstrated a positive correlation between serum IL-6 and clinical severity of chronic HBV infection, whereas the IFN-gamma levels appeared not to be correlated. From this we conclude that among chronic hepatitis patients IFN-gamma is mostly not expressed at a level detectable by serology, whereas according to other authors it is involved in the immediate immune response triggered by acute hepatitis. IL-6 on the other hand, might rather be responsible for liver inflammation and regeneration in chronic liver disease.     

Synergism between ethanol and carbon tetrachloride in the generation of liver fibrosis

In this study, alcohol-induced histological lesions in a short-term experimental rat model were compared with those characteristic of human alcoholic liver disease. In the rat model used, pretreatment with carbon tetrachloride (CCl4) for 6 weeks was employed possibly to sensitize the liver for the effects of alcohol and shorten the time of induction of alcoholic liver disease. After 6 weeks of CCl4 treatment, subsequent maintenance on drinking water containing up to 10 per cent alcohol for 7 weeks potentiated liver fibroplasia as compared with non-alcohol-treated rats. However, steatosis and alcoholic hepatitis, as histological evidence for alcoholic liver disease as seen in humans, were not observed. In non-CCl4-pretreated control animals, alcohol administration had no effect on liver histology. It can be concluded that in the model used, CCl4 pretreatment sensitizes the liver to increase collagen deposition following alcohol administration, but not to steatosis or alcoholic hepatitis as seen in human alcoholic liver disease. In this experimental set-up, direct metabolic interaction of CCl4 with alcohol as a cause of the increased fibroplasia can be excluded.     

慢性肝病患者外周血Ghrelin与炎性细胞因子的水平检测及其相关性研究

目的:探讨外周血Ghrelin与炎性细胞因子TNF-α、IL-1及IL-6表达水平与慢性乙型肝炎、肝炎肝硬化、非酒精性脂肪性肝病肝脏损害程度的相关关系.方法:慢性肝病患者组和健康对照组血浆中Ghrelin、TNF-α、IL-1及IL-6表达水平检测采用酶联免疫吸附实验(ELISA).结果:慢性乙型肝炎、肝炎肝硬化患者外周血Ghrelin表达明显升高,与正常对照组比较差异显著(P＜0.05,P＜0.01),失代偿期肝硬化(B、C级)患者外周血Ghrelin水平明显高于慢性乙型肝炎组(P＜0.05);Ghrelin在非酒精性脂肪肝病患者组外周血明显降低,与正常对照组比较差异显著(P＜0.01);慢性肝炎、肝炎肝硬化患者外周血Ghrelin表达与炎性细胞因子TNF-α、IL-1及IL-6呈正相关(慢性肝炎组r值分别为0.587、0.995、0.985,肝硬化组r值分别为0.730、0.966、0.979),而在NAFLD疾病组则呈负相关(r值分别为-0.660、-0.873、-0.894).结论:Ghrelin在慢性乙型肝炎、肝炎肝硬化患者组外周血高表达,而在非酒精性脂肪性肝病患者组外周血低表达,Ghrelin表达水平与慢性肝病的发生发展过程相关.     

Localisation of intrahepatic interleukin 6 in patients with acute and chronic liver disease.

AIM: To evaluate the role of local interleukin 6 (IL-6) in the pathogenesis of acute and chronic liver disease. METHODS: The cellular site of IL-6 in cryostat sections of liver from 31 patients with liver disease was examined using indirect immunofluorescence with a monoclonal antibody. RESULTS: IL-6 staining in sinusoidal endothelial cells was very noticeable and diffusely distributed in the lobules of specimens of acute viral hepatitis. IL-6 expression in endothelial cells, particularly in necrotic areas of hepatocytes, was increased and was accompanied by enhanced expression in Kupffer cells. In contrast, IL-6 staining in infiltrating mononuclear cells was prominent in portal tracts, and the numbers of cytokine positive cells were greater in specimens of chronic active hepatitis compared with chronic persistent hepatitis. In non-specific reactive hepatitis intrahepatic expression of IL-6 was minimal, while in alcoholic liver fibrosis the cytokine distribution in the lobules was similar to that of acute viral hepatitis. CONCLUSIONS: These results indicate that locally produced IL-6 contributes to the inflammatory process and immunological response in acute and chronic liver disease.     

HHV-6A in syncytial giant-cell hepatitis

Syncytial giant-cell hepatitis is a rare but severe form of hepatitis that is associated with autoimmune diseases, drug reactions, and viral infections. We used serologic, molecular, and immunohistochemical methods to search for an infectious cause in a case of syncytial giant-cell hepatitis that developed in a liver-transplant recipient who had latent infection with variant B of human herpesvirus 6 (HHV-6B) and who had received the organ from a donor with variant A latent infection (HHV-6A). At the onset of the disease, the detection of HHV-6A (but not HHV-6B) DNA in plasma, in affected liver tissue, and in single micromanipulated syncytial giant cells with the use of two different polymerase-chain-reaction (PCR) assays indicated the presence of active HHV-6A infection in the patient. Expression of the HHV-6A-specific early protein, p41/38, but not of the HHV-6B-specific late protein, p101, was demonstrated only in liver syncytial giant cells in the absence of other infectious pathogens. The same markers of HHV-6A active infection were documented in serial follow-up samples from the patient and disappeared only at the resolution of syncytial giant-cell hepatitis. Neither HHV-6B DNA nor late protein was identified in the same follow-up samples from the patient. Thus, HHV-6A may be a cause of syncytial giant-cell hepatitis.     

Non-specificity of circulating immune complexes in patients with acute and chronic liver disease.

Circulating immune complexes have been described in viral hepatitis and primary biliary cirrhosis but their significance is unclear. Seventy-three patients with acute and chronic liver diseases were evaluated to determine the specificity of immune complex detection for a given liver disease. Immune complexes were measured by the fluid- and solid-phase Clq-binding assays. They were demonstrated frequently in all patients with liver disease, including those with viral hepatitis, alcoholic cirrhosis, chronic active and persistent hepatitis, drug-induced hepatitis and hepatic metastases. The presence of immune complexes was not specific for a given type of liver disease and did not correlate with hepatic dysfunction. We conclude that the detection of immune complexes is of no apparent diagnostic use in liver disease. Further evaluation of the antigen-antibody composition would be required to determine any pathogenic significance of the detected circulating immune complexes.     

Iron overload and HFE gene mutations in Czech patients with chronic liver diseases

The aim of the study was to identify the prevalence of HFE gene mutations in Czech patients with chronic liver diseases and the influence of the mutations on iron status. The presence of HFE gene mutations (C282Y, H63D, and S65C) analyzed by the PCR-RFLP method, presence of cirrhosis, and serum iron indices were compared among 454 patients with different chronic liver diseases (51 with chronic hepatitis B, 122 with chronic hepatitis C, 218 with alcoholic liver disease, and 63 patients with hemochromatosis). Chronic liver diseases patients other than hemochromatics did not have an increased frequency of HFE gene mutations compared to controls. Although 33.3% of patients with hepatitis B, 43% of patients with hepatitis C, and 73.2% of patients with alcoholic liver disease had elevated transferrin saturation or serum ferritin levels, the presence of HFE gene mutations was not significantly associated with iron overload in these patients. Additionally, patients with cirrhosis did not have frequencies of HFE mutations different from those without cirrhosis. This study emphasizes the importance, not only of C282Y, but also of the H63D homozygous genetic constellation in Czech hemochromatosis patients. Our findings show that increased iron indices are common in chronic liver diseases but {\it HFE} mutations do not play an important role in the pathogenesis of chronic hepatitis B, chronic hepatitis C, and alcoholic liver disease.