JID:HIV-1患者经cART治疗后小肠内CD4+T细胞的恢复受损

2013-07-15 潘风雨无阻 dxy

HIV感染的主要特点是胃肠道固有层中CCR5+记忆CD4+的大量丢失。这种损失归因于HIV对细胞的直接杀伤作用和未感染细胞的凋亡作用。而肠道内CD4+T细胞的损耗意味着免疫功能异常和上皮完整性的丢失,进而导致微生物易位增加、免疫激活和疾病的进展。由于肠道CD4+T细胞也在非致病性SIV感染中丢失,所以对于肠道CD4+T细胞丢失与HIV致病性的了解还不清楚。最近的研究显示,Th17 CD4+T细胞的

HIV感染的主要特点是胃肠道固有层中CCR5+记忆CD4+的大量丢失。这种损失归因于HIV对细胞的直接杀伤作用和未感染细胞的凋亡作用。而肠道内CD4+T细胞的损耗意味着免疫功能异常和上皮完整性的丢失,进而导致微生物易位增加、免疫激活和疾病的进展。由于肠道CD4+T细胞也在非致病性SIV感染中丢失,所以对于肠道CD4+T细胞丢失与HIV致病性的了解还不清楚。

最近的研究显示,Th17 CD4+T细胞的分化损耗也许能解释这个矛盾,因这些细胞在HIV-1和致病性SIV感染中优先被消耗,而在非致病性SIV感染中得到保留。重要的是,Th17细胞在调节肠免疫和保持粘膜上皮中发挥了重要的作用。因此,针对恢复胃肠道内的CD4+T细胞的策略对于重建上皮完整性和减少慢性炎症和免疫激活是非常关键的。

然而,目前对于联合抗逆转录病毒疗法(cART)是否能够恢复肠道内的CD4+T细胞水平还没有统一的看法。已有研究表明,在那些经长期抑制治疗而细胞恢复有限的患者中,肠道内CD4+T细胞的恢复是不完全的,并且恢复的时间迟于血液中细胞的恢复。其他研究发现,CD4+T细胞在急性HIV感染患者空肠和接受长期抑制cART患者结肠和盲肠内的恢复几乎是完全的。

为了探究cART对不同胃肠道内免疫重建的影响,来自波士顿Dana-Farber癌症研究所Edana Cassol和同事开展了一项研究,该研究结果在线发表在2013年6月6日的Journal of Infectious Diseases上。研究发现,HIV-1患者经cART治疗后小肠内CD4+T细胞的恢复受损。

研究者每月收集一次血液样本,并分别在cART治疗前(十二指肠、空肠、盲肠、结肠)和治疗后3周(十二指肠)和6周(十二指肠、结肠)收集南非HIV-1感染者的活检组织样本,采用细胞流式和免疫组化检测CD4+、CD8+和CD38+CD8+T细胞数量,用Nuclisens assay测定HIV-1 RNA。

结果显示,与结肠相比,十二指肠和空肠内CD4+T细胞和HIV-1 RNA水平明显低,而CD8+T细胞包括活化的CD38+CD8+T细胞的水平较高。经过6个月的cART治疗后,在结肠和血中检测到CD4+T细胞有明显的恢复但不完全,而在十二指肠内没有细胞的恢复。十二指肠内的CD4+T细胞无法恢复与非特异性肠炎和CD8+T细胞活化有关。因此,致力于小肠内炎症反应和免疫活化的策略可能会促进CD4+T细胞的恢复和改善治疗结果。


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    2013-09-22 xuyu
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    2013-10-16 紫砂壶
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    2014-05-13 qidongfanjian
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    2013-07-17 zhaojie88
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