Immunologic mechanisms of fingolimod and the role of immunosenescence in the risk of cryptococcal infection: A case report and review of literature
Immunologic mechanisms of fingolimod and the role of immunosenescence in the risk of cryptococcal infection: A case report and review of literature
复制标题
DOI：
10.1016/j.msard.2016.07.015
复制
发表时间：
2016-09-01
影响因子：
4
通讯作者：
Bernard, Jacqueline T.
中科院分区：
文献类型：
--
作者：
Grebenciucova, Elena;Reder, Anthony T.;Bernard, Jacqueline T.
背景：Fingolimod是一种用于治疗复发/缓解性多发性硬化症的疾病改良剂。在MS临床研究中，Fingolimod组的总体感染率与安慰剂相似，除了稍微常见的下呼吸道感染和较小程度的HSV感染。最近，越来越多的隐球菌感染与长期使用这种药物有关。方法：我们回顾了与使用该药物相关的隐球菌感染的文献，并报告了我所的一例病例，并仔细评估了该药物已建立的免疫机制，并讨论了对其短期和长期免疫效应的新见解，这些效应可能在感染风险的背景下变得重要。结果：隐球菌病原体的独特特征，其免疫逃逸机制，其建立潜在感染的能力，以及Fingolimod对许多免疫系统的影响，无论是数量上还是质量上，治疗的持续时间，而且，Fingolimod的长期影响(以前没有描述)与似乎风险最高的患者群体的自然免疫衰老的影响相结合，可能对进一步了解长期使用Fingolimod对老年人感染的风险有意义。(C)2016爱思唯尔B.V.保留所有权利。
Background: Fingolimod is a disease-modifying agent used in the treatment of relapsing/remitting multiple sclerosis. In MS clinical studies, the overall rate of infections in fingolimod group was overall similar to placebo, except for slightly more common lower respiratory tract infections and to a lesser extent HSV. Recently, an increasing number of cryptococcal infections associated with a long-term use of this medication have been reported.Methods: We reviewed literature for cases of cryptococcal infection associated with the use of fingolimod and reported a case at our institution, as well as carefully evaluated the established immune mechanisms of the medication and discussed new insights into its short-term and long-term immunologic effects that may become important in the context of risk of infection.Results: Unique characteristics of cryptococcal pathogen, its immune escape mechanisms, its ability to establish a latent infection with a potential for later reactivation, fingolimod's effects on many lines of immune system, both quantitatively and qualitatively, duration of therapy, and long-term effects of fingolimod, not previously described, in conjunction with effects of natural immunosenescence of the patient population, that appears to be most at risk, may be meaningful in further understanding the risk of infection with long-term use of fingolimod in people of older age. (C) 2016 Elsevier B.V. All rights reserved.