Immunologic and imaging signatures in post tuberculosis lung disease.
Immunologic and imaging signatures in post tuberculosis lung disease.
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DOI：
10.1016/j.tube.2022.102244
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发表时间：
2022-09
期刊：
影响因子：
3.2
通讯作者：
Segal, L. N.
中科院分区：
文献类型：
--
作者：
Singh, S.;Allwood, B. W.;Chiyaka, T. L.;Kleyhans, L.;Naidoo, C. C.;Moodley, S.;Theron, G.;Segal, L. N.
结核病后肺部疾病（PTLD）影响着数百万结核病幸存者，是全球健康负担。驱动PTLD的免疫机制是复杂的，历史上一直在研究中。在这里，我们讨论了两种免疫介导的范式，可以驱动人类PTLD。我们回顾了纤维化肉芽肿的特征，其通过大量的辅助性T细胞和调节性T细胞以及TGF-β介导的胶原沉积的上调而有利于PTLD的发展。接下来，我们将讨论原发性肺结核后的模式和干酪性肺炎、空洞形成和纤维化的复杂混合物，这些也可能导致PTLD。我们回顾了先天性和适应性免疫系统的细胞亚群和细胞因子与宿主来源的蛋白酶之间的微妙平衡，这些蛋白酶可以使PTLD中看到的肺实质损伤永久化。接下来，我们将讨论新型宿主定向治疗（HDT）在限制PTLD发展中的作用，特别是最近对他汀类药物、二甲双胍和多西环素等已确立药物的再利用。最后，我们回顾了新的成像技术作为一种非侵入性的方式早期识别PTLD的新兴作用。虽然在结核病负担高的国家不太可能广泛使用计算机断层扫描成像，但在研究环境中使用它可以帮助表现PTLD。由于缺乏疾病特异性生物标志物和对照临床试验，目前没有基于证据的PTLD管理建议。同时针对炎症和促纤维化途径的综合抗纤维化策略可能会成为治疗这种复杂疾病的成功方法。在PTLD这样广泛的疾病谱中，单一的免疫学或放射学标志物可能是不够的，组合更有可能是一个成功的替代品，可以帮助发展成功的HDTs。
Post Tuberculosis Lung Disease (PTLD) affects millions of tuberculosis survivors and is a global health burden. The immune mechanisms that drive PTLD are complex and have historically been under investigated. Here, we discuss two immune-mediated paradigms that could drive human PTLD. We review the characteristics of a fibrotic granuloma that favors the development of PTLD via an abundance of T-helper-2 and T-regulatory cells and an upregulation of TGF-β mediated collagen deposition. Next, we discuss the post-primary tuberculosis paradigm and the complex mixture of caseous pneumonia, cavity formation and fibrosis that can also lead to PTLD. We review the delicate balance between cellular subsets and cytokines of the innate and adaptive immune system in conjunction with host-derived proteases that can perpetuate the parenchymal lung damage seen in PTLD. Next, we discuss the role of novel host directed therapies (HDT) to limit the development of PTLD and in particular, the recent repurposing of established medications such as statins, metformin and doxycycline. Finally, we review the emerging role of novel imaging techniques as a non-invasive modality for the early recognition of PTLD. While access to computed tomography imaging is unlikely to be available widely in countries with a high TB burden, its use in research settings can help phenotype PTLD. Due to a lack of disease-specific biomarkers and controlled clinical trials, there are currently no evidence-based recommendations for the management of PTLD. It is likely that an integrated antifibrotic strategy that could simultaneously target inflammatory and pro-fibrotic pathways will probably emerge as a successful way to treat this complex condition. In a disease spectrum as wide as PTLD, a single immunologic or radiographic marker may not be sufficient and a combination is more likely to be a successful surrogate that could aid in the development of successful HDTs.
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影响因子：
82.9
作者：
Harari A;Rozot V;Bellutti Enders F;Perreau M;Stalder JM;Nicod LP;Cavassini M;Calandra T;Blanchet CL;Jaton K;Faouzi M;Day CL;Hanekom WA;Bart PA;Pantaleo G
通讯作者：
Pantaleo G
影响因子：
168.9
作者：
Dickson, Robert P.;Martinez, Fernando J.;Huffnagle, Gary B.
通讯作者：
Huffnagle, Gary B.
影响因子：
15.9
作者：
Elkington, Paul;Shiomi, Takayuki;Friedland, Jon S.
通讯作者：
Friedland, Jon S.
DOI：
10.3889/oamjms.2019.544
发表时间：
2019-07-15
影响因子：
--
作者：
Christine, Tamara;Tarigan, Amira Permatasari;Ananda, Fannie Rizki
通讯作者：
Ananda, Fannie Rizki
影响因子：
6.4
作者：
Bekker, LG;Maartens, G;Kaplan, G
通讯作者：
Kaplan, G