Approaches to graft-vs-host disease.
Approaches to graft-vs-host disease.
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移植物抗宿主病的治疗方法。
DOI：
10.1111/j.1399-3046.2005.00441.x
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发表时间：
2005
期刊：
影响因子：
--
通讯作者：
Antin,JosephH
中科院分区：
文献类型：
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作者：
Antin,JosephH
摘要：移植物抗宿主病（GVHD）是干细胞移植中最困难的问题之一。最好在正常免疫反应的背景下考虑它。免疫系统的作用是识别和消除外来抗原。就 GVHD 而言，抗原是在炎症环境中识别的次要组织相容性抗原 (mHA)。不能合理地期望免疫系统选择性地识别微生物抗原而忽略 mHA。这种方法需要产生选择性耐受——这种现象显然会发生，但令人沮丧的是我们几乎无法控制。虽然我们通常可以治疗和缓解甚至危及生命的 GVHD，但其后果是发生致命的机会性感染。我们面临的挑战是改变我们对 GVHD 的思维方式，从以感染为代价控制 GVHD 的“核冬天”方法转变为认识到免疫抑制治疗局限性的更具选择性的患者方法。
Abstract:Graft‐vs‐host disease (GVHD) is one of the most difficult problems in stem cell transplantation. It is best considered in the context of the normal immune response. The role of the immune system is to identify and eliminate foreign antigens. In the case of GVHD, the antigens are minor histocompatibility antigens (mHA) recognized in an inflammatory milieu. The immune system cannot reasonably be expected to selectively recognize microbial antigens and ignore mHA. This approach would require the generation of selective tolerance – something that clearly occurs but which we have frustratingly little control over. While we can often treat and remit even life‐threatening GVHD, the consequence has been the development of fatal opportunistic infections. The challenge is to change our style of thinking about GVHD to allow a transition from a ‘nuclear winter’ approach that controls GVHD at the price of infection, to a more selective patient approach that recognizes the limitations of immunosuppressive therapy.