Idiopathic pneumonia syndrome after bone marrow transplantation: the role of pre-transplant radiation conditioning and local cytokine dysregulation in promoting lung inflammation and fibrosis.
Idiopathic pneumonia syndrome after bone marrow transplantation: the role of pre-transplant radiation conditioning and local cytokine dysregulation in promoting lung inflammation and fibrosis.
复制标题
骨髓移植后特发性肺炎综合征：移植前辐射调节和局部细胞因子失调在促进肺部炎症和纤维化中的作用。
DOI：
10.1111/j.1365-2613.2001.iep0082-0101-x
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发表时间：
2001
影响因子：
3
通讯作者：
Cohen,DA
中科院分区：
文献类型：
--
作者：
Shankar,G;Cohen,DA
肺部并发症和移植物抗宿主病（GVHD）仍然是骨髓移植（BMT）后生存的严重威胁。特发性肺炎综合征（IPS）占骨髓移植后间质性肺炎病例的近50%。IPS的特征在于早期炎症阶段，随后是肺组织的慢性炎症和纤维化;然而，这种疾病的免疫发病机制尚不清楚。在一些研究中，这种双相综合征与移植前辐射条件有关，而另一些研究表明GVHD或自身免疫现象可能是其发展的原因。BMT后早期阶段的特征是存在炎性细胞因子，其净效应是促进淋巴细胞流入肺部，纤维化程度最低，导致急性形式的移植物抗宿主反应介导的肺组织损伤。白细胞流入和活化随时间的逐渐变化导致由促进纤维化的细胞因子平衡的转变引起的失调的伤口修复机制。使用新的IPS动物模型的数据和人类IPS研究的信息，我们假设骨髓移植后急性和慢性期发生的细胞因子调节的免疫机制导致特发性肺炎综合征典型的进行性、炎症性和纤维化肺病的发展。
Pulmonary complications and graft‐vs.‐host disease (GVHD) remain severe threats to survival after bone marrow transplantation (BMT). Idiopathic pneumonia syndrome (IPS) accounts for nearly 50% of all the cases of interstitial pneumonitis after BMT. IPS is characterized by an early inflammatory phase followed by chronic inflammation and fibrosis of lung tissue; however, the immunopathogenesis of this disease is not yet clearly understood. This biphasic syndrome has been reported to be associated with pre‐transplant radiation conditioning in some studies while others have suggested that GVHD or autoimmune phenomena may be responsible for its development. The early post‐BMT phase is characterized by the presence of inflammatory cytokines whose net effect is to promote lymphocyte influx into lungs with minimal fibrosis, that leads to an acute form of graft‐vs.‐host reaction‐mediated pulmonary tissue damage. Gradual changes over time in leucocyte influx and activation lead to dysregulated wound repair mechanisms resulting from the shift in the balance of cytokines that promote fibrosis. Using data from new animal models of IPS and information from studies of human IPS, we hypothesize that cytokine‐modulated immunological mechanisms which occur during the acute and chronic phases after bone marrow transplantation lead to the development of the progressive, inflammatory, and fibrotic lung disease typical of idiopathic pneumonia syndrome.