Understanding Immune Responses to Surgical Transplant Procedures in Stevens Johnsons Syndrome Patients.
Understanding Immune Responses to Surgical Transplant Procedures in Stevens Johnsons Syndrome Patients.
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DOI：
10.3389/fmed.2021.656998
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发表时间：
2021
影响因子：
3.9
通讯作者：
Perez VL
中科院分区：
文献类型：
--
作者：
Soifer M;Mousa HM;Levy RB;Perez VL
Stevens Johnsons综合征（SJS）是一种由最常见的药物自身免疫反应引起的粘膜皮肤疾病。除非在急性情况下得到适当的处理，否则这种实体会影响眼表，引起慢性愈合性结膜炎，伴有角膜缘干细胞缺乏和眼睑异常，最终导致角膜混浊，可能限制患者的视力。当达到这个阶段时，一些患者可能需要接受某种形式的角膜和/或角膜缘干细胞移植，使已经致敏的免疫系统暴露于新的同种异体抗原。虽然先天免疫在角膜移植物存活中起作用，但适应性免疫应答在角膜移植物排斥和失败中起主要作用，即通过CD 4 + T细胞淋巴细胞。因此，SJS患者对外科移植手术的免疫应答的管理涉及双重方法，该方法在自身免疫致敏患者的背景下调节对新同种异体抗原的炎症应答。本综述将探讨和讨论目前的观点和未来的方向，在眼免疫学领域如何管理SJS免疫反应的眼部手术，审查系统和局部免疫抑制治疗和协议，以充分管理这种衰弱的条件。
Stevens Johnsons syndrome (SJS) is a mucocutaneous disorder caused by an autoimmune response most commonly to medications. Unless it is properly managed in the acute setting, this entity can affect the ocular surface causing chronic cicatrizing conjunctivitis with limbal stem cell deficiency and lid anomalies which ultimately result in corneal opacities that may limit patients' visual acuity. When this stage is reached, some patients might need to undergo some form of corneal and/or limbal stem cell transplantation that exposes an already sensitized immune system to a new alloantigen. While the innate immunity plays a role in corneal graft survival, adaptive immune responses play a major part in corneal graft rejection and failure, namely through CD4+ T cell lymphocytes. Hence, the management of the immune response to surgical transplant procedures in SJS patients, involves a dual approach that modulates the inflammatory response to a new alloantigen in the context of an autoimmune sensitized patient. This review will explore and discuss current perspectives and future directions in the field of ocular immunology on how to manage SJS immune responses to ocular surgical procedures, reviewing systemic and local immunosuppressive therapies and protocols to adequately manage this debilitating condition.
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