Viral connection between drug rashes and autoimmune diseases: How autoimmune responses are generated after resolution of drug rashes
Viral connection between drug rashes and autoimmune diseases: How autoimmune responses are generated after resolution of drug rashes
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DOI：
10.1016/j.autrev.2009.02.029
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发表时间：
2009-05-01
影响因子：
13.6
通讯作者：
Shiohara, Tetsuo
中科院分区：
文献类型：
--
作者：
Aota, Noriko;Shiohara, Tetsuo
病毒感染最有可能是自身免疫性疾病的触发因素，尽管单个小瓶感染不足以引起临床上明显的自身免疫性疾病。任何深刻改变免疫系统的疾病都可能导致病毒感染紊乱，从而使难治性患者易患自身免疫性疾病。在这方面，药物诱导的超敏反应综合征（DIHS），一种以疱疹病毒的连续再激活和随后的自身免疫性疾病的发展为特征的药疹，提供了一个独特的机会来研究病毒感染后如何引发自身免疫的机制。事实上，据报道，在DIHS临床消退后，几种自身免疫性疾病会以数月至数年的间隔发生。显示了两个在DIHS后三到四年发展为自身免疫性疾病的代表性病例。我们最近对发展中疾病的动力学的分析表明，全功能FoxP3（+）调节性T（Treg）细胞在急性期扩增，从而允许病毒再活化，但在临床消退时失去与其收缩一致的抑制功能。Treg细胞的功能缺陷可能是导致自身免疫性疾病的原因。DIHS患者需要密切监测，因为即使在完全消退后也可能进展为自身免疫性疾病。(C)2009爱思唯尔有限公司版权所有。
Viral infections are most likely triggering factors of autoimmune diseases, although a single vial infection is not sufficient to cause clinically evident autoimmune diseases. Any disease that profoundly alters the immune system may cause perturbed viral infections, thereby rendering otherwise refractory patients susceptible to autoimmune diseases. In this regard, drug-induced hypersensitivity syndrome (DIHS), a drug rash characterized by sequential reactivations of herpesviruses and the subsequent development of autoimmune diseases, offers a unique opportunity to investigate the mechanism of how autoimmunity is elicited after viral infections. Indeed, several autoimmune diseases have been reported to occur at intervals of several months to years after clinical resolution of DIHS. Two representative cases who developed autoimmune diseases three to four years after DIHS are shown. Our recent analyses of the kinetics of a developing disease have shown that fully functional FoxP3(+) regulatory T (Treg) cells are expanded at the acute stage thereby allowing viral reactivations but lose their suppressive function coincident with their contraction upon clinical resolution. The functional defect of Treg cells would be responsible for the subsequent development of autoimmune diseases. Patients with DIHS need close monitoring because of possible progression to autoimmune diseases even after the complete resolution. (C) 2009 Elsevier B.V. All rights reserved.