The immunological landscape in necrotising enterocolitis.
The immunological landscape in necrotising enterocolitis.
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DOI：
10.1017/erm.2016.13
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发表时间：
2016-06-24
影响因子：
6.2
通讯作者：
Nold, Marcel F.
中科院分区：
文献类型：
--
作者：
Cho, Steven X.;Berger, Philip J.;Nold-Petry, Claudia A.;Nold, Marcel F.
坏死性小肠结肠炎（NEC）是一种罕见的，但破坏性的肠道炎症性疾病，主要影响早产儿。NEC有时被称为新生儿重症监护病房的幽灵，因为它的发病是不知不觉的非特异性，一旦疾病表现出来，对婴儿肠道造成的损害已经是灾难性的。随后的败血症和多器官衰竭导致高达65%的死亡率。NEC的有效治疗方法的发展一直停滞不前，主要是因为我们缺乏对NEC发病机制的了解。然而，很明显，NEC是由严重失调的免疫系统驱动的。NEC与促炎介质的局部增加相关，例如Toll样受体（TLR）4、核因子-κB、肿瘤坏死因子、血小板活化因子（PAF）、白细胞介素（IL）-18、干扰素-γ、IL-6、IL-8和IL-1β。包括IL-1受体拮抗剂（IL-1 Ra）、TLR 9、PAF-乙酰水解酶、转化生长因子β（TGF-β）1和2、IL-10和调节性T细胞在内的反调节机制的缺陷可能促进NEC受累肠中的促炎环境。没有足够的证据得出结论，适应性Th 1-，Th 2-或Th 17-反应在疾病中占主导地位。我们对伴随的全身免疫调节的理解仍然很差;然而，IL-1 Ra、IL-6、IL-8和TGF-β1显示出作为生物标志物的前景。在这里，我们图表新兴的免疫景观，巩固NEC的参与和潜在的临床意义的先天性和适应性免疫介质及其调节NEC。
Necrotising enterocolitis (NEC) is an uncommon, but devastating intestinal inflammatory disease that predominantly affects preterm infants. NEC is sometimes dubbed the spectre of neonatal intensive care units, as its onset is insidiously non-specific, and once the disease manifests, the damage inflicted on the baby's intestine is already disastrous. Subsequent sepsis and multi-organ failure entail a mortality of up to 65%. Development of effective treatments for NEC has stagnated, largely because of our lack of understanding of NEC pathogenesis. It is clear, however, that NEC is driven by a profoundly dysregulated immune system. NEC is associated with local increases in pro-inflammatory mediators, e.g. Toll-like receptor (TLR) 4, nuclear factor-κB, tumour necrosis factor, platelet-activating factor (PAF), interleukin (IL)-18, interferon-gamma, IL-6, IL-8 and IL-1β. Deficiencies in counter-regulatory mechanisms, including IL-1 receptor antagonist (IL-1Ra), TLR9, PAF-acetylhydrolase, transforming growth factor beta (TGF-β)1&2, IL-10 and regulatory T cells likely facilitate a pro-inflammatory milieu in the NEC-afflicted intestine. There is insufficient evidence to conclude a predominance of an adaptive Th1-, Th2- or Th17-response in the disease. Our understanding of the accompanying regulation of systemic immunity remains poor; however, IL-1Ra, IL-6, IL-8 and TGF-β1 show promise as biomarkers. Here, we chart the emerging immunological landscape that underpins NEC by reviewing the involvement and potential clinical implications of innate and adaptive immune mediators and their regulation in NEC.
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影响因子：
0.2
作者：
Albanna EA;Ahmed HS;Awad HA
通讯作者：
Awad HA
影响因子：
12.2
作者：
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Gookin, Jody L.
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Hamrick, Shannon E.
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作者：
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