Role of staphylococcal superantigens in airway disease.
Role of staphylococcal superantigens in airway disease.
复制标题
DOI：
10.1159/000100897
复制
发表时间：
2007-01-01
期刊：
影响因子：
--
通讯作者：
Perez-Novo, Claudina
中科院分区：
文献类型：
--
作者：
Bachert, C;Gevaert, P;Perez-Novo, Claudina
革兰氏阳性金黄色葡萄球菌组成型有可能释放经典的和来自egc位点的肠毒素，这些毒素表现出超抗原活性，并有效地改变T细胞和B细胞、嗜酸性粒细胞以及其他炎症和结构细胞的功能。这种刺激可能会导致 2 型 T 辅助细胞极化的嗜酸性粒细胞炎症以及多克隆 IgE 的产生，从而加重上呼吸道和下呼吸道的气道疾病。最近，金黄色葡萄球菌已被证明存在于上皮内，并可能从上皮细胞内将超抗原释放到组织中。先天免疫或适应性免疫的免疫缺陷可能是造成这种现象的原因。在粘膜组织内可以发现滤泡样结构和淋巴细胞聚集，特异性结合肠毒素。有趣的是，大多数对阿司匹林敏感的患者、鼻息肉和严重哮喘患者中都可以发现针对肠毒素的 IgE 抗体。我们在此总结了目前来自动物和人体研究的证据，证明葡萄球菌肠毒素 (SE) 在过敏性鼻炎、鼻息肉、哮喘、慢性阻塞性肺病以及儿童早期喘息中发挥着积极作用，并讨论了这些疾病表现之间的相似性。原则上，SE 的 IgE 抗体的出现与总 IgE 形成、炎症标志物和疾病临床表达方面的疾病严重程度相关。来自动物模型的初步证据强调了 SE 诱导或调节疾病的高效力，一些试点干预试验可以作为 SE 对疾病严重程度影响的概念证明。然而，迄今为止，治疗方法仍然有限且凭经验，需要进一步改进以应对这一目前被低估的临床挑战。
Gram-positive Staphylococcus aureus germs constitutively have the possibility to release classical and egc-locus-derived enterotoxins which show superantigen activity, and effectively modify the functions of T and B cells, eosinophils, and other inflammatory and structural cells. The stimulation may lead to a type 2 T helper cell-polarized eosinophilic inflammation as well as a multiclonal IgE production, aggravating airway disease in the upper and lower respiratory tract. Recently, S. aureus has been demonstrated to reside intraepithelially, and potentially to release superantigens into the tissue from within the epithelial cells. An immune defect, either in the innate or adaptive immunity, might be responsible for this phenomenon. Follicle-like structures and lymphocyte accumulations, specifically binding enterotoxins, can be found within the mucosal tissue. Interestingly also, IgE antibodies to enterotoxins can be found in the majority of aspirin-sensitive patients, in nasal polyps and severe asthma alike. We here summarize the current evidence from animal and human studies for an active role of staphylococcal enterotoxins (SEs) in allergic rhinitis, nasal polyps, asthma, chronic obstructive pulmonary disease and finally early childhood wheezing, and discuss the similarities between those disease manifestations. As a principle, the occurrence of IgE antibodies to SEs correlates with disease severity in terms of total IgE formation, inflammatory markers and clinical expression of the disease. Preliminary evidence from animal models underlines the high potency of SEs to induce or modulate disease, and a few pilot intervention trials may serve as proof of concept for the impact of SEs on disease severity. However, therapeutic approaches are so far limited and empirical, and need further improvement to tackle this currently underestimated clinical challenge.