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作 者:程占睿 孔玉洁[1] 田力 刘忠[1] CHENG Zhanrui;KONG Yujie;TIAN Li;LIU Zhong(Chinese Academy of Medical Sciences&Peking Union Medical College,Institute of Blood Transfusion,Key Laboratory of Transfusion Adverse Reactions,Chinese Academy of Medical Sciences,Chengdu 610052,China)
机构地区:[1]中国医学科学院北京协和医学院输血研究所中国医学科学院输血不良反应研究重点实验室,四川成都610052
出 处:《中国输血杂志》2022年第7期776-782,共7页Chinese Journal of Blood Transfusion
基 金:中国医学科学院医学与健康科技创新工程(2021-1-I2M-060);中国医学科学院中央级公益性科研院所基本科研业务费专项资金(2018PT32016);四川省国际科技创新合作/港澳台科技创新合作项目(2020YFH0024)。
摘 要:体外光分离置换疗法(ECP)是1种基于白细胞分离技术的双向细胞免疫调节疗法,在一定条件下可以同时介导免疫增强/抑制效应。临床上已观察到ECP对于皮肤T细胞淋巴瘤(CTCL)、移植物抗宿主病(GVHD)和实体器官移植排斥反应等具有较好的疗效,且美国食品药品监督管理局(FDA)批准了ECP用于CTCL的治疗,美国和欧洲的GVHD治疗指南也将ECP列入其中,国内则缺乏相关指南指导。虽然确切的作用机制迄今尚不完全清楚,但近年来的研究为进一步理解ECP的双向调控作用提供了理论基础。最初假设是8-甲氧基补骨脂素(8-MOP)和紫外线(UVA)联合诱导免疫细胞的凋亡,随着研究进展,这种观点转变为单核细胞往树突状细胞的分化、细胞因子的改变和调节性T细胞(Treg)的刺激。本文就目前ECP免疫调节作用机制的探索进展与临床应用现状,特别是最新的ECP介导免疫增强/耐受分子作用机制进展作了综合分析,并对ECP进一步在国内的推广与临床应用作出展望。Extracorporeal photopheresis(ECP) is a bidirectional cellular immunomodulatory therapy based on leukapheresis,which can mediate not only immunopotentiation but also immunosuppression.Clinically,ECP has been observed to have good efficacy in the treatment of cutaneous T cell lymphoma(CTCL),graft versus-host disease(GVHD) and solid organ transplant rejection,also the US Food and Drug Administration(FDA) has approved ECP for the treatment of CTCL.The treatment guidelines for GVHD in the US and Europe also include ECP,however,there is a lack of relevant guidelines in China.Although the exact mechanism of ECP is not fully explained,recent studies provide a theoretical basis for a further understanding of the bidirectional regulation of ECP.The initial hypothesis was the combination of 8-methoxypsoralen(8-MOP) and ultraviolet A(UVA) to induce apoptosis of immune cells.As the research progressed,this idea was transformed into the differentiation of monocyte to dendritic cell(DC),cytokine alteration and the regulatory T cell(Treg) stimulation.In this article,the current exploration of the immunomodulatory mechanism in ECP and its clinical application were reviewed,also the latest molecular mechanism of ECP mediated immunopotentiation and immunosuppression was comprehensively analyzed,meanwhile the further promotion and clinical application of ECP in China had been prospected.
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