PTCy

PTCy
  • 文章类型: Journal Article
    单倍同组合(单倍BMT)之间的骨髓移植(BMT)可能导致不可接受的骨髓移植排斥和移植物抗宿主病(GVHD)。为了跨越这些障碍,已使用由单倍BMT和移植后(PT)环磷酰胺(Cy)组成的约翰霍普金斯大学平台。尽管约翰·霍普金斯方案的主要机制是Cy诱导的骨髓细胞(BMC)耐受,然后在第3天和第4天进行Cy,但Cy诱导耐受的机制可能尚未得到很好的理解。这里,我回顾了我们在通过完全同种异体抗原差异从次要组织相容性(H)抗原差异到异种抗原差异的皮肤耐受性方面的研究。为了克服皮肤移植的完全同种异体抗原屏障或异种屏障,在需要进行细胞注射前,用针对T细胞的单克隆抗体(mAb)对受者进行预处理.在提供成功皮肤耐受性的细胞-继之Cy系统中,主要在H-2相同的鼠组合中,使用超抗原和T细胞受体(TCR)Vβ片段之间的相关性鉴定了五种机制。它们包括:1)用Cy克隆破坏抗原刺激的因此增殖的成熟T细胞;2)与立即外周嵌合相关的外周克隆缺失;3)与胸腺内嵌合相关的胸腺内克隆缺失;4)抑制T(Ts)细胞的延迟产生;和5)克隆无反应性的延迟产生。当供体-受体组合在MHC抗原加上次要H抗原中不同时,这五种机制不足以诱导耐受性,如在单倍BMT中所见。当抗原差异太强以建立胸腺内混合嵌合体时,克隆破坏是不完全的。尽管这种不完全的克隆破坏使增殖较少的人,抗原刺激的T细胞在后面,这些细胞可能在单倍BMT/PTCy后赋予移植物抗白血病(GVL)效应.
    The bone marrow transplantation (BMT) between haplo-identical combinations (haploBMT) could cause unacceptable bone marrow graft rejection and graft-versus-host disease (GVHD). To cross such barriers, Johns Hopkins platform consisting of haploBMT followed by post-transplantation (PT) cyclophosphamide (Cy) has been used. Although the central mechanism of the Johns Hopkins regimen is Cy-induced tolerance with bone marrow cells (BMC) followed by Cy on days 3 and 4, the mechanisms of Cy-induced tolerance may not be well understood. Here, I review our studies in pursuing skin-tolerance from minor histocompatibility (H) antigen disparity to xenogeneic antigen disparity through fully allogeneic antigen disparity. To overcome fully allogeneic antigen barriers or xenogeneic barriers for skin grafting, pretreatment of the recipients with monoclonal antibodies (mAb) against T cells before cell injection was required. In the cells-followed-by-Cy system providing successful skin tolerance, five mechanisms were identified using the correlation between super-antigens and T-cell receptor (TCR) Vβ segments mainly in the H-2-identical murine combinations. Those consist of: 1) clonal destruction of antigen-stimulated-thus-proliferating mature T cells with Cy; 2) peripheral clonal deletion associated with immediate peripheral chimerism; 3) intrathymic clonal deletion associated with intrathymic chimerism; 4) delayed generation of suppressor T (Ts) cells; and 5) delayed generation of clonal anergy. These five mechanisms are insufficient to induce tolerance when the donor-recipient combinations are disparate in MHC antigens plus minor H antigens as is seen in haploBMT. Clonal destruction is incomplete when the antigenic disparity is too strong to establish intrathymic mixed chimerism. Although this incomplete clonal destruction leaves the less-proliferative, antigen-stimulated T cells behind, these cells may confer graft-versus-leukemia (GVL) effects after haploBMT/PTCy.
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