干细胞移植和全基性免疫:治疗后的控制还是治愈艾滋病毒?
Megan Cleary1, Lishomwa C Ndhlovu2, Jonah B Sacha1,3
1Division of Pathobiology and Immunology, Oregon National Primate Research Center.
Current opinion in HIV and AIDS
|November 1, 2024
概括
造血干细胞移植 (HSCT) 可以导致长期的艾滋病毒缓解在一些人. 这种缓解可能是由于免疫系统清除了病毒,而不仅仅是CCR5缺乏.
科学领域:
- 免疫学 免疫学 免疫学
- 病毒学 病毒学
- 血液学 血液学 血液学
背景情况:
- 在针对血液性恶性瘤的全源造血干细胞移植 (HSCT) 后,在一小部分艾滋病毒感染者 (PWH) 中观察到持久的艾滋病毒缓解.
- 停止抗逆转录病毒疗法 (ART) 后艾滋病毒缓解的机制最初尚不清楚,但现在正在通过临床病例和临床前研究来阐明.
研究的目的:
- 审查六个已发表的人类病例的长期,无ART的HIV缓解后HSCT.
- 探索促进持续的艾滋病毒缓解后HSCT的机制.
主要方法:
- 发表的临床案例研究的综述,这些研究对在HSCT后实现HIV缓解的个体进行了审查.
- 分析诸如捐赠细胞特征 (如CR5状态) 和移植后免疫反应等因素.
- 考虑涉及猿类免疫缺陷病毒 (SIV) 的非人类灵长类动物研究结果.
主要成果:
- 自最初病例以来,已报告了另外五例HSCT诱导的持续性艾滋病毒缓解.
- 大多数人接受的干细胞来自于CCR5-delta 32删除 (ccr5Δ32) 的同卵性捐赠者.
- 虽然CCR5缺乏可能提供早期保护,但长期缓解似乎是由异构免疫驱动的,它调解了移植与储存器的反应,导致病毒储存器的切除.
结论:
- 在HSCT后持久的艾滋病毒缓解的个体可能会被治愈,这可以通过完全根除可复制的艾滋病毒储存器来证明.
- 这种疗法的特点是抗艾滋病毒免疫力逐渐下降,持续的肺血病持续超过五年.
- 高血压细胞培养,特别是CCR5缺乏干细胞,通过免疫介导的病毒清除提供了一条潜在的途径来治愈HIV.
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