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在早期类风湿关节炎中,可溶性免疫检查点分子PD1和4-1BB与CTLA-4Ig治疗反应的关联
Tilia Selldén1, Kristina Lend2, Jon Lampa3
1Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
ACR open rheumatology
|August 29, 2025
概括
在早期类风湿性关节炎患者中,可溶性编程细胞死亡-1 (sPD1) 和可溶性4-1BB (s4-1BB) 的高水平预示着阿巴特雷克萨特治疗对阿巴特雷克萨特的良好反应. 这些生物标志物与PD1+ T毛囊辅助细胞结合,显示出预测治疗缓解的潜力.
科学领域:
- 免疫学
- 关节病学
- 药理学
背景情况:
- 早期类风湿性关节炎需要有效的疾病修饰性抗风湿药物.
- 免疫检查点分子在免疫调节中起作用,并可能影响治疗反应.
- 流通中的可溶性免疫检查点分子 (sICM) 可以作为预测生物标志物.
研究的目的:
- 确定可溶性免疫检查点分子的血水平是否与早期类风湿性关节炎 (eRA) 的治疗反应有关.
- 在接受不同DMARD的患者中调查sPD1和s4-1BB的缓解预测值.
主要方法:
- 在NORD- STAR研究中,有328名未接受过治疗的瑞典eRA患者被随机分组.
- 治疗组包括甲基 (MTX) 与CTLA- 4Ig (阿巴塔塞普),抗TNF,抗IL- 6R或普雷尼索隆.
- 在基线,24周和48周测量了sPD1和s4-1BB血水平.
- 缓解被定义为临床疾病活动指数 (CDAI) ≤2. 8.
主要成果:
- 在接受CTLA-4Ig加MTX治疗的患者中,高基线sPD1和s4-1BB水平与24周CDAI缓解有关 (分别为1. 31和1. 50).
- 在其他治疗组中没有观察到这些关联.
- 基线sPD1或s4-1BB水平,结合PD1+T毛囊辅助细胞 (TFh) 的比例,预测CTLA-4Ig与MTX在48周后的治疗反应,预测值高 (90-100%).
结论:
- 在eRA患者中,高血sPD1和s4-1BB水平与CTLA-4Ig (abatacept) 与MTX相结合的良好反应相关.
- 在CTLA-4Ig治疗中,sPD1或s4-1BB水平和PD1+TFh细胞比例的组合可以作为预测性生物标志物.
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