IRF5调控AChR特异性T细胞参与EAMG疾病发生、发展的实验研究

目的:体内外实验探讨干扰素调节因子5(Interferon regulatory factor 5,IRF5)在乙酰胆碱受体(Acetylcholine Receptor,ACh R)特异性T、B细胞中的表达情况以及与实验性自身免疫性重症肌无力(Experimental Autoimmune Myasthenia Gravis,EAMG)疾病的发生存在的可能关系。方法:ELISA法检测不同发病时相大鼠血清中IRF5的含量;流式细胞仪法检测早期晚期发病时相CD4+T细胞以及CD45R+B细胞中IRF5的表达情况;QPCR法及Western blotting法分别检测体外ACh R刺激不同时间点的T、B细胞中IRF5的m RNA和蛋白水平的表达差异。结果:血清学检测结果显示,IRF5高表达于EAMG大鼠的晚期发病时相的血清中,并随着疾病进程的不断加重呈现逐渐增高的表达,与CFA对照组大鼠相比较差异显著,有统计学意义(***,P0.001);流式结果表明,来自EAMG大鼠早、晚期发病时相的无论是淋巴结还是脾脏中的ACh R特异性T细胞均高表达IRF5,且与CFA对照组相比较,有统计学差异,而B细胞中IRF5的表达即便是在晚期发病时相也与CFA对照组无明显区别;QPCR结果发现,EAMG晚期发病时相的ACh R特异性T细胞在经过ACh R体外刺激0 h,72 h后,均可见IRF5 m RNA水平的高表达,而B细胞中IRF5的m RNA水平则在两组中无统计学差异;Western blotting结果进一步证实,IRF5蛋白水平在ACh R特异性T细胞中呈现高表达。结论:IRF5是通过对ACh R特异性T淋巴细胞的调控进而参与EAMG疾病的发生和发展过程的。     

S100/RAGE在实验性自身免疫性重症肌无力中对T细胞的作用及其机制研究

目的:探讨RAGE及其配体S100B在实验性自身免疫性重症肌无力(EAMG)中对T细胞的作用及其相关机制。方法:选取体重160-180g的Lewis大鼠,并将其随机分为EAMG模型组和CFA对照组。EAMG模型组大鼠通过尾根部注入200μL含有R-ACh R97-116肽段的免疫乳剂,并于初始免疫后的第30天尾根部追加免疫一次;CFA对照组大鼠为免疫乳剂中不含有R-ACh R97-116肽段。采用流式细胞术检测和比较两组大鼠CD4+T细胞上RAGE的表达情况;ELISA方法检测淋巴细胞培养上清中IFN-γ、IL-4、IL-17、TGF-β、IL-6和S100B的表达水平;采用S100B体外干预淋巴细胞,进一步检测S100B对EAMG大鼠T细胞增殖、亚型分布、细胞因子分泌的影响。结果:在疾病发生的晚期时相(初次免疫后第45天),EAMG组淋巴细胞CD4+T细胞上RAGE的表达明显高于CFA组(P0.001),血清中RAGE的配体S100B的表达也高于CFA组(P0.001);体外加入S100B干预能促进T淋巴细胞的增殖,与未干预组相比较差异显著(P0.05);S100B刺激后,Th1细胞和Th17细胞的百分比进一步增高,Th2细胞和Treg细胞百分比下降(PTh10.05,PTh170.05,PTh20.05,PTreg0.05),IFN-γ和IL-17的表达上调(PIFN-γ0.05,PIL-170.05),而IL-4和TGF-β表达下降(PTGF-β0.01,PIL-40.05),Th17细胞的调控因子IL-6表达升高(PIL-60.05)。结论:RAGE及其配体S100B参与EAMG的发病过程,在晚期时相中表现出明显的致病性;RAGE与S100B相互作用可以上调T细胞的致病性作用,加重四种辅助性T细胞之间的网络失衡。     

IFN-γ鼻黏膜免疫耐受治疗EAMG的实验研究

探讨鼻黏膜给予少量IFN-γ对实验性自身免疫性重症肌无力(EAMG)鼻黏膜免疫耐受的逆转作用。在用自身抗原乙酰胆碱受体(AChR)和完全弗氏佐剂(CFA)免疫Lewis大鼠之前,通过鼻黏膜分别给予重组大鼠IFN-γ(5 000 U/只);AChR IFN-γ或单独给予AChR,另外给予等量AChR的同时,腹膜注射IFN-γ(5 000 U/只)。评估不同组对EAMG发病的影响。可见,鼻黏膜单独给予AChR有效诱导EAMG免疫耐受,而同时给予AChR和IFN-γ与对照组(只给予PBS)相比扩大了T、B细胞对AChR的免疫应答,出现了与对照组相似的临床症状。相反,AChR IFN-γi.p.不影响对EAMG的耐受,鼻黏膜单独给予IFN-γ对EAMG的临床症状没有影响。经不同途径给予IFN-γ对免疫耐受有不同的影响:鼻黏膜给予少量IFN-γ可以打破免疫耐受;而经腹腔给予IFN-γ不会影响免疫耐受。     

循环滤泡辅助性T细胞亚型与重症肌无力患者临床特点之间的相关性分析

目的:分析循环滤泡辅助性T(c Tfh)细胞亚型与重症肌无力(MG)患者临床特点之间的关系。方法:横断面研究30例MG患者外周血c Tfh细胞各个亚型百分比和临床特点之间的关系。c Tfh细胞亚型的百分比是通过流式细胞术获取的。MG患者的临床特点包括性别、年龄、病程、胸腺情况、美国重症肌无力协会(MGFA)分型和重症肌无力量化(QMG)评分。结果:CD4~+CXCR5~+ICOS~+、CD4~+CXCR5~+PD-1~+和CD4~+CXCR5~+CXCR3-CCR6~+(Th17样)c Tfh细胞亚型百分比与QMG评分之间存在正相关关系;全身型重症肌无力(GMG)患者在CD4~+CXCR5~+ICOS~+、CD4~+CXCR5~+PD-1~+和Th17样c Tfh细胞亚型百分比要高于眼肌型重症肌无力(OMG)患者,OMG患者在CD4~+CXCR5~+CXCR3-CCR6-(Th2样)c Tfh亚型细胞百分比要高于GMG患者。c Tfh细胞各个亚型百分比与MG患者的性别、年龄、病程、胸腺情况均无显著相关性。结论:CD4~+CXCR5~+ICOS~+、CD4~+CXCR5~+PD-1~+和Th17样c Tfh细胞亚型百分比与MG病情严重性间存在正相关关系,提示c Tfh细胞与MG之间的密切关系。     

骨化三醇对自身免疫性甲状腺炎大鼠T淋巴细胞亚群的影响

目的:研究骨化三醇对自身免疫性甲状腺炎模型大鼠甲状腺功能、甲状腺过氧化物酶抗体(TPOAb)、甲状腺球蛋白抗体(TGAb)及脾脏T淋巴细胞亚群的影响。方法:20只Lewis大鼠采用高碘饮水联合猪甲状腺球蛋白皮下注射的方法建立自身免疫性甲状腺炎动物模型。造模成功后大鼠随机分为模型组和骨化三醇组。经10周灌胃后,检测各组大鼠甲状腺功能三项、甲状腺抗体,流式细胞技术检测大鼠脾脏T淋巴细胞亚群的比例。结果:(1)与正常组相比,模型组及骨化三醇组大鼠促甲状腺激素(TSH)明显降低,血清游离甲状腺素(FT4)及TPOAb、TGAb明显升高,差异均具有统计学意义(P0.01);与模型组大鼠相比,骨化三醇组大鼠TPOAb、TGAb明显降低(P0.01);(2)与正常组相比,模型组大鼠表现为Th1、Th17细胞比例升高(P0.05),Th1/Th2、Th17/Treg比例升高(P0.05),与模型组相比,骨化三醇组大鼠Th1、Th17细胞比例降低(P0.05),Th2、Treg比例升高(P0.05),Th1/Th2、Th17/Treg比例降低(P0.01)。结论:骨化三醇可通过抑制Th1、Th17免疫亢进,改善Th1/Th2、Th17/Treg失调,改善自身免疫性甲状腺炎免疫反应。     

芪参地黄颗粒对实验性自身免疫性重症肌无力大鼠B细胞介导的免疫机制研究

摘要 目的：探讨芪参地黄颗粒对实验性自身免疫性重症肌无力（EAMG）大鼠B细胞介导的免疫机制。方法：通过Rα97-116肽段和完全弗氏佐剂免疫,成功将30只Lewis大鼠构建EAMG模型,将EAMG大鼠随机分为模型组、芪参地黄颗粒低、中、高剂量组和阳性药组,每组6只。进一步观察大鼠体重及临床症状,检测血清中乙酰胆碱受体抗体（AChR-Ab）含量、脾脏组织CD19和CD27的蛋白表达、B淋巴细胞刺激因子（BAFF）、B细胞趋化因子CXC配体13（CXCL13）、C-X-C趋化因子受体5型（CXCR5） mRNA表达。结果：经给药治疗后芪参地黄颗粒低、中、高剂量组和阳性药组与模型组相比体重增加（P＜0.05）,临床症状评分均下降（P＜0.05）。经给药治疗后,与模型组相比,芪参地黄颗粒低、中、高剂量组血清中AChR-Ab含量均降低（P<0.05）,芪参地黄颗粒中、高剂量组脾脏组织CD27蛋白表达、CD19蛋白表达和BAFF mRNA表达降低（P＜0.05）,芪参地黄颗粒高剂量组脾脏组织CXCL13和CXCR5 mRNA表达降低（P＜0.05）,且芪参地黄颗粒中、高剂量组脾脏组织CD19蛋白表达较阳性药组下降（P＜0.05）。结论：芪参地黄颗粒通过降低EAMG大鼠CD19和CD27蛋白、BAFF、CXCL13和CXCR5 mRNA的表达,减少B细胞的分化增殖,抑制B细胞产生AChR-Ab,减少对乙酰胆碱受体的破坏,使EAMG大鼠体重增加,临床症状得到改善。     

5-氮杂胞苷对T淋巴细胞Jurkat miR-126及IFN-γ、GATA3、ROR-γ、Foxp3表达的影响

目的:探究甲基化酶抑制剂5-氮杂胞苷(5-azacytidin,5-aza)对T淋巴细胞(Jurkat)mi R-126、Th1/Th2、Th17/Treg细胞亚群及因子IFN-γ、GATA3、ROR-γ和Foxp3的调控作用。方法:采用不同浓度5-aza干预T淋巴细胞,24 h、48 h后检测其对细胞增殖抑制作用;实时荧光定量PCR、Western Blot检测5-aza干预后mi R-126表达水平以及IFN-γ、GATA3、ROR-γ和Foxp3的m RNA及蛋白表达水平;流式细胞术检测5-aza干预后Th1/Th2、Th17/Treg细胞亚群分化比例。结果:甲基化酶抑制剂干预T淋巴细胞后,细胞抑制率随5-aza浓度增大及作用时间延长呈递增趋势(P<0.01);细胞抑制率在24 h、48 h,低、中、高浓度下分别为(14.73±0.93)%、(32.67±8.40)%、(60.87±5.78)%以及(18.98±0.73)%、(39.80±8.42)%、(64.11±6.04)%;抑制率在24 h与48 h之间无差异(P>0.05)。甲基化酶抑制剂干预后mi R-126表达降低(P<0.01);IFN-γ蛋白表达降低(P<0.05)、Th1细胞亚群数目降低(P<0.01);GATA3 m RNA和蛋白表达升高(P<0.05)、Th2细胞亚群数目增加(P<0.01);ROR-γ蛋白表达降低(P>0.05)、Th17细胞亚群数目降低(P<0.05);Foxp3 m RNA和蛋白表达升高(P>0.05)、Treg细胞亚群数目增加(P<0.05)。结论:甲基化酶抑制剂可以下调Jurkat细胞mi R-126基因表达;下调Th1、Th17细胞亚群分化,上调Th2、Treg细胞亚群分化;调控细胞因子IFN-γ、GATA3、ROR-γ和Foxp3的表达。     

中国西北部1221例重症肌无力患者的临床特点分析

目的:分析中国西北部重症肌无力患者的临床特点。方法:收集2006年1月~2013年9月第四军医大学唐都医院神经内科及胸外科收治的重症肌无力患者,应用重症肌无力定量评分表(QMGs)进行病情评分,胸腺组织学类型以WHO分类为主,同时对部分患者进行随访观察。结果:共纳入1221例重症肌无力患者,包括男性595例,女性626例。Ⅰ型MG患者的起病年龄最轻,其次是Ⅲa;各临床类型MG患者的病程比较均无明显统计学差异(P0.05);Ⅳb型MG患者的QMGs评分最高,病情最严重,Ⅰ型最低,病情最轻。合并胸腺增生的MG患者起病年龄最轻,其次是胸腺正常患者,合并胸腺瘤患者的起病年龄最大,显著大于合并胸腺增生者(P0.05);不同胸腺病理状态MG患者的QMGs比较无统计学差异(P0.05)。合并不同类型胸腺瘤MG患者的起病年龄、QMGs比较均无明显统计学差异(P0.05)。与住院期间QMGs相比,随访患者各组QMGs均较前明显下降,且以胸腺瘤各组QMGs评分下降显著。结论:1眼肌型MG患者起病年龄最轻,临床症状也最轻;2胸腺增生患者起病年龄较胸腺瘤明显早,而胸腺瘤不同病理分型间起病年龄无明显区别;3胸腺手术切除患者病情恢复明显优于未切除胸腺患者,提示手术切除胸腺对于治疗MG是行之有效的方法。     

重症肌无力风险基因挖掘

目的:挖掘重症肌无力(Myasthenia gravis,MG)可能的风险基因。方法:通过人工挖掘在Pub Med数据库收集重症肌无力风险基因,通过Gene数据库获取重症肌无力风险基因编号,用以表示基因或者其相应的蛋白。应用基因功能分析软件DAVID(http://david.abcc.ncifcrf.gov/)对重症肌无力风险基因进行KEGG通路富集分析,挖掘重症肌无力风险通路,进而对任意两个通路进行关联分析。应用基因功能分析软件DAVID的Gene Ontology,对MG风险基因进行功能注释,以P0.01来判定注释是否有显著意义。结果:(1)本研究挖掘出97个重症肌无力的风险基因,KEGG基因富集分析共筛选出44条与重症肌无力显著相关的通路,主要包括多种自身免疫性疾病相关通路、信号转导相关通路、肿瘤相关通路、抗原的加工提呈通路等等。(2)以上44条风险通路两两通路间均具有相关性(P.0.01)。结论:本研究共挖掘出44条重症肌无力风险通路,8个重症肌无力风险基因,分别为:NF-kB、TNFR、MEK、AP-1、Raf、MEK1/2、MSK1、TAPBP。其中,MEK同时出现在多个风险通路中,考虑其风险性更高。     

321例重症肌无力患者睡眠质量分析

目的:分析312例重症肌无力患者病情稳定期的睡眠质量。方法:收集2013年2月—2014年6月第四军医大学唐都医院神经内科门诊就诊的重症肌无力患者,应用匹兹堡睡眠质量指数(PSQI)对患者进行近1月的睡眠质量问卷调查、重症肌无力定量评分表(QMG)进行病情评分,以P0.05为有统计学意义,对MG患者睡眠质量指数、各因子分进行分析研究。结果:符合重症肌无力诊断标准、知情同意并纳入研究患者共有321例,男156,女165。研究发现,多数重症肌无力患者有睡眠质量问题:性别与睡眠质量、病情评定无相关性(P0.05);重症肌无力患者睡眠质量问题主要表现为入睡时间、睡眠效率、睡眠障碍、日间功能方面。结论:重症肌无力患者存在睡眠质量差这一问题。改善MG患者肌无力症状的同时,应注重改善患者的睡眠质量。     

重症肌无力患者的免疫指标与临床疗效分析

目的:探讨并分析重症肌无力(MG)患者的免疫指标和临床治疗效果。方法:选取我院2010年6月~2014年6月接收的200例重症肌无力患者,在治疗前和治疗后采用细胞仪检测外周血CD3、CD4和CD8及采用比浊法检测IgG、IgA和IgM,进行分类比较其变化。结果:全身型重症肌无力患者的IgG、IgA较眼肌型高(P0.05),差异具有统计学意义。在治疗前后的免疫指标(CD3、CD4、CD8、IgG、IgA及IgM)和临床资料(男/女、眼肌型/全身型、检测时病程、检测时年龄)的对比中,差异无统计学意义(P0.05)。在体液免疫低下组中,用丙种球蛋白治疗的缓解率比未用丙种球蛋白组的缓解率高(P0.01),差异具有统计学意义。结论:重症肌无力患者免疫指标IgG、IgA、IgM、CD3、CD4、CD8虽然不能作为重症肌无力患者的病情和疗效的唯一评价指标,但对指导治疗具有一定的参考价值,且体液免疫低下者用丙球蛋白的疗效较好。     

肝豆状核变性类似杂合丢失现象的报告及可能机制探讨

对39个家系45个病人及60例正常人的ATP7B基因的几个外显子采用8～10%的非变性丙稀酰胺胶进行SSCP分析, 并对异常者测序（放射自显影）, 发现一个家系的8号外显子上同时存在两个突变(C2250G和G2273T),患者属纯合子,其父为杂合子,母亲和妹妹为正常, 类似“杂合丢失现象”。提示在除了肿瘤之外的体细胞遗传病中,二次突变理论也可能是突变发生的机制之一。 Abstract：　 Screen for mutation in many exons with 45 Wilson disease patients in 39 Chinese families by SSCP and nucleotide sequence analysis by autoradiograph. There are two mutations in exon 8 of a patients family: C2250G and G2273T. Found in these two mutation points, the patients father is a heterozygote, patients mother and sister are normal sequences, and patient is a homozygous. It just like a loss of heterogyzosity in this family with Wilson disease. The patient and her parent sibship were confirmed by taternity test with microsatellite vWF SE33 AR and D9S112. The result suggested that Loss of heterozygosity (LOH) is probable mutate mechanism of hereditary disease besides tumor and cancer.     

肝豆状核变性类似杂合丢失现象的报告及可能机制探讨

对39个家系45个病人及60例正常人的ATP7B基因的几个外显子采用8～10%的非变性丙稀酰胺胶进行SSCP分析, 并对异常者测序（放射自显影）, 发现一个家系的8号外显子上同时存在两个突变(C2250G和G2273T),患者属纯合子,其父为杂合子,母亲和妹妹为正常, 类似“杂合丢失现象”。提示在除了肿瘤之外的体细胞遗传病中,二次突变理论也可能是突变发生的机制之一。 Abstract：　 Screen for mutation in many exons with 45 Wilson disease patients in 39 Chinese families by SSCP and nucleotide sequence analysis by autoradiograph. There are two mutations in exon 8 of a patients family: C2250G and G2273T. Found in these two mutation points, the patients father is a heterozygote, patients mother and sister are normal sequences, and patient is a homozygous. It just like a loss of heterogyzosity in this family with Wilson disease. The patient and her parent sibship were confirmed by taternity test with microsatellite vWF SE33 AR and D9S112. The result suggested that Loss of heterozygosity (LOH) is probable mutate mechanism of hereditary disease besides tumor and cancer.     

HLA—DQ分子遗传结构与中国人重症肌无力的相关性

重症肌无力与ＨＬＡⅡ类基因关联性在不同人种和民族中具有不同遗传易感性,为探讨中国人重症肌无力（ＭＧ）与ＨＬＡ０ＤＱ分子关联性,采用聚合酶链式反应－限制性片段长度多态性（ＰＣＲ－ＲＦＬＰ）方法,分析了５０例中国正常人及４９例重症肌无力患者的ＨＬＡ－ＤＱＡ１和－ＤＱＢ１座位的基因型,结果：共检出正常人ＤＱＡ１等位基因８种,ＤＱＢ１等位基因１０种,重症肌无力患者ＤＱＡ１等位基因８种,ＤＱＢ１等位基因９种     

Agrin binds to the N-terminal region of Lrp4 protein and stimulates association between Lrp4 and the first immunoglobulin-like domain in muscle-specific kinase (MuSK)

Neuromuscular synapse formation depends upon coordinated interactions between motor neurons and muscle fibers, leading to the formation of a highly specialized postsynaptic membrane and a highly differentiated nerve terminal. Synapse formation begins as motor axons approach muscles that are prepatterned in the prospective synaptic region in a manner that depends upon Lrp4, a member of the LDL receptor family, and muscle-specific kinase (MuSK), a receptor tyrosine kinase. Motor axons supply Agrin, which binds Lrp4 and stimulates further MuSK phosphorylation, stabilizing nascent synapses. How Agrin binds Lrp4 and stimulates MuSK kinase activity is poorly understood. Here, we demonstrate that Agrin binds to the N-terminal region of Lrp4, including a subset of the LDLa repeats and the first of four β-propeller domains, which promotes association between Lrp4 and MuSK and stimulates MuSK kinase activity. In addition, we show that Agrin stimulates the formation of a functional complex between Lrp4 and MuSK on the surface of myotubes in the absence of the transmembrane and intracellular domains of Lrp4. Further, we demonstrate that the first Ig-like domain in MuSK, which shares homology with the NGF-binding region in Tropomyosin Receptor Kinase (TrKA), is required for MuSK to bind Lrp4. These findings suggest that Lrp4 is a cis-acting ligand for MuSK, whereas Agrin functions as an allosteric and paracrine regulator to promote association between Lrp4 and MuSK.     

Lineage tree analysis of immunoglobulin variable-region gene mutations in autoimmune diseases: chronic activation, normal selection

Autoimmune diseases show high diversity in the affected organs, clinical manifestations and disease dynamics. Yet they all share common features, such as the ectopic germinal centers found in many affected tissues. Lineage trees depict the diversification, via somatic hypermutation (SHM), of immunoglobulin variable-region (IGV) genes. We previously developed an algorithm for quantifying the graphical properties of IGV gene lineage trees, allowing evaluation of the dynamical interplay between SHM and antigen-driven selection in different lymphoid tissues, species, and disease situations. Here, we apply this method to ectopic GC B cell clones from patients with Myasthenia Gravis, Rheumatoid Arthritis, and Sj?gren's Syndrome, using data scaling to minimize the effects of the large variability due to methodological differences between groups. Autoimmune trees were found to be significantly larger relative to normal controls. In contrast, comparison of the measurements for tree branching indicated that similar selection pressure operates on autoimmune and normal control clones.     

Neuropeptides of human thymus in normal and pathological conditions

Human thymus of healthy subjects and patients affected by thymoma-associated Myastenia Gravis were studied in order to visualize and compare the morphological distributive pattern of four neuropeptides: vasoactive intestinal peptide, substance P, neuropeptide Y, and neurotensin. Based on our observations, we formulated hypotheses on their relations in neuro-immunomodulation under physiological and pathophysiological conditions. Immuno-histochemical staining for neuropeptides was performed and morphological and morphometrical analyses were conducted on healthy and diseased thymus. In normal thymus, a specific distributive pattern was observed for the several neuropeptide-positive nerves in different thymus lobular zones. In particular substance P-positive fibers were observed in subcapsular zone, specifically located into parenchyma, where they represent the almost total amount of fibers; neurotensin-positive fibers were observed primarily located in parenchyma than perivascular site of several thymus lobular zones, and more abundant the cortico-medullary and medullary zones. Instead VIP- and NPY-positive fibers were widely distributed in perivascular and parenchymal sites of several thymus lobular zones. In thymoma, the distribution of neuropeptide-positive fibers was quantitatively reduced, while cells immunopositive to VIP and substance P were quantitatively increased and dispersed. Observation of the perivascular and parenchymal distribution of the analyzed neuropeptides suggests evidence that a regulatory function is performed by nerves and cells that secrete neuropeptide into the thymus. The alteration of neuropeptide patterns in thymoma suggests that these neurotransmitters play a role in autoimmune diseases such as Myastenia Gravis.     

AMP-Deaminase from Thymus of Patients with Myasthenia Gravis

Myasthenia gravis (MG) is characterized clinically by skeletal muscle fatigue following the excessive exercise. Interestingly most of MG patients manifest parallely also some abnormalities of the thymus.AMP-deaminase (AMPD) from human thymus was not a subject of studies up to now. In this paper, mRNA expression and some physico-chemical and immunological properties of AMPD purified from the thymus of MG patients were described. Experiments performed identified the liver isozyme (AMPD2) as the main isoform of AMPD expressed in this organ. The activity of AMPD found in this organ was higher than in other human non-(skeletal) muscle tissues indicating on role the enzyme may play in supplying of guanylates required for the intensive multiplication of thymocytes.