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Catalán Serra, Ignacio
Andreu Ballester, Juan Carlos (dir.); Bixquert Jiménez, Miguel (dir.) Departament de Medicina |
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Aquest document és un/a tesi, creat/da en: 2015 | |
Inflammatory bowel disease (IBD) is a chronic relapsing systemic disease, mainly affecting the gastrointestinal tract with extraintestinal manifestations which includes two main conditions: ulcerative colitis (UC) and Crohn´s disease (CD). It affects mainly young individuals, thus requiring the use of anti-inflammatory and immunsupressive drugs for long periods of time, with the subsequent need for specialist controls and the burden of frequent side effects. Moreover, IBD patients frequently require hospitalizations and surgical procedures, impacting directly in the medical associated costs and quality of life.
The increasing incidence and prevalence of the disease and its unknown exact pathogenesis has raised the interest of an increasingly diverse group of clinicians and research groups, reinforcing the need for translational and multidisciplinary approaches. It is well recognized ...
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Inflammatory bowel disease (IBD) is a chronic relapsing systemic disease, mainly affecting the gastrointestinal tract with extraintestinal manifestations which includes two main conditions: ulcerative colitis (UC) and Crohn´s disease (CD). It affects mainly young individuals, thus requiring the use of anti-inflammatory and immunsupressive drugs for long periods of time, with the subsequent need for specialist controls and the burden of frequent side effects. Moreover, IBD patients frequently require hospitalizations and surgical procedures, impacting directly in the medical associated costs and quality of life.
The increasing incidence and prevalence of the disease and its unknown exact pathogenesis has raised the interest of an increasingly diverse group of clinicians and research groups, reinforcing the need for translational and multidisciplinary approaches. It is well recognized that an altered immune reponse to commensal intestinal bacteria takes place in genetically predisposed individuals, and it can be considered an immune deficiency condition. Attempts to bolster and regulate immunity (especially the T lymphocytes) and/or correct the immunity defects to prevent chronic inflammation represents a change of paradigme from conventional anti-inflammatory treatments to immunotherapy, that has showed positive results in other autoimmune and infectious diseases and cancer. Thus, the study of these immunological alterations, and specifically, the role of lymphocytes and their regulators in IBD, is a key element for understanding its pathogenesis, and develop new and more effective therapeutic alternatives.
There are two T lymphocyte populations that can be distinguished by the expression of αβ or γδ chains. αβ T lymphocytes (αβTL) are more frequent (90-95%) in the peripheral blood, spleen and lymph nodes. On the other hand, γδ T lymphocytes (γδTL) constitute only a small proportion (1-5%) of the lymphocytes that circulate in the blood and peripheral organs, and they are present mainly in the epithelia, where they can constitute up to 50% of intraepithelial T lymphocytes (IELs).
There are two major features that make γδTL different from the αβ subtype: 1)γδ TL can recognize antigens without the normal constraints of antigen processing and presentation (Major Histocompatibility Complex -MHC- restriction), providing a direct and quick response; 2)γδ TL can recognize non peptide ligands like viral proteins, bacterial superantigens, or heat shock proteins and are highly stimulated by phosphoantigens. These special features allow γδ TL to provide a comprehensive response for pathogen clearance through direct recognition, to collaborate intensely in immune modulation and in wound healing mechanisms.
Interleukin 7 (IL-7) belongs to the class 1 of cytokines that signal through the common heterodimeric γc chain and has been recognized as a mediator of the homeostatic mechanisms that maintains a stable number of naive memory T cells in the peripheral immune system. Moreover IL-7 is absolutely critical for the development of γδTL, and γδTL cannot be detected in IL-7R α knockout mice.
These potent immunological homeostatic properties and particularly its unique capacity of expanding naive T lymphocyte pools, make IL-7 a promising candidate for treating conditions causing T lymphocyte dysfunction or lymphopenia like chronic viral infections (HIV, CMV), regeneration of T cells after hematopoietic stem cell transplant, immunodeficiencies, autoimmune disorders and cancer immunotherapy. This could also be the case in IBD.
Our hypothesis is that IBD patients present an alteration in the innate immunity, specifically in the function of γδTL and its main regulator IL-7, that contributes to the initiation and/or perpetuation of the intestinal inflammation.
We aimed to determine the levels of γδTL and IL-7 in peripheral blood of 102 Crohn´s disease patients and controls and analyse its relation with several clinical and endoscopiacal variables.
Our results show a decrease in the overall lymphocyte population and specially in γδTL in the peripheral blood of patients with CD. This decrease occurred in all different clinical settings and was inversely correlated with the clinical and endoscopical activity.
We also found a surprising decreased level of serum IL-7 in CD –although not statistically significative- (high compensating IL-7 levels were expected due to lymphopenia). This results represents a new pathogenic mechanism in CD, with potential therapeutical implications.La EII es un proceso inflamatorio crónico y recidivante de carácter sistémico que afecta predominantemente al tracto gastrointestinal, asociándose frecuentemente con manifestaciones extraintestinales . Existen dos subtipos principales de EII: la enfermedad de Crohn (EC) y la colitis ulcerosa (CU). La EC puede afectar cualquier parte del tracto digestivo, es de carácter transmural y suele afectar a individuos jóvenes, alternando periodos de remisión clínica y brotes de actividad. El control clínico de estos brotes recidivantes requiere el empleo de fármacos antiinflamatorios no exentos de efectos secundarios (corticoides, inmunosupresores, agentes biológicos etc.) siendo frecuente la necesidad de hospitalizaciones e incluso de cirugía para el tratamiento de las complicaciones.
La etiopatogenia de la EC es en muchos aspectos desconocida. Actualmente se considera la EII como un trastorno poligénico inmunitario de causa multifactorial en el que intervienen: 1) factores genéticos individuales; 2) factores ambientales; 3) la flora intestinal (microbioma) y 4) la respuesta inmunitaria. Una combinación de estos factores produce una respuesta inmunitaria inadecuada y excesiva contra la flora comensal en sujetos genéticamente predispuestos.
Los linfocitos T (LT) pueden dividirse en dos grandes subpoblaciones según el receptor para antígeno que expresan en la membrana de superficie (TCR): los LT αβ y los LT γδ, que expresan el TCR-αβ y el TCR-γδ respectivamente. Tres características fundamentales diferencian a los LTγδ de los LTαβ: 1) Se localizan fundamentalmente en las mucosas constituyendo hasta el 50% de los linfocitos intraepiteliales (LIE) y son escasos en sangre periférica y órganos linfoides secundarios, donde predominan los LTαβ ; 2) reconocen proteínas directamente sin el procesamiento antigénico previo por las moléculas del complejo mayor de histocompatibilidad (CMH); y 3) son potentemente estimuladas directamente por metabolitos microbianos fosforilados y antígenos lipídicos. Estas células se consideran una pieza clave en la primera línea de defensa contra la invasión de patógenos invasivos (los epitelios), así como en la homeostasis de la respuesta inmune y en el control de las infecciones, los tumores y las enfermedades autoinmunitarias. Actualmente existen varias líneas de investigación empleando estas células como diana terapéutica aprovechando estas características con resultados prometedores.
La IL-7 pertenece a la familia de hematopoyetinas de clase 1 (γc), se produce fundamentalmente por las células del estroma no hematopoyéticas y por las células epiteliales de la médula ósea y el timo. Se considera como el factor más importante para la estimulación y homeostasis de los LT en general, y en particular de los linfocitos intraepiteliales (LIEs) y los LTγδ.
El presente estudio se propone evaluar y comparar los valores séricos de linfocitos y sus distintas subpoblaciones, y de la IL-7 en 102 pacientes con EC y sujetos sanos, y su variación según las distintas variables clínicas estudiadas. Nuestros resultados confirman la presencia de linfopenia con una deficiencia de LTγδ en sangre periférica en pacientes con EC, corroborando estudios previos, así como su relación inversa con marcadores de actividad clínica y endoscópica, que se mantiene con independencia de la presencia o no de tratamiento y que constituye un nuevo mecanismo patogénico en la enfermedad. Se confirma asimismo la ausencia de una elevación compensatoria de la IL-7 lo que apunta a un posible defecto inmunitario en la regulación de estas células, con posibles implicaciones terapéuticas.
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