{"title":"Lymphocytes in autoimmune encephalitis: Pathogenesis and therapeutic target","authors":"","doi":"10.1016/j.nbd.2024.106632","DOIUrl":null,"url":null,"abstract":"<div><p>Autoimmune encephalitis (AE) is an inflammatory disease of the central nervous system characterized by the production of various autoimmune antibodies targeting neuronal proteins. The pathogenesis of AE remains elusive. Accumulating evidence suggests that lymphocytes, particularly B and T lymphocytes, play an integral role in the development of AE. In the last two decades, autoimmune neural antibodies have taken center stage in diagnosing AE. Recently, increasing evidence has highlighted the importance of T lymphocytes in the onset of AE. CD4<sup>+</sup> T cells are thought to influence disease progression by secreting associated cytokines, whereas CD8<sup>+</sup> T cells exert a cytotoxic role, causing irreversible damage to neurons mainly in patients with paraneoplastic AE. Conventionally, the first-line treatments for AE include intravenous steroids, intravenous immunoglobulin, and plasma exchange to remove pathogenic autoantibodies. However, a minority of patients are insensitive to conventional first-line treatment protocols and suffer from disease relapse, a condition referred to as refractory AE. In recent years, new treatments, such as rituximab or CAAR-T, which target pathogenic lymphocytes in patients with AE, have offered new therapeutic options for refractory AE. This review aims to describe the current knowledge about the function of B and T lymphocytes in the pathophysiology of AE and to summarize and update the immunotherapy options for treating this disease.</p></div>","PeriodicalId":19097,"journal":{"name":"Neurobiology of Disease","volume":null,"pages":null},"PeriodicalIF":5.1000,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0969996124002328/pdfft?md5=cb16a141899e17a5588bc41b2d7a8f7c&pid=1-s2.0-S0969996124002328-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neurobiology of Disease","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0969996124002328","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
引用次数: 0
Abstract
Autoimmune encephalitis (AE) is an inflammatory disease of the central nervous system characterized by the production of various autoimmune antibodies targeting neuronal proteins. The pathogenesis of AE remains elusive. Accumulating evidence suggests that lymphocytes, particularly B and T lymphocytes, play an integral role in the development of AE. In the last two decades, autoimmune neural antibodies have taken center stage in diagnosing AE. Recently, increasing evidence has highlighted the importance of T lymphocytes in the onset of AE. CD4+ T cells are thought to influence disease progression by secreting associated cytokines, whereas CD8+ T cells exert a cytotoxic role, causing irreversible damage to neurons mainly in patients with paraneoplastic AE. Conventionally, the first-line treatments for AE include intravenous steroids, intravenous immunoglobulin, and plasma exchange to remove pathogenic autoantibodies. However, a minority of patients are insensitive to conventional first-line treatment protocols and suffer from disease relapse, a condition referred to as refractory AE. In recent years, new treatments, such as rituximab or CAAR-T, which target pathogenic lymphocytes in patients with AE, have offered new therapeutic options for refractory AE. This review aims to describe the current knowledge about the function of B and T lymphocytes in the pathophysiology of AE and to summarize and update the immunotherapy options for treating this disease.
自身免疫性脑炎(AE)是一种中枢神经系统炎症性疾病,其特征是产生针对神经元蛋白的各种自身免疫抗体。自身免疫性脑炎的发病机理仍然难以捉摸。越来越多的证据表明,淋巴细胞,尤其是 B 淋巴细胞和 T 淋巴细胞在 AE 的发病过程中起着不可或缺的作用。在过去二十年中,自身免疫性神经抗体已成为诊断 AE 的核心。最近,越来越多的证据强调了 T 淋巴细胞在 AE 发病中的重要性。CD4+ T 细胞被认为通过分泌相关细胞因子影响疾病进展,而 CD8+ T 细胞则发挥细胞毒性作用,主要对副肿瘤性 AE 患者的神经元造成不可逆转的损伤。传统上,AE 的一线治疗包括静脉注射类固醇、静脉注射免疫球蛋白和血浆置换以清除致病性自身抗体。然而,少数患者对传统的一线治疗方案不敏感,导致疾病复发,这种情况被称为难治性 AE。近年来,针对AE患者致病淋巴细胞的新疗法(如利妥昔单抗或CAAR-T)为难治性AE提供了新的治疗选择。本综述旨在描述目前有关 B 淋巴细胞和 T 淋巴细胞在 AE 病理生理学中的功能的知识,并总结和更新治疗这种疾病的免疫疗法方案。
期刊介绍:
Neurobiology of Disease is a major international journal at the interface between basic and clinical neuroscience. The journal provides a forum for the publication of top quality research papers on: molecular and cellular definitions of disease mechanisms, the neural systems and underpinning behavioral disorders, the genetics of inherited neurological and psychiatric diseases, nervous system aging, and findings relevant to the development of new therapies.