Hematopoietic stem cell transplantation in leukodystrophies.

Caroline Sevin, Fanny Mochel
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Abstract

More than 50 leukodystrophies have been described. This group of inherited disorders affects myelin development and/or maintenance and can manifest from birth to adulthood. Neuroinflammation is a hallmark of some leukodystrophies, explaining in part the therapeutic benefit of hematopoietic stem cell transplantation (HSCT). Indeed, in addition to supplying the CNS with myelomonocyte donor cells expressing the deficient protein or enzyme, HSCT allows the restoration of normal microglia function, which may act on neuroinflammation. In this chapter, we explore the rationale, indication, and outcome of HSCT in Cerebral Adrenoleukodystrophy (CALD), Metachromatic Leukodystrophy (MLD), Krabbe Disease (KD), and Adult-onset Leukoencephalopathy with Axonal Spheroids and Pigmented Glia (ALSP), which are among the most frequent leukodystrophies. For these leukodystrophies, HSCT may modify notably the natural history and improve CNS-related deficits, provided that the procedure is performed early into the disease course. In addition, we discuss the recent development of ex vivo gene therapy for CALD and MLD as a promising alternative to allograft.

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白质营养不良症中的造血干细胞移植。
目前已描述了 50 多种白质营养不良症。这类遗传性疾病影响髓鞘的发育和/或维持,从出生到成年都有可能发病。神经炎症是某些白质营养不良症的特征,这在一定程度上解释了造血干细胞移植(HSCT)的治疗效果。事实上,除了向中枢神经系统提供表达缺失蛋白或酶的骨髓单核细胞供体细胞外,造血干细胞移植还能恢复小胶质细胞的正常功能,从而抑制神经炎症。在本章中,我们将探讨造血干细胞移植治疗脑性肾上腺白质营养不良症(CALD)、变色斑性白质营养不良症(MLD)、克拉伯病(KD)和伴轴突海绵体和色素性胶质细胞的成人型白质脑病(ALSP)的原理、适应症和疗效,这些疾病都是最常见的白质营养不良症。对于这些白质营养不良症,造血干细胞移植可显著改变自然病史,改善中枢神经系统相关障碍,但前提是必须在病程早期进行。此外,我们还讨论了针对 CALD 和 MLD 的体外基因疗法的最新进展,这是一种替代异体移植的可行方法。
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来源期刊
Handbook of clinical neurology
Handbook of clinical neurology Medicine-Neurology (clinical)
CiteScore
4.10
自引率
0.00%
发文量
302
期刊介绍: The Handbook of Clinical Neurology (HCN) was originally conceived and edited by Pierre Vinken and George Bruyn as a prestigious, multivolume reference work that would cover all the disorders encountered by clinicians and researchers engaged in neurology and allied fields. The first series of the Handbook (Volumes 1-44) was published between 1968 and 1982 and was followed by a second series (Volumes 45-78), guided by the same editors, which concluded in 2002. By that time, the Handbook had come to represent one of the largest scientific works ever published. In 2002, Professors Michael J. Aminoff, François Boller, and Dick F. Swaab took on the responsibility of supervising the third (current) series, the first volumes of which published in 2003. They have designed this series to encompass both clinical neurology and also the basic and clinical neurosciences that are its underpinning. Given the enormity and complexity of the accumulating literature, it is almost impossible to keep abreast of developments in the field, thus providing the raison d''être for the series. The series will thus appeal to clinicians and investigators alike, providing to each an added dimension. Now, more than 140 volumes after it began, the Handbook of Clinical Neurology series has an unparalleled reputation for providing the latest information on fundamental research on the operation of the nervous system in health and disease, comprehensive clinical information on neurological and related disorders, and up-to-date treatment protocols.
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