Expert Review of Clinical Immunology最新文献

Objective: This study aimed to investigate the association between MMP-2 rs243865 and TIMP-2 rs8179090 gene polymorphisms and skin barrier function, as well as inflammatory cytokine levels, in acne patients, to explore potential genetic mechanisms underlying acne pathogenesis.

Methods: A total of 200 acne patients and 100 healthy controls were enrolled. Genotyping was performed using PCR-RFLP. Skin barrier function was assessed via transepidermal water loss (TEWL) and hydration measurements. Serum levels of IL-1β and TNF-α were quantified by ELISA. Statistical analyses included Pearson correlation and logistic regression.

Results: The MMP-2-CC and TIMP-2-CC genotypes were significantly more prevalent in acne patients (p < 0.05). These genotypes correlated with higher TEWL (p < 0.05), reduced skin hydration (p < 0.05), and elevated IL-1β and TNF-α levels (p < 0.05) compared to CT/TT genotypes. Logistic regression confirmed associations between CC genotypes and increased acne severity (OR = 1.86-2.24).

Conclusion: The MMP-2 and TIMP-2 CC genotypes are linked to impaired skin barrier function and heightened inflammation in acne, suggesting their role in genetic susceptibility and disease progression. These findings may inform future targeted therapies.

Clinical trial registration: www.clinicaltrials.gov identifier is NCT07069075.

Introduction: Asthma coupled with neurodevelopmental and mental disorders (NMD) is an important childhood issue. Children living in rural areas may experience unique exposures or require novel health care approaches. The purpose of this report is to explore the effects of rural dwelling on the relationship between childhood asthma and NMDs.

Areas covered: Medline, Embase, CINAHL, and APA databases were searched from date of inception up to February 2025. Few studies investigated the role of rural dwelling on the relationship between childhood asthma and NMDs. Of those, purpose, methods and sampling varied greatly. Despite this, there is evidence of differences in the frequency of childhood asthma-NMD multimorbidity (CANM) between urban and rural areas, albeit with some inconsistency, as well as some indication of rural specific interventions improving health outcomes. A major gap is the lack of evidence about the role of rural dwelling on the impact of CANM.

Expert opinion: Consideration of rurality on CANM should be a focal point of research and practice; this may contribute to the understanding of CANM etiology. In addition, needs of rural dwellers should drive the development of novel forms of health care delivery. These approaches will address research and care gaps around CANM.

Introduction: Our objective is to delineate the evolution of lupus nephritis (LN) histological classifications and management, from their origins to the present histopathological framework and treatment strategies, and to consider prospective future directions.

Areas covered: We describe the origins and progressive development of LN, particularly on histological classifications and pharmacological approaches to prevent renal disease progression and disease flares between 1950 and 2000 (the Past). Then, we discuss the remarkable advances achieved from 2001 to the present in the management, prognosis, and understanding of LN(the Present). Then, we envision a future shaped by the broader adoption of personalized medicine, the integration of novel biomarkers and artificial intelligence, and the innovative therapeutic strategies (the Future). Bibliography was searched in databases including PubMed, Medline, and Embase.

Expert opinion: Despite improvement in LN diagnosis and management, many patients experience a poor quality of life and may progress to renal failure or die from complications often associated with immunosuppressive therapy. Future strategies are expected to make substantial contributions to the field of LN, including the identification of novel biomarkers, the application of artificial intelligence, the implementation of personalized medicine, and the development of innovative therapies improving long-term renal survival and patients' quality of life.

Introduction: Bruton's tyrosine kinase inhibitors (BTKi) have transformed the management of B-cell malignancies by selectively targeting signaling pathways essential for malignant B-cell survival, thereby reducing the systemic toxicity of conventional chemotherapy. However, with their expanding use, cutaneous adverse events are increasingly recognized as clinically relevant complications that may affect quality of life and treatment adherence.

Areas covered: This review provides an updated overview of first- and second-generation BTKi, including ibrutinib, acalabrutinib, zanubrutinib, and pirtobrutinib, with a specific focus on dermatologic toxicities. A comprehensive literature search was conducted using PubMed, Embase, and Scopus, covering publications up to February 2025. Clinical studies, case series, and case reports describing skin-related adverse events associated with BTKi therapy were reviewed.

Expert opinion: Cutaneous toxicities related to BTKi are often underrecognized but clinically significant, ranging from xerosis and bruising to lichenoid eruptions and vasculitis. First-generation agents, particularly ibrutinib, are associated with a broader spectrum of dermatologic adverse events, whereas newer BTKi show improved selectivity and potentially reduced skin toxicity. Early recognition, standardized dermatologic evaluation, and proactive multidisciplinary management are essential to minimize patient discomfort, preserve quality of life, and prevent unnecessary treatment discontinuation.

Introduction: Interleukin-15 (IL-15) is a pleiotropic, pro-inflammatory cytokine, constitutively expressed in both hematopoietic and non-hematopoietic cells. The role of IL-15 during systemic inflammatory diseases, including autoimmune and autoinflammatory disorders, is to be fully clarified yet. Due to its effects on immune cells, IL-15 has attracted attention as a potential new therapeutic target for modulating immune responses, either by enhancing immune surveillance or by controlling excessive inflammation.

Areas covered: We provided a landscape about IL-15 in systemic inflammatory diseases, from its biological functions to the possible mechanistic roles, using rheumatoid arthritis (RA) and Still's disease as autoimmune and autoinflammatory models, respectively.

Expert opinion: IL-15 exerts its pathogenetic activity by the induction of a deregulated activation of innate and adaptive arms of the immune system, at the crossroad of autoimmune and autoinflammatory disorders. During RA, IL-15 mediates the production from T cells and macrophages of TNF, which may induce further production of IL-15 by synoviocytes via a vicious pathogenic loop. During Still's disease, together with IFN-I, IL-15 promotes the expansion of NK cells and of CD38+HLA-DR+ T cells, which are highly activated in disease life-threatening evolution. Thus, novel IL-15-targeted therapeutic strategies could be explored to improve the management of systemic inflammatory diseases.

Introduction: Management of inoperable and advanced malignant melanoma has been transformed in recent years by the advent of a number of approaches, including immune checkpoint blockade, small-molecule inhibitors, and adoptive immunotherapy with ex vivo expanded tumor-infiltrating lymphocytes.

Areas covered: In this review, we describe efforts made to develop an alternative immunotherapeutic approach for this disease using chimeric antigen receptor (CAR) engineered T-cells. Literature was reviewed in the PubMed database and clinicaltrials.gov website (1998-2025).

Expert opinion: CAR T-cell immunotherapy has proven transformative in the treatment of selected hematological malignancies. However, solid tumors such as melanoma remain much more challenging to treat using this emerging modality. Here we consider issues surrounding target selection, encompassing both tumor cells and accompanying stroma, in addition to armoring approaches that may potentiate delivery to or efficacy within the tumor microenvironment. We also consider a number of advanced CAR-based architectures to enable multi-antigen or universal antigen targeting and combination-based approaches.

Introduction: Climate change and global warming have major consequences for human health, including effects on the immune system.

Areas covered: The impact of global warming on vector transmitted infectious diseases, such as West Nile Virus and dengue. Changes in pollen grain composition and pollen season duration, along with increased frequencies of dust storms, have detrimental impacts on asthmatic and allergic patients. The direct and indirect effects of climate change on autoimmune and cardiovascular diseases are also discussed. Literature on climate and the immune system was retrieved from PubMed and Google Scholar up to 21 July 2025.

Expert opinion: Climate change will lead to the spread of tropical infectious diseases toward moderate climate regions. Recommended vaccination schedules should be adapted to include these diseases. The changing climate has also extended pollen season and increased both the frequency and severity of dust storms, which impacts asthmatic patients. There are indications that next to extreme heath, pollen exposure contributes to acute cardiac events and complications after cardiovascular surgery. More insight into the underlying mechanisms of the negative effects of climate changes on the immune system could allow to take the appropriate measures and interventions to mitigate climate-associated immune-mediated diseases.

Introduction: Inflammatory brain diseases (IBrainDs) are rare, potentially devastating diseases that affect children and adolescents. Clinical presentation is often subacute with focal and diffuse neurological manifestations and psychiatric symptoms which may occur without early aggressive treatment.

Areas covered: In this review performed in Pubmed including English Literature until July 2025 on the different IBrainDs categories include the clinical presentation, laboratory features, treatment, and outcome of these IBrainDs.

Expert opinion: As IBrainDs often present subacute and insidious, a high index of suspicion is warranted as often CSF and MRI findings are nonspecific and specific antibody testing, angiography, or brain biopsy are necessary to confirm the diagnosis. Here we will review the main categories of IBrainDs, clinical presentation, and discuss pathophysiologic mechanisms to support treatment choices.