儿童复发性A族链球菌性扁桃体炎免疫机制的研究进展

doi:10.16352/j.issn.1001-6325.2023.02.336

摘要/Abstract

摘要： A族β溶血性链球菌(GAS)是儿童常见感染病原,其引起的扁桃体炎性反应反复发作,即为复发性A族链球菌性扁桃体炎(GAS-RT)。新近研究认为,GAS-RT并非传统意义上的感染性疾病,而是一种免疫敏感性疾病,经由超抗原(SAgs)和生发中心(GC)的滤泡辅助T细胞(Tfh)相互作用,发挥对GC的B细胞细胞毒作用来逃避免疫应答,该理论为临床提供了新的免疫靶向治疗的思路。

关键词: 复发性扁桃体炎, 免疫机制, 链球菌热原外毒素A, T滤泡辅助细胞, 细菌疗法

Abstract: Group A beta-hemolytic Streptococcus (GAS) is a common infectious agent in children which may cause recurrent inflammation of the tonsils, known as recurrent group A Streptococcus tonsillitis (GAS-RT). Recent studies found that GAS-RT is not an infectious disease as traditional sense, but rather than an immunosensitive disease that evades the immune response through the interaction between superantigens (SAgs) and follicular helper T cells (Tfh) in the germinal center (GC), which exerts a cytotoxic effects on B cells in the GC. This theory suggested a potential new strategy for clinical treatement.

Key words: recurrent tonsillitis, immune mechanism, Streptococcus pyrogenic exotoxins A, T follicular helper cells, bacteriotherapy

中图分类号:

施佳, 蔡成. 儿童复发性A族链球菌性扁桃体炎免疫机制的研究进展[J]. 基础医学与临床, 2023, 43(2): 336-340.

SHI Jia, CAI Cheng. Advances in immune mechanism of recurrent group A Streptococcus tonsillitis in children[J]. Basic & Clinical Medicine, 2023, 43(2): 336-340.

参考文献 25

[1]	Kalaiarasi R, Subramanian KS, Vijayakumar C, et al. Microbiological profile of chronic tonsillitis in the pediatric age group[J]. Cureus,2018,10:e3343.doi: 10.7759/cureus.3343.
[2]	Brouwer S, Barnett TC, Ly D, et al. Prophage exotoxins enhance colonization fitness in epidemic scarlet fever-causing Streptococcus pyogenes[J]. Nat Commun,2020, 11:5018.doi: 10.1038/s41467-020-18700-5.
[3]	Kasper KJ, Zeppa JJ, Wakabayashi AT, et al. Bacterial superantigens promote acute nasopharyngeal infection by Streptococcus pyogenes in a human MHC Class Ⅱ-dependent manner[J]. PLoS Pathog,2014,10:e1004155.doi: 10.1371/journal.ppat.1004155.
[4]	Yoshitomi H, Ueno H. Shared and distinct roles of T peripheral helper and T follicular helper cells in human diseases[J]. Cell Mol Immunol,2021, 18:523-527.doi: 10.1038/s41423-020-00529-z.
[5]	Dong L, He Y, Cao Y, et al. Functional differentiation and regulation of follicular T helper cells in inflammation and autoimmunity[J]. Immunology,2021, 163:19-32.doi: 10.1111/imm.13282.
[6]	Baessler A, Hale JS. Recurrent tonsillitis Tfh cells acquire a killer identity[J]. Trends Immunol,2019, 40:377-379.doi: 10.1016/j.it.2019.03.007.
[7]	Dan JM, Havenar-Daughton C, Kendric K, et al. Recurrent group A streptococcus tonsillitis is an immunosusceptibility disease involving antibody deficiency and aberrant T(FH) cells[J]. Sci Transl Med,2019,11:eaau3776.doi: 10.1126/scitranslmed.aau3776.
[8]	Davies FJ, Olme C, Lynskey NN, et al. Streptococcal superantigen-induced expansion of human tonsil T cells leads to altered T follicular helper cell phenotype, B cell death and reduced immunoglobulin release[J]. Clin Exp Immunol,2019,197:83-94.doi: 10.1111/cei.13282.
[9]	Dickinson A, Kankaanpää H, Silén S, et al. Tonsillar surface swab bacterial culture results differ from those of the tonsillar core in recurrent tonsillitis[J]. Laryngoscope,2020, 130:E791-e794.doi: 10.1002/lary.28403.
[10]	Eslami A, Can NT, Ng DL. Infectious disease diagnosed by fine needle aspiration biopsy[J]. J Am Soc Cytopathol,2020, 9:152-158.doi: 10.1016/j.jasc.2020.01.001.
[11]	Sarkar S, Sil A, Sarkar S, et al. A comparison of tonsillar surface swabbing, fine-needle aspiration core sampling, and dissected tonsillar core biopsy culture in children with recurrent tonsillitis[J]. Ear Nose Throat J,2017, 96:E29-e32.doi: 10.1177/014556131709600606.
[12]	Hoffmeister L, Diekmann M, Brand K, et al. GSK3: A Kinase balancing promotion and resolution of inflammation[J]. Cells,2020, 9:820.doi: 10.3390/cells9040820.
[13]	Gao Y, Mi J, Chen F, et al. Detection of GSK-3β activation index in pediatric chronic tonsillitis is an indicator for chronic recurrent inflammation[J]. Am J Otolaryngol,2018, 39:277-281.doi: 10.1016/j.amjoto.2018.03.005.
[14]	Green MR, Sambrook J. Alkaline phosphatase[J]. Cold Spring Harb Protoc,2020, 2020:100768.doi: 10.1101/pdb.top100768.
[15]	Rader BA. Alkaline phosphatase, an unconventional immune protein[J]. Front Immunol,2017, 8:897.doi: 10.3389/fimmu.2017.00897.
[16]	Mustafa Z, Ghaffari M. Diagnostic methods, clinical guidelines, and antibiotic treatment for group a streptococcal pharyngitis: a narrative review[J]. Front Cell Infect Microbiol,2020,10:563627.doi: 10.3389/fcimb.2020.563627.
[17]	Feleszko W, Marengo R, Vieira AS, et al. Immunity-targeted approaches to the management of chronic and recurrent upper respiratory tract disorders in children[J]. Clin Otolaryngol,2019, 44:502-510.doi: 10.1111/coa.13335.
[18]	Abdelghani Z, Hourani N, Zaidan Z, et al. Therapeutic applications and biological activities of bacterial bioactive extracts[J]. Arch Microbiol,2021, 203:4755-4776.doi: 10.1007/s00203-021-02505-1.
[19]	Salzmann M, Haider P, Kaun C, et al. Innate immune training with bacterial extracts enhances lung macrophage recruitment to protect from betacoronavirus infection[J]. J Innate Immun,2021,22:1-13.
[20]	Cao C, Wang J, Li Y, et al. Efficacy and safety of OM-85 in paediatric recurrent respiratory tract infections which could have a possible protective effect on COVID-19 pandemic: A meta-analysis[J]. Int J Clin Pract,2021, 75:e13981.doi: 10.1111/ijcp.13981.
[21]	Taylor A, Rudd CE. Small molecule inhibition of glycogen synthase kinase-3 in cancer immunotherapy[J]. Adv Exp Med Biol,2019, 1164:225-233.doi: 10.1007/978-3-030-22254-3_17.
[22]	Cortés-Vieyra R, Silva-García O, Gómez-García A, et al. Glycogen synthase kinase 3β modulates the inflammatory response activated by bacteria, viruses, and parasites[J]. Front Immunol,2021, 12:675751.doi: 10.3389/fimmu.2021.675751.
[23]	Bellussi LM, Passali FM, Ralli M, et al. An overview on upper respiratory tract infections and bacteriotherapy as innovative therapeutic strategy[J]. Eur Rev Med Pharmacol Sci,2019, 23(1 Suppl):27-38.doi: 10.26355/eurrev_201903_17345.
[24]	Passali D, Passali GC, Vesperini E, et al. The efficacy and tolerability of Streptococcus salivarius 24SMB and Streptococcus oralis 89a administered as nasal spray in the treatment of recurrent upper respiratory tract infections in children[J]. Eur Rev Med Pharmacol Sci,2019, 23(1 Suppl):67-72.doi: 10.26355/eurrev_201903_17352.
[25]	Tarantino V, Savaia V, D'Agostino R, et al. Oral bacteriotherapy in children with recurrent respiratory infections: a real-life study[J]. Acta Biomed,2020, 91:73-76.doi: 10.23750/abm.v91i1-S.9230.