DOI QR코드

DOI QR Code

Cytokine Storm Related to CD4+ T Cells in Influenza Virus-Associated Acute Necrotizing Encephalopathy

  • Shushu Wang (Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Dongyao Wang (Department of Hematology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Xuesong Wang (Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Mingwu Chen (Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Yanshi Wang (Reproductive and Genetic Hospital, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Haoquan Zhou (Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Yonggang Zhou (Key Laboratory of Immune Response and Immunotherapy, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Yong Lv (Department of Pediatrics, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China) ;
  • Haiming Wei (Key Laboratory of Immune Response and Immunotherapy, Division of Life Sciences and Medicine, University of Science and Technology of China)
  • 투고 : 2023.09.19
  • 심사 : 2024.04.18
  • 발행 : 2024.04.30

초록

Acute necrotizing encephalopathy (ANE) is a rare but deadly complication with an unclear pathogenesis. We aimed to elucidate the immune characteristics of H1N1 influenza virus-associated ANE (IANE) and provide a potential therapeutic approach for IANE. Seven pediatric cases from a concentrated outbreak of H1N1 influenza were included in this study. The patients' CD4+ T cells from peripheral blood decreased sharply in number but highly expressed Eomesodermin (Eomes), CD69 and PD-1, companied with extremely high levels of IL-6, IL-8 in the cerebrospinal fluid and plasma. Patient 2, who showed high fever and seizures and was admitted to the hospital very early in the disease course, received intravenous tocilizumab and subsequently showed a reduction in temperature and a stable conscious state 24 h later. In conclusion, a proinflammatory cytokine storm associated with activated CD4+ T cells may cause severe brain pathology in IANE. Tocilizumab may be helpful in treating IANE.

키워드

과제정보

This work was supported by the Strategic Priority Research Program of the Chinese Academy of Sciences, Grant No. XDB0490000. This work was also supported by the National Natural Science Foundation of China (Nos. U19A2024, 81930037 to H.W.), the Anhui Natural Science Foundation (No. 2208085J38 to Y.Z.) and the Fundamental Research Funds for the Central Universities (No. YD9110002019 to D.W.). This research has been approved by human research review boards in the in the first affiliated hospital of USTC.

참고문헌

  1. Clayville LR. Influenza update: a review of currently available vaccines. P T 2011;36:659-684.
  2. McAlister VC. H1N1-related SIRS? CMAJ 2009;181:616-617.
  3. Mizuguchi M, Abe J, Mikkaichi K, Noma S, Yoshida K, Yamanaka T, Kamoshita S. Acute necrotising encephalopathy of childhood: a new syndrome presenting with multifocal, symmetric brain lesions. J Neurol Neurosurg Psychiatry 1995;58:555-561.
  4. Li S, Hu D, Li P, Xiao W, Li H, Liu G, Song Y, Ning S, Peng Q, Zhao D, et al. Parameters indicating development of influenza-associated acute necrotizing encephalopathy: experiences from a single center. Med Sci Monit 2021;27:e930688.
  5. Qin N, Wang J, Peng X, Wang L. Pathogenesis and management of acute necrotizing encephalopathy. Expert Rev Neurother 2023;23:641-650.
  6. Mizuguchi M. Acute necrotizing encephalopathy of childhood: a novel form of acute encephalopathy prevalent in Japan and Taiwan. Brain Dev 1997;19:81-92.
  7. Hsiao A, Buck PO, Yee A, Hansen J, Lewis EM, Aukes LL, Yanni E, Bekkat-Berkani R, Schuind A, Klein NP. Retrospective study of the use of an influenza disease two-tiered classification system to characterize clinical severity in US children. Hum Vaccin Immunother 2020;16:1753-1761.
  8. Raveney BJ, Sato W, Takewaki D, Zhang C, Kanazawa T, Lin Y, Okamoto T, Araki M, Kimura Y, Sato N, et al. Involvement of cytotoxic Eomes-expressing CD4+ T cells in secondary progressive multiple sclerosis. Proc Natl Acad Sci U S A 2021;118:e2021818118.
  9. Joulia E, Michieletto MF, Agesta A, Peillex C, Girault V, Le Dorze AL, Peroceschi R, Bucciarelli F, Szelechowski M, Chaubet A, et al. Eomes-dependent mitochondrial regulation promotes survival of pathogenic CD4+ T cells during inflammation. J Exp Med 2024;221:e20230449.
  10. Zappasodi R, Budhu S, Hellmann MD, Postow MA, Senbabaoglu Y, Manne S, Gasmi B, Liu C, Zhong H, Li Y, et al. Non-conventional Inhibitory CD4+ Foxp3-PD-1hi T cells as a biomarker of immune checkpoint blockade activity. Cancer Cell 2018;34:691. 
  11. Majer C, Lingel H, Arra A, Heuft HG, Bretschneider D, Balk S, Vogel K, Brunner-Weinzierl MC. PD-1/PD-L1 control of antigen-specifically activated CD4 T-cells of neonates. Int J Mol Sci 2023;24:5662.
  12. Zelinskyy G, Myers L, Dietze KK, Gibbert K, Roggendorf M, Liu J, Lu M, Kraft AR, Teichgraber V, Hasenkrug KJ, et al. Virus-specific CD8+ T cells upregulate programmed death-1 expression during acute friend retrovirus infection but are highly cytotoxic and control virus replication. J Immunol 2011;187:3730-3737.
  13. Rha MS, Jeong HW, Ko JH, Choi SJ, Seo IH, Lee JS, Sa M, Kim AR, Joo EJ, Ahn JY, et al. PD-1-expressing SARS-CoV-2-specific CD8+ T cells are not exhausted, but functional in patients with COVID-19. Immunity 2021;54:44-52.e3.
  14. Liuzzo G, Patrono C. COVID 19: in the eye of the cytokine storm. Eur Heart J 2021;42:150-151.
  15. Yuan S, Jiang SC, Zhang ZW, Fu YF, Hu J, Li ZL. Quantification of cytokine storms during virus infections. Front Immunol 2021;12:659419.
  16. Cardone M, Yano M, Rosenberg AS, Puig M. Lessons learned to date on COVID-19 hyperinflammatory syndrome: considerations for interventions to mitigate SARS-CoV-2 viral infection and detrimental hyperinflammation. Front Immunol 2020;11:1131.
  17. West PK, McCorkindale AN, Guennewig B, Ashhurst TM, Viengkhou B, Hayashida E, Jung SR, Butovsky O, Campbell IL, Hofer MJ. The cytokines interleukin-6 and interferon-α induce distinct microglia phenotypes. J Neuroinflammation 2022;19:96.
  18. Khan M, Bhattarai S, Boyce TG, Hayek RA, Zhadanov SI, Hooper EE, Fernandez EG, Koehn MA. Acute necrotizing encephalopathy associated with coronavirus disease 2019 in an infant. J Pediatr 2022;247:160-162.