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Panorama
Inmunología
Vol. 23 / Núm 1/ Enero-Marzo 2004: 56-62
RESUMEN ABSTRACT
Las inmunodeficiencias (ID) congénitas son desafortunados Congenital immunodeficiencies (ID) are unfortunate expe-
experimentos de la Naturaleza que afectan a la inmunidad. Resul- riments of Nature that impair immunity. It is only fair that, by
ta especialmente apropiado que puedan curarse mediante afor- fortunate experiments of man, they may be cured. This was first
tunados experimentos diseñados por el ser humano. Ya fue así true by 1968, when an X-linked ID became the first human dise-
en 1968, cuando una ID ligada al cromosoma X se convirtió en ase successfully cured by bone marrow transplantation, now a
la primera enfermedad humana curada con éxito por trasplante standard therapeutic procedure for many other disorders inclu-
de médula ósea, un procedimiento terapéutico que ahora es están- ding cancer. Of course, serious adverse events were reported, such
dar para muchas otras patologías incluida el cáncer. Naturalmente, as graft versus host disease. More than 30 years later, the same ID
se observaron efectos adversos graves como la enfermedad del has become the first to be cured by gene therapy. Hurdles lie
injerto contra el huésped. Más de 30 años después, la misma ID ahead, as the development of T cell leukaemia by insertional onco-
ha sido la primera en ser curada por terapia génica. Hay obstá- genesis in two patients has painfully demonstrated. Immunity
culos que superar, como ha demostrado la leucemia de células itself may become a hurdle for gene therapy when directed against
T desarrollada por oncogénesis insercional en dos pacientes. La the vector or even the therapeutic protein. But gene therapy is
propia inmunidad puede ser un obstáculo para la terapia géni- here to stay. Cancer, infectious diseases including Acquired Immu-
ca cuando se dirige contra el vector o incluso la proteína tera- nodeficiency Syndrome (AIDS), and other congenital disorders
péutica. Pero la terapia génica seguirá adelante. El cáncer, las are next down the pipeline. As already shown for transplanta-
enfermedades infecciosas incluido el Sindrome de la Inmuno- tion, the overall benefits may well be worth the risks.
deficiencia Adquirida (SIDA), y otras enfermedades congénitas
son las siguientes de la lista. Los beneficios globales serán pro- KEY WORDS: Gene therapy / Immunodeficiency / Immunity.
bablemente más que los riesgos, como se demostró para el tras-
plante.
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Inmunologia 64p 6.0 1/4/04 11:03 Página 57
LA TERAPIA GÉNICA CURA ALGUNOS DEFECTOS del transgén en el genoma (4), y que algunas células T
DE LA INMUNIDAD transducidas aún estaban en el organismo 10 años después(5,
6). Luego siguió un éxito en toda regla (beneficio clínico a 3
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Inmunologia 64p 6.0 1/4/04 11:03 Página 58
Proteína Síndrome
• Complemento
C1inhibidor, C4bp Angioedema
C1-C4, MBL, factor D Lupus, infecciones
C5-C9, Factor I, B, Properdina Meningitis
Factor H Hemolítico-urémico
MASP2 Susceptibilidad a S. pneumoniae
• Fagocitosis, adhesión y movilidad celular
NADPH oxidasa (gp91, p22, 47, 67phox) Granulomatoso crónico
Glucosa 6PDH (XL) Anemia +/- ID
WASP Wiskott Aldrich / XLT / neutropenia
CD18/GDP-Transportador de fucosa Deficiencia de adhesión leucocitaria 1/2
Rac 2 Defecto de quimiotaxis
C/EBP (CCAAT/enhancer binding protein) Deficiencia de gránulos específicos
Elastasa / GFI1 Neutropenia
• Modificación y reparación del ADN
RAG, Artemis T–B– SCID, Omenn
ADA, PNP SCID
DNA metilltransferasa DNMT3B ICF
CD40L/ AID/ CD40/ NEMO (IKKγ) /UNG Hiper IgM-1/2/3 (displasia ectodérmica)/4
ATM, hMRE 11, Nibrina, DNA ligasa IV Ataxia Telangiectasia y AT-Like
• Reconocimiento de citocinas
γc / IL-7Rα / Jak 3 SCID
IL-2R α SCID
IL-12 / IL-12R / IFN-γR / STAT-1 Susceptibilidad a Mycobacterias
STAT5B CID sin respuesta a IFN-γ
CXCR4 WHIM, susceptibilidad a papilomavirus
βc (IL-3,-5,GM-CSF) Proteinosis alveolar pulmonar
• Presentación de antígeno
MHC-clase I (TAP1,TAP2) Granulomatosis, CID
MHC-clase II (RFX5,AP,B/ANK, CIITA) SCID
• Reconocimiento de antígeno y señalización
λ5 o VpreB / µ / Igα o β / BLNK / Syk Agammaglobulinemia (no XL)
Btk Agammaglobulinemia (XL)
CD3γ, δ, ε, ζ, CD8α, CD45 CID, SCID
ZAP-70, Lck SCID, CVID
ICOS CVID
IRAK4/IκBα/IKKγ Infecciones piógenas (TLR4/IL-1R/IL-18R)
• Citolisis
Perforina / Munc13-4 Linfohistiocitosis hemofagocítica
Lyst Chediak-Higashi (albinismo)
Rab27A/Miosina-5a Griscelli (albinismo)
SAP or SH2D1A (XL) Linfoproliferativo de Duncan
• Apoptosis
TNFR1, criopirina, mevalonato cinasa, mn Autoinflamatorio/Fiebres recurrentes
CD95L/CD95/Caspase 8, 10 Linfoproliferativo autoinmune
Foxp3, Aire IPEX, APECED
• Otros defectos
Del22q11 DiGeorge, CATCH 22
Ever 1 y 2 Susceptibilidad a papilomavirus
Winged helix nude Desarrollo T, pelo y uñas alterado
Desconocido CVID, deficiencia de IgA
*Abreviaturas: AID, activation-induced cytidine deaminase; Aire, autoimmune regulator; APECED, autoimmune polyendocrinopathy, candidiasis and
ectodermal dystrophy; C4bp, C4 binding protein; CATCH 22, cardiac defects, abnormal facial features, thymic hypoplasia, cleft palate, and hypocalce-
mia; CID, combined ID; CVID, common variable ID; Ever, epidermodysplasia verruciformis endoplasmic reticulum; ICF, ID, centromeric instability and
facial anomalies; ICOS, inducible costimulator; IKK-γ, inhibitor of κB kinase-γ; IPEX, immunodysregulation, polyendocrinopathy, enteropathy, X linked;
IRAK, IL-1R-associated kinase; MASP, MBL-associated serine protease; mn, marenostrina o pirina; NEMO, NF-κB essential modulator; SAP, SLAM-
associated protein; SCID, severe combined ID; SLAM, signalling lymphocytic activation molecule, CD150; STAT, signal transducer and activator of trans-
cription; TLR, Toll-like receptor; UNG, uracil-DNA glycosylase; WHIM, warts, hypogammaglobulinemia, infections and myelokathexis; XL, X-linked;
ID, inmunodeficiencia; XLT, X-linked thrombocytopenia; ZAP, zeta associated protein.
58
Inmunologia 64p 6.0 1/4/04 11:03 Página 59
Terapia génica
TIMO PBL
A
Precursores
afectados Normal
(ex vivo)
Vector
SCID
Fenotipo 5’LTR γc 3’LTR
función γc
longevidad (30%) IL7Ra
Expansión RAG 1, 2
(ventaja ADA
selectiva) JAK3
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