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<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">mimmun</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинская иммунология</journal-title><trans-title-group xml:lang="en"><trans-title>Medical Immunology (Russia)</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1563-0625</issn><issn pub-type="epub">2313-741X</issn><publisher><publisher-name>SPb RAACI</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.15789/1563-0625-2015-6-499-516</article-id><article-id custom-type="elpub" pub-id-type="custom">mimmun-958</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ОБЗОРЫ</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="en"><subject>REVIEWS</subject></subj-group></article-categories><title-group><article-title>ИММУНОБИОЛОГИЯ ОСТРОЙ РЕАКЦИИ «ТРАНСПЛАНТАТ ПРОТИВ ХОЗЯИНА»</article-title><trans-title-group xml:lang="en"><trans-title>IMMUNOBIOLOGY OF ACUTE GRAFT-VERSUS-HOST DISEASE</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Ефимов</surname><given-names>Г. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Efimov</surname><given-names>G. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>к.б.н., заведующий лабораторией трансплантационной иммунологии ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия 125167, Россия, Москва, Новый Зыковский пр., 4. Тел.: 8 (964) 551-55-51</p></bio><bio xml:lang="en"><p>PhD (Biology), Chief, Laboratory of Transplantation Immunology, National Research Center for Hematology, Moscow, Russian Federation 125167, Russian Federation, Moscow, Novy Zykovsky proezd, 4. Phone: 7 (964) 551 5551</p></bio><email xlink:type="simple">efimov.g@blood.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Вдовин</surname><given-names>А. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Vdovin</surname><given-names>A. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>научный сотрудник лаборатории трансплантационной иммунологии ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия</p></bio><bio xml:lang="en"><p>Research Associate, Laboratory of Transplantation Immunology, National Research Center for Hematology, Moscow, Russian Federation</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Григорьев</surname><given-names>А. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Grigoryev</surname><given-names>A. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>к.б.н, научный сотрудник лаборатории трансплантационной иммунологии ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия</p></bio><bio xml:lang="en"><p>PhD (Biology), Research Associate, Laboratory of Transplantation Immunology, National Research Center for Hematology, Moscow, Russian Federation</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Филькин</surname><given-names>С. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Filkin</surname><given-names>S. Yu.</given-names></name></name-alternatives><bio xml:lang="ru"><p>научный сотрудник лаборатории трансплантационной иммунологии ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия</p></bio><bio xml:lang="en"><p>Research Associate, Laboratory of Transplantation Immunology, National Research Center for Hematology, Moscow, Russian Federation</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Быкова</surname><given-names>Н. А.</given-names></name><name name-style="western" xml:lang="en"><surname>Bykova</surname><given-names>N. A.</given-names></name></name-alternatives><bio xml:lang="ru"><p>научный сотрудник лаборатории трансплантационной иммунологии ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия</p></bio><bio xml:lang="en"><p>Research Associate, Laboratory of Transplantation Immunology, National Research Center for Hematology, Moscow, Russian Federation</p></bio><email xlink:type="simple">efimov.g@blood.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Савченко</surname><given-names>В. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Savchenko</surname><given-names>V. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>д.м.н., профессор, академик РАН, генеральный директор ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия</p></bio><bio xml:lang="en"><p>PhD, MD (Medicine), Professor, Full Member of Russian Academy of Sciences, Director General, National Research Center for Hematology, Moscow, Russian Federation</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБУ «Гематологический научный центр» Министерства здравоохранения РФ, Москва, Россия</institution><country>Россия</country></aff><aff xml:lang="en"><institution>National Research Center for Hematology, Moscow, Russian Federation</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>13</day><month>01</month><year>2016</year></pub-date><volume>17</volume><issue>6</issue><fpage>499</fpage><lpage>516</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Ефимов Г.А., Вдовин А.С., Григорьев А.А., Филькин С.Ю., Быкова Н.А., Савченко В.Г., 2016</copyright-statement><copyright-year>2016</copyright-year><copyright-holder xml:lang="ru">Ефимов Г.А., Вдовин А.С., Григорьев А.А., Филькин С.Ю., Быкова Н.А., Савченко В.Г.</copyright-holder><copyright-holder xml:lang="en">Efimov G.A., Vdovin A.S., Grigoryev A.A., Filkin S.Y., Bykova N.A., Savchenko V.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.mimmun.ru/mimmun/article/view/958">https://www.mimmun.ru/mimmun/article/view/958</self-uri><abstract><p>Для целого ряда заболеваний системы кроветворения единственным методом излечения является аллогенная трансплантация гемопоэтических стволовых клеток, которая имеет своей целью замену кроветворной системы реципиента на донорскую. Однако попадание в организм реципиента содержащихся в трансплантате зрелых Т-лимфоцитов может приводить к развитию тяжелого пост-трансплантационного осложнения – реакции «трансплантат против хозяина» (РТПХ). Она вызвана тем, что иммунная система донора содержит клоны Т-лимфоцитов, специфичные к аллоантигенам реципиента, которые, встречая свои антигены, активируются и вызывают системное повреждение здоровых тканей. Наличие аллореактивных клонов обусловлено генетическими различиями между донором и реципиентом. Важнейшим фактором, определяющим успех трансплантации, является совместимость по генам главного комплекса гистосовместимости, которые экспрессируются во всех ядерных клетках и отвечают за презентацию антигенов клеткам иммунной системы. В настоящее время созданы обширные банки доноров стволовых гемопоэтических клеток, которые позволяют подобрать для большинства пациентов совместимого донора. Однако это не полностью предотвращает развитие РПТХ, так как помимо генов главного комплекса гистосовместимости, донор и реципиент могут различаться по так называемым минорным антигенам совместимости. Минорные антигены обусловлены генетическими полиморфизмами во всех кодирующих областях генома. Дополнительным фактором, способствующим развитию реакции «трансплантат против хозяина», является предтрансплантационная подготовка пациента, которая необходима для приживления трансплантата, но в качестве побочного эффекта приводит к формированию в организме реципиента провоспалительного окружения. Тяжелые формы РТПХ развиваются приблизительно у 40% пациентов, совпадающих по генам главного комплекса гистосовместимости, а в случаях неполной совместимости эта доля еще больше. Смертность от РТПХ сравнима с другими причинами посттрансплантационной летальности, такими как рецидив изначального заболевания и вирусные инфекции. Таким образом, развитие тяжелых форм РТПХ существенно лимитирует клиническое применение трансплантации стволовых кроветворных клеток. Агрессивная иммуносупрессия или исключение из трансплантата донора зрелых Т-лимфоцитов приводит к увеличению вероятности рецидива и ослабляет противоинфекционный иммунитет, что требует поиска альтернативных, более специфичных путей профилактики реакции «трансплантат против хозяина». В настоящем обзоре будут рассмотрены механизмы формирования аллореактивных клонов Т-лимфоцитов и этапы патогенеза острой формы реакции «трансплантат против хозяина».</p></abstract><trans-abstract xml:lang="en"><p>Transplantation of allogeneic hematopoietic stem cells is the only curative option for a number of diseases of hematopoietic system. It is intended to replace the hematopoietic system of the recipient withthe donor’s. However, when mature T cells contained in the graft enter the recipient organism, it may lead to a severe post-transplant complication, the “graft versus host” disease (GVHD). It occurs due to the fact that the donor immune system contains T cell clones specific to recipient alloantigens. These cell clones are activated upon encountering their antigens, thus causing systemic damage to healthy tissues. Development of the alloreactive clones is caused by genetic differences between donor and recipient. The most importantfactors determining successful transplantation concern the compatibility for the genes coding for Major Histocompatibility Complex (MHC), that are expressed in all nucleated cells and are responsible for antigen presentation to the immune cells. Currently established extensive donor banks allow for majority of patients to choose a compatible donor. However, this does not provide complete prevention of the GVHD development, because in addition to the MHC genes the donor and recipient may differ in so-called minor histocompatibility antigens. Minor antigens may be caused by genetic polymorphisms in all of the genome coding regions. Pre-transplantation conditioning of the patient, which is necessary for engraftment represent an additional factor contributing to the GVHDdevelopment, since as its side effect it leads to formation of a pro-inflammatory environment in the organism of recipient. Severe GVHD develops in approximately 40% of MHC-matched patients, while in cases of partial compatibility this proportion is even higher. GVHD causes mortality comparable to other causes of posttransplantdeath, such as viral infections or relapse of underlying disease. Thus, the development of severe GVHD is a significant limitation for clinical applications of stem cell transplantation. Severe immunesuppression or depletion of mature donor T cells from the transplant leads to increased probability of relapse and weakens anti-infectious immunity. Hence, further search for alternative, more specific ways to prevent GVHD is required. This review will focus on the mechanisms of alloreactive T lymphocyte clone development and key pathogenetic stages of acute “graft versus host” disease.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>РТПО</kwd><kwd>РТПХ</kwd><kwd>трансплантация костного мозга</kwd><kwd>аллореактивность</kwd><kwd>иммунобиология</kwd><kwd>молекулярные механизмы</kwd></kwd-group><kwd-group xml:lang="en"><kwd>graft-versus-tumor reaction</kwd><kwd>graft-versus-host disease</kwd><kwd>bone marrow transplantation</kwd><kwd>alloreactivity</kwd><kwd>immunobiology</kwd><kwd>molecular mechanisms</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Боголюбова А.В., Ефимов Г.А., Друцкая М.С., Недоспасов С.А. Иммунотерапия опухолей, основанная на блокировке иммунологических контрольных «точек» («чекпойнтов») // Медицинская иммунология, 2015, Т. 17, № 5. С. 395-406. 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