RESUMEN
Long-acting steroids (LAS) are widely used to treat various inflammatory diseases and allergies. They have many adverse effects including the inhibition of the hypothalamopituitary axis that can last several months. LAS are also strong immunosuppressors and can result in severe opportunistic infections and immunodeficiency-related malignancies. However, the time needed for immune recovery after withdrawal of LAS is unknown. Here we report a case of Kaposi's sarcoma (KS) and severe immunosuppression after a chronic triamcinolone acetonide (TA) treatment. Six months after withdrawal, traces of TA were still detected in the serum by HPLC mass spectrometry. At 8 months, the drug became undetectable, and clinical and biological signs of immune recovery - beginning of KS regression, normalization of IgG levels and CD4 T lymphocyte counts - became noticeable. We then provide a review of the literature on the time until remission of KS after immunosuppression reduction. We also reviewed the cases of KS induced by TA, and the metabolic side effects of TA when compared to standard glucocorticoids.
Asunto(s)
Antiinflamatorios/efectos adversos , Terapia de Inmunosupresión/efectos adversos , Infecciones Oportunistas/inmunología , Sarcoma de Kaposi/inmunología , Triamcinolona Acetonida/efectos adversos , Antiinflamatorios/administración & dosificación , Antiinflamatorios/sangre , Bleomicina/uso terapéutico , Glucemia/efectos de los fármacos , Recuento de Linfocito CD4 , Humanos , Inmunoglobulina G/sangre , Insulina/uso terapéutico , Interferón-alfa/uso terapéutico , Masculino , Persona de Mediana Edad , Infecciones Oportunistas/patología , Paclitaxel/uso terapéutico , Sarcoma de Kaposi/patología , Úlcera Cutánea/inducido químicamente , Úlcera Cutánea/inmunología , Triamcinolona Acetonida/administración & dosificación , Triamcinolona Acetonida/sangreRESUMEN
Exosomes are 60 to 90 nm membrane vesicles originating from late endosomes and secreted from most hematopoietic and epithelial cells in vitro. B cell derived-exosome antigenicity was first reported in 1996 in MHC class II restricted CD4+ T lymphocytes. In 1998, we reported that dendritic cell derived-exosomes are immunogenic in mice leading to tumor rejection. These findings have renewed the interest in exosomes. The current challenge consists in understanding the mechanisms and the physiological relevance of exosomes that could contribute to the design of the optimal exosome based-vaccination. Here, we will focus on the biological features pertaining to dendritic cell- and tumor cell derived-exosomes and will discuss their potential clinical implementation.
Asunto(s)
Endosomas/metabolismo , Inmunoterapia/métodos , Neoplasias/inmunología , Neoplasias/terapia , Animales , Antígenos de Neoplasias , Sistema Libre de Células , Ensayos Clínicos como Asunto , Células Dendríticas/inmunología , Endosomas/química , HumanosRESUMEN
Exosomes are small vesicles released by a broad array of hematopoietic cells. Previous studies showed that exosomes released by antigen loaded dendritic cells induce immune-mediated anti-tumor response in mice. Here, we will describe the biochemical properties of tumor-derived exosomes and, their pre-clinical activity as cancer vaccines.