Mikrokimerizm ve Otoimmün Hastalıklar
Özet
Genetik olarak farklı bir bireye ait az sayıda hücrenin veya DNA'nın barındırılması anlamına gelen mikrokimerizm (MK); tanımı, kaynakları, tespit yöntemleri ve özellikle kadınlarda daha yüksek insidansa sahip otoimmün hastalıklarla ilişkisi çerçevesinde incelenmektedir. MK'in en yaygın doğal kaynağı gebelik olup, fetal ve maternal hücrelerin çift yönlü geçişiyle oluşur; ancak kan transfüzyonu ve organ transplantasyonu gibi durumlar da bu duruma yol açabilir. MK analizi için yaygın olarak STR polimorfizmleri kullanılırken, son yıllarda qPCR, ddPCR ve NGS gibi daha hassas moleküler yöntemler geliştirilmiştir. Kadınların enfeksiyonlara karşı daha güçlü bağışıklık tepkileri vermesi, paradoksal olarak otoimmün hastalıklara yatkınlıklarını artırmaktadır. Bu kapsamda; sistemik skleroz (SSc), primer biliyer siroz (PBC), sjögren sendromu (SS), sistemik lupus eritematozus (SLE) ve otoimmün tiroid hastalıklarında (AITD) mikrokimerizmin patojenik, koruyucu veya nötr rolleri ele alınmaktadır. Örneğin, SSc'li kadınlarda daha yüksek fetal MK seviyeleri ve sHLA-G molekülleri saptanırken, lupus nefriti hastalarında erkek fetal hücrelerinin varlığı daha iyi böbrek fonksiyonlarıyla ilişkilendirilmiştir. Sonuç olarak, MK'in kadın sağlığı ve otoimmünite üzerindeki karmaşık mekanizmalarını netleştirmek için daha fazla araştırmaya ihtiyaç duyulmaktadır.
Microchimerism (MC)—the harboring of a small number of cells or DNA originating from a genetically distinct individual—is examined within the framework of its definition, sources, detection methods, and its relationship with autoimmune diseases, which exhibit a higher incidence in women. Pregnancy is the most common natural source of MC, characterized by the bidirectional transfer of fetal and maternal cells, although blood transfusions and organ transplantations can also induce this phenomenon. While STR polymorphism analysis is widely used for MC monitoring, ultra-sensitive molecular methods such as qPCR, ddPCR, and NGS have emerged recently. Paradoxically, women's stronger immune responses to infections lead to a higher susceptibility to autoimmunity. Within this scope, the pathogenic, protective, or neutral roles of MC in systemic sclerosis (SSc), primary biliary cirrhosis (PBC), Sjögren's syndrome (SS), systemic lupus erythematosus (SLE), and autoimmune thyroid diseases (AITD) are analyzed. For instance, women with SSc display higher fetal MC levels and sHLA-G expressions, whereas the presence of male fetal cells in lupus nephritis patients is correlated with better renal outcomes. Ultimately, further studies are required to fully elucidate the complex mechanisms of MC in female health and autoimmunity.
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