CAR - T细胞对抗合成酶综合征表现的影响。(一)神经病理学。上,苏木素和伊红染色显示明显的筋周肌萎缩和坏死肌纤维。中左,MHC-1染色显示肌纤维上普遍表达,以束周边界为主。右中,酸性磷酸酶染色显示结缔组织或肌周碎片。左下,C5b9染色显示肌纤维的肌膜装饰,主要分布在筋周边缘,很少有肌浆染色纤维。右下,CD3染色显示t细胞浸润,侵入肌内膜室室,起源于肌周区。比例尺=100 μm。(B) CD19 CAR - T细胞治疗前后的肌酐激酶浓度以及之前治疗的时间。水平线表示正常范围的上限。 (C) Dot plots showing the expression of CD3 and CD19 CAR in circulating CD19 CAR T cells, quantified by FACS on day 2 and day 8 after infusion. (D) Concentration of circulating CD19 CAR T cells over time. (E) Concentration of CD19+ B cells over time. (F) Disease activity assessed using the PGA (left), PtGA (middle), and MMT8 (right) measures. (G) Concentrations of serum creatinine kinase (left) and autoantibodies against Jo-1 (right) over time. Dashed lines show the upper limit of normal range. (H) Disease activity assessed with the EMDA scale. (I) Disease activity assessed with the ACR/EULAR TIS, showing cutoffs for major, moderate, minor, or no improvement. (J) MRI. Top left, baseline coronal axial T2-weighted, fat-suppressed sequence shows the longitudinal extent of the hamstring pathology on both sides (asterisks). Bottom left, the corresponding axial MRI shows diffuse oedematous changes reflecting myositis of almost all thigh muscle groups, but primarily of the quadriceps muscles (asterisk). Marked fasciitis is also seen, particularly in the vastus medialis and semitendinosus muscles (arrows). Top right, complete resolution of muscle and fascial inflammatory alterations 3 months after treatment. Bottom right, corresponding axial MRI confirms that healthy muscle signal has been restored in the quadriceps and the hamstrings. (K) Chest CT scans. Left, baseline coronal reformatted CT scans showing bilateral basal opacities (arrows) and right upper lobe opacities consistent with alveolitis. A reticular abnormality reflecting interstitial lung disease can also be seen. Right, CT scans obtained 3 months after initiation of therapy show complete resolution of right upper lobe findings (asterisk) and alveolitis, and minor residual findings of basal interstitial lung disease (arrows). RTX=rituximab. IVIG=intravenous immunoglobulins. TAC=tacrolimus. CX=cyclophosphamide. CAR=chimeric antigen receptor. FACS=fluorescence-activated cell sorting. VAS=visual analog scale. PGA=physician global assessment. PtGA=patient global assessment. MMT8=manual muscle testing score 8. EMDA=extramuscular disease activity. ACR/EULAR TIS=American College of Rheumatology/European League Against Rheumatism total improvement score. Credit:《柳叶刀》(2023)。DOI: 10.1016 / s0140 - 6736 (23) 00023 - 5