Recent advances in precision medicine for individualized immunosuppression.
Recent advances in precision medicine for individualized immunosuppression.
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DOI：
10.1097/mot.0000000000000771
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发表时间：
2020-08
影响因子：
2.2
通讯作者：
Zarrinpar A
中科院分区：
文献类型：
--
作者：
Fu S;Zarrinpar A
目前在实体器官移植中主动指导和个体化免疫抑制的工具是有限的。尽管移植后结局持续改善，但过度或免疫抑制不足的副作用很常见。本文综述了个体化免疫抑制的最新进展。人们一直非常关注基因组信息来预测药物剂量需求，特别是CYP3A5和ABCB 1的单核苷酸多态性。此外，生物标志物研究已经开发出更好地预测临床结果的方法，例如移植物排斥。人工神经网络和机器学习等先进计算工具与基因组测序的整合，在个人或群体特定剂量要求方面产生了有趣的发现。快速计算允许处理数据并发现否则未检测到的临床模式。CYP3A5和ABCB 1的遗传多态性产生的结果表明，不同的剂量需求与种族和性别相关。新提出的生物标志物提供了精确和非侵入性的方法来监测患者的状态。游离DNA定量越来越多地被探索作为同种异体移植物损伤和排斥反应的指标，这可以帮助避免不必要的活检和更频繁地监测移植物功能。
The current tools to proactively guide and individualize immunosuppression in solid organ transplantation are limited. Despite continued improvements in post-transplant outcomes, the side effects of over- or under-immunosuppression are common. This review is intended to highlight recent advances in individualized immunosuppression. There has been a great focus on genomic information to predict drug dose requirements, specifically on single nucleotide polymorphisms of CYP3A5 and ABCB1. Furthermore, biomarker studies have developed ways to better predict clinical outcomes, such as graft rejection. The integration of advanced computing tools, such as artificial neural networks and machine learning, with genome sequencing has led to intriguing findings on individual or group-specific dosing requirements. Rapid computing allows for processing of data and discovering otherwise undetected clinical patterns. Genetic polymorphisms of CYP3A5 and ABCB1 have yielded results to suggest varying dose requirements correlated with race and sex. Newly proposed biomarkers offer precise and noninvasive ways to monitor patient’s status. Cell-free DNA quantitation is increasingly explored as an indicator of allograft injury and rejection, which can help avoid unneeded biopsies and more frequently monitor graft function.