Pros and cons for C4d as a biomarker.
Pros and cons for C4d as a biomarker.
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DOI：
10.1038/ki.2011.497
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发表时间：
2012-04
影响因子：
19.6
通讯作者：
中科院分区：
文献类型：
--
作者：
90年代末，C4D在日常临床实践中的引入引起了人们对抗体介导的机制在同种异体移植排斥反应中作用的日益浓厚的兴趣。作为经典补体激活的标志物，C4D使在移植物中抗体结合部位可视化抗供体抗体与组织损伤之间的直接联系成为可能。随着C4D在世界范围内的广泛使用，人们发现了C4D的一些局限性。例如，在ABO血型不合的移植中，C4D存在于大多数移植物中，但这似乎表明“移植物适应”而不是抗体介导的排斥反应。C4D现在越来越多地被认为是其他领域的潜在生物标记物，在这些领域，抗体可能会导致组织损伤，如全身自身免疫性疾病和怀孕。在所有这些领域，C4D有望检测出面临抗体介导疾病后果风险的患者。此外，阻断补体激活的新疗法的出现使C4D成为可能识别可能从这些药物中受益的患者的标志物。本文综述了C4D作为生物标记物的过去、现在和未来的前景，重点介绍了它在固体器官移植中的应用，并讨论了它在自身免疫和妊娠中可能的新作用。
The introduction of C4d in daily clinical practice in the late nineties aroused an ever-increasing interest in the role of antibody-mediated mechanisms in allograft rejection. As a marker of classical complement activation, C4d made it possible to visualize the direct link between anti-donor antibodies and tissue injury at sites of antibody binding in a graft. With the expanding use of C4d worldwide several limitations of C4d were identified. For instance, in ABO-incompatible transplantations C4d is present in the majority of grafts but this seems to point at ‘graft accommodation’ rather than antibody-mediated rejection. C4d is now increasingly recognized as a potential biomarker in other fields where antibodies can cause tissue damage, such as systemic autoimmune diseases and pregnancy. In all these fields, C4d holds promise to detect patients at risk for the consequences of antibody-mediated disease. Moreover, the emergence of new therapeutics that block complement activation makes C4d a marker with potential to identify patients who may possibly benefit from these drugs. This review provides an overview of the past, present, and future perspectives of C4d as a biomarker, focusing on its use in solid organ transplantation and discussing its possible new roles in autoimmunity and pregnancy.
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