Tolerance in liver transplantation: Biomarkers and clinical relevance.
Tolerance in liver transplantation: Biomarkers and clinical relevance.
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肝移植的耐受性：生物标志物和临床相关性。
DOI：
10.3748/wjg.v22.i34.7676
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发表时间：
2016-09-14
影响因子：
4.3
通讯作者：
Pons JA
中科院分区：
文献类型：
--
作者：
Baroja-Mazo A;Revilla-Nuin B;Parrilla P;Martínez-Alarcón L;Ramírez P;Pons JA
移植是终末期器官衰竭的最佳治疗方法，现代免疫抑制在短期结果方面取得了重要进展。然而，在目前的临床实践中，免疫抑制对慢性排斥反应的影响很小，并且会引起慢性毒性反应。因此，移植的一个主要目标是理解和诱导耐受。已经证实，表达转录因子FoxP3的人调节性T细胞在维持免疫自身耐受和免疫稳态方面发挥着重要作用。对移植物耐受性和存活率的诱导和长期维持至关重要的主要调节性T细胞亚群和扩增机制正在积极研究中。同样，其他免疫细胞，如树突状细胞、单核/巨噬细胞或自然杀伤细胞，也被描述为“操作耐受”过程的一部分。然而，将这些结果转化为临床实践需要坚实的工具来准确和可靠地识别将会耐受的患者。通过这种方式，大量的遗传和细胞生物标记物正在产生，并在全球范围内得到大型多中心临床试验的验证。到目前为止，很少有研究详细分析停用免疫抑制药物对长期服用免疫抑制药物所产生的先前存在的并发症的影响以及与其相关的副作用。肝移植的未来目标是开发新的治疗方法，以提高实际低耐受者与非耐受者的比率。
Transplantation is the optimal treatment for end-stage organ failure, and modern immunosuppression has allowed important progress in short-term outcomes. However, immunosuppression poorly influences chronic rejection and elicits chronic toxicity in current clinical practice. Thus, a major goal in transplantation is to understand and induce tolerance. It is well established that human regulatory T cells expressing the transcription factor FoxP3 play important roles in the maintenance of immunological self-tolerance and immune homeostasis. The major regulatory T cell subsets and mechanisms of expansion that are critical for induction and long-term maintenance of graft tolerance and survival are being actively investigated. Likewise, other immune cells, such as dendritic cells, monocyte/macrophages or natural killer cells, have been described as part of the process known as “operational tolerance”. However, translation of these results towards clinical practice needs solid tools to identify accurately and reliably patients who are going to be tolerant. In this way, a plethora of genetic and cellular biomarkers is raising and being validated worldwide in large multi-center clinical trials. Few of the studies performed so far have provided a detailed analysis of the impact of immunosuppression withdrawal on pre-existing complications derived from the long-term administration of immunosuppressive drugs and the side effects associated with them. The future of liver transplantation is aimed to develop new therapies which increase the actual low tolerant vs non-tolerant recipients ratio.
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影响因子：
64.8
作者：
Araki, Koichi;Turner, Alexandra P.;Shaffer, Virginia Oliva;Gangappa, Shivaprakash;Keller, Susanne A.;Bachmann, Martin F.;Larsen, Christian P.;Ahmed, Rafi
通讯作者：
Ahmed, Rafi
影响因子：
13.6
作者：
Ashton-Chess, Joanna;Dugast, Emilie;Soulillou, Jean-Paul
通讯作者：
Soulillou, Jean-Paul
DOI：
10.1073/pnas.90.8.3373
发表时间：
1993-04-15
影响因子：
11.1
作者：
AUCHINCLOSS, H;LEE, R;GLIMCHER, LH
通讯作者：
GLIMCHER, LH
影响因子：
3.1
作者：
Braudeau, Cecile;Racape, Maud;Brouard, Sophie
通讯作者：
Brouard, Sophie
影响因子：
6.2
作者：
Bhorade SM;Chen H;Molinero L;Liao C;Garrity ER;Vigneswaran WT;Shilling R;Sperling A;Chong A;Alegre ML
通讯作者：
Alegre ML