Current status of the microbiome in renal transplantation.
Current status of the microbiome in renal transplantation.
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DOI：
10.1097/mnh.0000000000000262
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发表时间：
2016-11
影响因子：
3.2
通讯作者：
Bromberg JS
中科院分区：
文献类型：
--
作者：
Ahmad S;Bromberg JS
病原微生物群和保护性微生物群之间的不平衡是生态失调的特征。生态失调的存在可能会影响免疫力、耐受性或疾病，这取决于各种情况。在移植患者群体中，免疫抑制的需要和预防性和治疗性抗菌药物的广泛使用创造了新的移植后微生物群，这些微生物群仍有待充分定义。对小鼠的研究表明，微生物群衍生产品与宿主免疫细胞之间存在显著的双向相互作用。特定产物对Treg和Th17细胞的刺激分别导致免疫稳态的维持和炎症的激活。生态失调可能导致抗原交叉反应性的发展，这可能影响同种异体反应性。由于尿毒症和微生物代谢产物的肾脏代谢，慢性肾脏疾病中微生物群的某些免疫后遗症是明显的。饮食调整、益生菌和粪便微生物群移植已被研究用于人类微生物群的改变。研究人员已经开始确定与临床状况相关的生物代谢障碍，包括慢性肾脏疾病、移植后感染和排斥反应。这些信息将使临床医生不仅可以选择有风险的患者进行早期干预，而且还可以开发治疗方法，使微生物群恢复到稳态或耐受性状态。
An imbalance between pathogenic and protective microbiota characterizes dysbiosis. Presence of dysbiosis may affect immunity, tolerance, or disease depending on a variety of conditions. In the transplant patient population, the need for immunosuppression and widespread use of prophylactic and therapeutic antimicrobial agents creates new post-transplant microbiota communities that remain to be fully defined. Studies in mice have demonstrated significant bidirectional interactions between microbiota derived products and host immune cells. The stimulation of Treg and Th17 cells by specific products leads to maintenance of immune homeostasis versus activation of inflammation, respectively. Dysbiosis may lead to development of antigen cross-reactivity, which may affect alloreactivity. Certain immunologic sequelae of microbiota are pronounced in chronic kidney disease, due to uremia and renal metabolism of microbiota metabolites. Dietary modifications, probiotics, and fecal microbiota transplant have been investigated for alteration of microbiota in humans. Researchers have begun to identify dysbioses associated with clinical conditions, including chronic kidney disease, post-transplant infection, and rejection. This information will allow clinicians not only to select at-risk patients for early intervention, but also to develop therapies that restore the microbiota to a state of homeostasis or tolerance..