Heart Transplantation: Immunological Challenges Revisited.

IF 2.2 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Sara Assadiasl, Sepehr Safdel, Mahsa Gheitasi, Mohammad Hossein Nicknam
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引用次数: 0

Abstract

Introduction: Immunologic responses to cardiac allografts initiate before transplantation during brain-dead organ procurement and might persist for years after transplantation, culminating in chronic allograft dysfunction. Despite remarkable advances in post-transplant care and immunosuppressive agents, acute cellular and antibody-mediated rejections as well as chronic allograft vasculopathy significantly affect cardiac allograft and patient survival.

Methods: Herein, recent findings of the molecular mechanisms involved in the inflammatory responses before and after heart transplantation, including brain death donor inflammation, acute cellular rejection, antibody-mediated rejection, and chronic allograft dysfunction, have been summarized, along with novel therapeutic approaches for their treatment. Finally, recent developments in prognostic and diagnostic biomarkers for immunological complications have been provided, with an overview of the most promising biomarkers to date.

Results: Due to the recent developments in the description of molecular mechanisms involved in the immunopathogenesis of cardiac allograft rejection, some immune cells, proinflammatory cytokines, and adhesion molecules have been proposed as therapeutic targets for the prevention or treatment of alloimmune responses. In addition, several molecules derived from graft tissue or immune cells, e.g. natriuretic peptides, cardiac troponins, exosomal products, microRNAs, and donor-derived cell-free DNA, have been suggested as potential biomarkers for the prediction or diagnosis of cardiac transplant rejection.

Conclusion: Considering the need to design non-invasive, low-cost tests for early diagnosis of post-transplant complications and convenient follow-up of the cardiac transplant recipients, peripheral blood biomarkers could be appropriate candidates for this purpose.

心脏移植:免疫学挑战重访。
对同种异体心脏移植的免疫反应始于移植前的脑死亡器官获取过程,并可能在移植后持续数年,最终导致慢性同种异体移植功能障碍。尽管移植后护理和免疫抑制剂取得了显著进展,但急性细胞和抗体介导的排斥反应以及慢性同种异体移植物血管病变显著影响心脏移植物和患者的生存。方法:本文总结了心脏移植前后炎症反应的分子机制的最新发现,包括脑死亡供体炎症、急性细胞排斥反应、抗体介导的排斥反应和慢性同种异体移植物功能障碍,以及治疗这些反应的新方法。最后,提供了免疫并发症预后和诊断生物标志物的最新进展,并概述了迄今为止最有前途的生物标志物。结果:由于近年来对心脏异体移植排斥反应免疫发病机制的研究进展,一些免疫细胞、促炎细胞因子和粘附分子已被提出作为预防或治疗异体免疫反应的治疗靶点。此外,来自移植物组织或免疫细胞的一些分子,如利钠肽、心脏肌钙蛋白、外泌体产物、microrna和供体来源的无细胞DNA,已被认为是预测或诊断心脏移植排斥反应的潜在生物标志物。结论:考虑到需要设计无创、低成本的检测方法来早期诊断心脏移植术后并发症和方便心脏移植受者的随访,外周血生物标志物可能是这一目的的合适人选。
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来源期刊
Current Cardiology Reviews
Current Cardiology Reviews CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
10.50%
发文量
117
期刊介绍: Current Cardiology Reviews publishes frontier reviews of high quality on all the latest advances on the practical and clinical approach to the diagnosis and treatment of cardiovascular disease. All relevant areas are covered by the journal including arrhythmia, congestive heart failure, cardiomyopathy, congenital heart disease, drugs, methodology, pacing, and preventive cardiology. The journal is essential reading for all researchers and clinicians in cardiology.
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