免疫抑制在肾移植中的教训:退却还是坚持?

IF 2.5 3区 工程技术 Q2 BIOLOGY
Qian-Qian Zhang, Ya-Long Xie, Sha Cao, Song Chen, Wei-Jie Zhang, Sheng Chang
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引用次数: 0

摘要

背景:为了解本中心长期存活肾移植受者是否存在接近耐受的情况,甚至可以根据其免疫状态尝试操作性耐受,我们分析了各组免疫细胞亚群和细胞因子的变化,评估了长期存活受者的免疫状态。方法:在我院进行一项现实世界、观察性、回顾性队列研究。选取28名长期接受者作为研究对象,15名近期术后稳定接受者,15名健康受试者作为对照。检测并分析T淋巴细胞亚群、B淋巴细胞亚群、MDSCs和细胞因子。结果:长期和近期肾移植患者Treg/CD4 T细胞、总B细胞和B10细胞均低于健康对照组(HC)。长期生存组IFN-γ和IL-17A水平明显高于近期术后稳定受体和HC,而TGF-β1水平明显低于术后短期组和HC。值得注意的是,与短期受者相比,HLA阳性组和阴性组的IL-6水平均明显降低(均为p)。结论:这项“真实世界”的研究验证了临床试验中观察到的长期生存受者的真实状态。与预期的适当耐受状态相反,长期生存组受者伴随着免疫应答指标的增加,而与免疫耐受相关的指标并未显著增加。长期存活且肾功能稳定的受者,在低强度免疫因子的作用下,可能处于免疫抑制与排斥并存的免疫平衡状态。如果免疫抑制剂减少甚至去除,可能会发生排斥反应。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

A Lesson of Immunosuppression in Renal Transplant: Retreat or Hold?

A Lesson of Immunosuppression in Renal Transplant: Retreat or Hold?

A Lesson of Immunosuppression in Renal Transplant: Retreat or Hold?

A Lesson of Immunosuppression in Renal Transplant: Retreat or Hold?

Background: Aiming at understanding whether there are cases of near-tolerance among long-term surviving kidney transplant recipients in our center, or even operant tolerance can be attempted based on their immune status, we analyzed changes of immune cell subsets and cytokines in various groups, and evaluated immune status of long-term survival recipients. Methods: A real-world, observational, retrospective cohort study was conducted in our hospital. Twenty-eight long-term recipients were selected as study subjects, 15 recent postoperative stable recipients, and 15 healthy subjects as controls. T and B lymphocyte subsets, MDSCs, and cytokines were detected and analyzed. Results: Treg/CD4 T cells, total B and B10 cells in long-term and recent renal recipients were lower than healthy controls (HC). The level of IFN-γ and IL-17A in long-term survival patients was obviously higher than that in recent postoperative stable recipients and HC, while TGF-β1 level was significantly lower in long-term survival group than in short-term postoperative group and HC. Notably, compared with short-term recipients, it has been found that the IL-6 level in both positive and negative HLA groups were obviously lower (all P<0.05). In the long-term survival group, 43% of recipients were positive for urinary protein and 50% were positive for HLA antibody. Conclusion: This "real-world" study validates the findings of real status of long-term survival recipients observed in clinical trials. Contrary to a state of proper tolerance as expected, the group recipients in long-term survival were accompanied by the increased indicators of immune response, while those related to immune tolerance were not significantly increased. Long-term survival recipients with stable renal function may be in an immune equilibrium state where immunosuppression and rejection coexist under the action of low-intensity immune agents. If immunosuppressive agents are reduced or even removed, rejection may occur.

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来源期刊
Yale Journal of Biology and Medicine
Yale Journal of Biology and Medicine Biochemistry, Genetics and Molecular Biology-General Biochemistry,Genetics and Molecular Biology
CiteScore
5.00
自引率
0.00%
发文量
41
期刊介绍: The Yale Journal of Biology and Medicine (YJBM) is a graduate and medical student-run, peer-reviewed, open-access journal dedicated to the publication of original research articles, scientific reviews, articles on medical history, personal perspectives on medicine, policy analyses, case reports, and symposia related to biomedical matters. YJBM is published quarterly and aims to publish articles of interest to both physicians and scientists. YJBM is and has been an internationally distributed journal with a long history of landmark articles. Our contributors feature a notable list of philosophers, statesmen, scientists, and physicians, including Ernst Cassirer, Harvey Cushing, Rene Dubos, Edward Kennedy, Donald Seldin, and Jack Strominger. Our Editorial Board consists of students and faculty members from Yale School of Medicine and Yale University Graduate School of Arts & Sciences. All manuscripts submitted to YJBM are first evaluated on the basis of scientific quality, originality, appropriateness, contribution to the field, and style. Suitable manuscripts are then subject to rigorous, fair, and rapid peer review.
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