Cortesini Raffaello, Suciu-Foca Nicole
Department of Pathology, Columbia University, 630 West 168 Street, P&S 14-401, New York, NY 10032, USA.
Transpl Immunol. 2004 Sep-Oct;13(2):101-4. doi: 10.1016/j.trim.2004.05.002.
The status of "partial" tolerance to organ allografts versus the status of complete tolerance is the main topic of this paper. Progress made in immunosuppression, particularly by use of various lymphocyte depleting agents for "induction therapy", seems to favor the subsequent development of T cells with suppressor/regulatory properties. The effective deletion of alloreactive T helper and cytotoxic cells in conjunction with the expansion of antigen-specific suppressor (CD8 + CD28 - FOXP3+) and regulatory (CD4 + CD25+ FOXP3+) T cells creates a milieu in which the graft is well tolerated under an "umbrella" of low dosage immunosuppression. The most effective induction treatment is Campath-1H, although ATGAM at high dosage is also widely used. Total lymphoid irradiation (TLI) is another very effective pretreatment strategy in spite of the risks which are associated with it. The induction of "partial" tolerance is a step in the right direction for exploring strategies that may lead to the induction of complete tolerance. It is safe for the patients and can prolong significantly the function of the graft, preventing the onset of chronic rejection.
器官同种异体移植的“部分”耐受状态与完全耐受状态是本文的主要主题。免疫抑制方面取得的进展，特别是通过使用各种淋巴细胞清除剂进行“诱导治疗”，似乎有利于随后具有抑制/调节特性的T细胞的发展。同种异体反应性辅助性T细胞和细胞毒性T细胞的有效清除，以及抗原特异性抑制性（CD8 + CD28 - FOXP3 +）和调节性（CD4 + CD25 + FOXP3 +）T细胞的扩增，创造了一种环境，在低剂量免疫抑制的“保护伞”下，移植物能够得到良好的耐受。最有效的诱导治疗是Campath - 1H，尽管高剂量的抗胸腺细胞球蛋白（ATGAM）也被广泛使用。尽管全身淋巴照射（TLI）存在相关风险，但它是另一种非常有效的预处理策略。诱导“部分”耐受是探索可能导致诱导完全耐受策略的正确方向上的一步。它对患者是安全的，并且可以显著延长移植物的功能，防止慢性排斥反应的发生。
