Dragun Duska, Hegner Bjorn
Department of Nephrology and Intensive Care Medicine, Charité Campus Virchow Clinic, Augustenburger Platz 1, D-13353 Berlin, Germany.
Contrib Nephrol. 2009;162:129-39. doi: 10.1159/000170845. Epub 2008 Oct 31.
Antibodies and B cells are increasingly recognized as major modulators of allograft function and survival. Improved immunohistochemical and serologic diagnostic procedures have been developed to monitor antibody responses against HLA antigens during the last decade. Acute and chronic allograft rejection can occur in HLA-identical sibling transplants implicating the importance of immune response against non-HLA targets. Non-HLA anti-bodies may occur as alloantiboides, yet they seem to be predominantly autoantibodies. Antigenic targets of non-HLA antibodies described thus far include various minor histocompatibility antigens, vascular receptors, adhesion molecules, and intermediate filaments. Non-HLA antibodies may function as complement- and non-complement-fixing antibodies and they may induce a wide variety of allograft injuries, reflecting the complexity of their acute and chronic actions. Refined approaches considering the subtle mechanistic differences in the individual antibody responses directed against non-HLA antigens may help to define patients at particular risk for irreversible acute or chronic allograft injuries and improve over-all outcomes. We attempted to summarize the current state of research, development in diagnostic and therapeutic strategies, and to address some emerging problems in the area of humoral response against non-HLA antigens beyond ABO blood group and MHC class I chain-related gene A and B (MICA and MICB) antigens in solid organ transplantation.
抗体和B细胞越来越被认为是同种异体移植功能和存活的主要调节因子。在过去十年中，已开发出改进的免疫组织化学和血清学诊断程序来监测针对HLA抗原的抗体反应。急性和慢性同种异体移植排斥反应可发生在HLA相同的同胞移植中，这表明针对非HLA靶点的免疫反应的重要性。非HLA抗体可能作为同种异体抗体出现，但它们似乎主要是自身抗体。迄今为止描述的非HLA抗体的抗原靶点包括各种次要组织相容性抗原、血管受体、黏附分子和中间丝。非HLA抗体可作为补体结合和非补体结合抗体发挥作用，它们可能导致多种同种异体移植损伤，反映出其急性和慢性作用的复杂性。考虑到针对非HLA抗原的个体抗体反应中细微的机制差异的精细方法，可能有助于确定有不可逆急性或慢性同种异体移植损伤特定风险的患者，并改善总体结果。我们试图总结目前的研究状况、诊断和治疗策略的进展，并解决实体器官移植中除ABO血型和MHC I类链相关基因A和B（MICA和MICB）抗原之外针对非HLA抗原的体液反应领域中一些新出现的问题。
