Emory University School of Medicine, 5105 WMB, 101 Woodruff Circle, Atlanta, GA 30322, USA.
J Clin Invest. 2010 Apr;120(4):1036-9. doi: 10.1172/JCI42532. Epub 2010 Mar 24.
Belying the spectacular success of solid organ transplantation and improvements in immunosuppressive therapy is the reality that long-term graft survival rates remain relatively unchanged, in large part due to chronic and insidious alloantibody-mediated graft injury. Half of heart transplant recipients develop chronic rejection within 10 years - a daunting statistic, particularly for young patients expecting to achieve longevity by enduring the rigors of a transplant. The current immunosuppressive pharmacopeia is relatively ineffective in preventing late alloantibody-associated chronic rejection. In this issue of the JCI, Kelishadi et al. report that preemptive deletion of B cells prior to heart transplantation in cynomolgus monkeys, in addition to conventional posttransplant immunosuppressive therapy with cyclosporine, markedly attenuated not only acute graft rejection but also alloantibody elaboration and chronic graft rejection. The success of this preemptive strike implies a central role for B cells in graft rejection, and this approach may help to delay or prevent chronic rejection after solid organ transplantation.
尽管实体器官移植的巨大成功和免疫抑制治疗的改善，长期移植物存活率仍然相对不变，这一现实令人震惊，这在很大程度上是由于慢性和隐匿性同种抗体介导的移植物损伤。半数心脏移植受者在 10 年内发生慢性排斥反应 - 这是一个令人望而生畏的统计数据，特别是对于年轻患者，他们希望通过忍受移植的严格要求来延长寿命。目前的免疫抑制药物在预防晚期同种抗体相关的慢性排斥反应方面相对无效。在本期 JCI 中，Kelishadi 等人报告说，在恒河猴心脏移植前预先删除 B 细胞，除了常规的移植后环孢素免疫抑制治疗外，不仅显著减轻了急性移植物排斥反应，而且还减轻了同种抗体的产生和慢性移植物排斥反应。这种先发制人的策略的成功表明 B 细胞在移植物排斥反应中起核心作用，这种方法可能有助于延迟或预防实体器官移植后的慢性排斥反应。
