Crescioli Clara
Department of Movement, Human and Health Sciences, Unit of Endocrinology, University of Rome 'Foro Italico', Rome, Italy.
Curr Opin Organ Transplant. 2013 Oct;18(5):595-600. doi: 10.1097/MOT.0b013e328364fd93.
To summarize the promises and limitations of candidate noninvasive immunological biomarkers in cardiac rejection, with a special focus on the chemokine CXCL10, as a pretransplant predictive marker of early heart acute rejection. Potential issues for transfer from research to the clinic are addressed.
Early changes of immune biomolecules in peripheral blood, reflecting graft or heart recipient's immune status, are candidate biomarkers able to diagnose or predict cardiac rejection, ideally giving an opportunity to intervene before heart failure occurs. The support of robust analytical methodologies is necessary for the transition from biomarker discovery to clinical implementation.
Cardiac rejection represents the main problem after heart transplantation. Endomyocardial biopsy, although invasive and not risk free, is the gold-standard procedure for rejection monitoring. Noninvasive heart damage biomarkers manifest substantially after rejection occurrence. The goal is to detect graft injury at the earliest possible stage in disease initiation. Some biomolecules associated with the early immune response to cardiac allograft retain the power to be diagnostic and, even better, predictive of acute rejection, as in the case of pretransplant CXCL10 serum level. Multicenter studies for assay validation and standardization, integrated analysis of multiple biomarkers, and cost-effectiveness evaluation are mandatory efforts.
总结心脏移植排斥反应中候选非侵入性免疫生物标志物的前景与局限性，特别关注趋化因子CXCL10作为心脏移植早期急性排斥反应的移植前预测标志物。探讨从研究转化至临床过程中可能存在的问题。
外周血中免疫生物分子的早期变化反映了移植物或心脏受体的免疫状态，这些候选生物标志物能够诊断或预测心脏移植排斥反应，理想情况下可在心力衰竭发生前进行干预。从生物标志物发现到临床应用，强大的分析方法支持至关重要。
心脏移植排斥反应是心脏移植后的主要问题。心内膜心肌活检虽具有侵入性且并非毫无风险，但仍是监测排斥反应的金标准方法。非侵入性心脏损伤生物标志物在排斥反应发生后才会显著表现出来。目标是在疾病起始的最早阶段检测移植物损伤。一些与心脏同种异体移植早期免疫反应相关的生物分子具有诊断能力，甚至更具预测急性排斥反应的能力，如移植前CXCL10血清水平的情况。开展多中心研究以进行检测验证和标准化、对多种生物标志物进行综合分析以及进行成本效益评估是必不可少的工作。
