Argani Hassan
From Urology and Nephrology Research Center of Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Exp Clin Transplant. 2016 Nov;14(Suppl 3):6-13.
In solid-organ transplant, cell therapy is used as an immunomodulation therapy or as a functioning graft (bioengineering medicine). Before such treatment can be more accepted among transplant societies, some uncertainties should be clarified. These include: why is such therapy mandatory? What are the indications for this therapy, and what are the mechanism(s) of actions? What types of cells are involved and what are their routes of actions? Finally, what is known about the safety? In general, the risks associated with intravenous administration of immunoregulatory cell products are similar to those encountered with conventional blood transfusions. The adverse effects of immunosuppressive drugs, such as infections, cardiovascular disease, metabolic complications, and malignancies, would be decreased with cell therapy. Immunoregulatory cells act when necessary and through multiple mechanisms through different targets. Immunoregulatory cells are not only passive inhibitors such as drugs, but they have active functions. Treatment would only be once or perhaps a few times but not indefinitely, which is in contrast to immunosuppressive drugs; therefore, complications involving immunosuppressive drugs are no longer present. Cell therapy in solid-organ transplant is indicated for treatment of ischemic-reperfusion injury, prevention of chronic allograft nephropathy, minimization of immune suppression, and induction of long-term allograft tolerance. Many cell types have being investigated as potential cell-based immunotherapies for use in solid-organ transplant, including mesenchymal stromal cells, regulatory macrophages, tolerogenic dendritic cells, regulatory T cells, and regulatory B cells. Efficacy and safety of each group of cells should be clarified before widespread clinical use. The landscape of transplant science would be at least partially, if not totally, changed with cell therapy.
在实体器官移植中，细胞疗法被用作免疫调节疗法或作为功能性移植物（生物工程医学）。在这种治疗方法被移植学会更广泛接受之前，一些不确定性需要得到澄清。这些不确定性包括：为什么这种疗法是必要的？这种疗法的适应症是什么，其作用机制是什么？涉及哪些类型的细胞，它们的作用途径是什么？最后，关于安全性有哪些了解？一般来说，静脉注射免疫调节细胞产品的风险与传统输血的风险相似。细胞疗法可降低免疫抑制药物的不良反应，如感染、心血管疾病、代谢并发症和恶性肿瘤等。免疫调节细胞在必要时通过多种机制作用于不同靶点。免疫调节细胞不仅仅是像药物那样的被动抑制剂，它们具有主动功能。与免疫抑制药物不同，治疗通常只需进行一次或几次，而不是无限期进行；因此，不再存在与免疫抑制药物相关的并发症。实体器官移植中的细胞疗法适用于治疗缺血再灌注损伤、预防慢性移植肾肾病、尽量减少免疫抑制以及诱导长期移植耐受。许多细胞类型正在被研究作为实体器官移植中潜在的基于细胞的免疫疗法，包括间充质基质细胞、调节性巨噬细胞、耐受性树突状细胞、调节性T细胞和调节性B细胞。在广泛临床应用之前，应明确每组细胞的疗效和安全性。细胞疗法至少会部分改变（如果不是完全改变）移植科学的局面。
