Salcido-Ochoa Francisco, Allen John Carson
Tregs and HLA Research Force, Francisco Kidney and Medical Centre, Mount Elizabeth Novena Hospital, Singapore 329563, Singapore.
Centre for Quantitative Medicine, Duke-NUS Graduate Medical School, Singapore 169856, Singapore.
World J Transplant. 2017 Dec 24;7(6):276-284. doi: 10.5500/wjt.v7.i6.276.
A literature review on immune monitoring in kidney transplantation produced dozens of research articles and a multitude of promising biomarkers, all in the quest for the much sought after - but perennially elusive - "holy grail" of kidney biomarkers able to unequivocally predict acute transplant rejection non-rejection. Detection methodologies and study designs were many and varied. Hence the motivation for this editorial, which espouses the notion that in today's kidney transplantation milieu, the judicious use of disease classifiers tailored to specific patient immune risks may be more achievable and productive in the long run and confer a greater advantage for patient treatment than the pursuit of a single "omniscient" biomarker. In addition, we desire to direct attention toward greater scrutiny of biomarker publications and decisions to implement biomarkers in practice, standardization of methods in the development of biomarkers and consideration for adoption of "biomarker-driven" biopsies. We propose "biomarker-driven" biopsies as an adjunctive to and/or alternative to random surveillance (protocol) biopsies or belated indication biopsies. The discovery of a single kidney transplantation biomarker would represent a major breakthrough in kidney transplantation practice, but until that occurs - if ever it does occur, other approaches offer substantial potential for unlocking prognostic, diagnostic and therapeutic options. We conclude our editorial with suggestions and recommendations for productively incorporating current biomarkers into diagnostic algorithms and for testing future biomarkers of acute rejection in kidney transplantation.
一篇关于肾移植免疫监测的文献综述产生了数十篇研究文章和众多有前景的生物标志物，所有这些都是为了寻找备受追捧但长期难以捉摸的肾生物标志物“圣杯”，这种标志物能够明确预测急性移植排斥反应或非排斥反应。检测方法和研究设计多种多样。因此才有了这篇社论的动机，社论支持这样一种观点，即在当今的肾移植环境中，从长远来看，明智地使用针对特定患者免疫风险量身定制的疾病分类器可能更可行、更有成效，并且与追求单一的“全知”生物标志物相比，在患者治疗方面具有更大优势。此外，我们希望引导人们更加仔细地审查生物标志物的出版物以及在实践中应用生物标志物的决策，规范生物标志物开发中的方法，并考虑采用“生物标志物驱动”的活检。我们提议将“生物标志物驱动”的活检作为随机监测（方案）活检或延迟指征活检的辅助手段和/或替代方法。发现单一的肾移植生物标志物将代表肾移植实践中的一项重大突破，但在那之前——如果真的会发生的话，其他方法在解锁预后、诊断和治疗选项方面具有巨大潜力。我们在社论结尾提出了一些建议，包括如何有效地将当前的生物标志物纳入诊断算法，以及如何测试肾移植急性排斥反应的未来生物标志物。
