Department of Surgery, Division of Transplant, University of Colorado Aurora, Denver, Colorado.
Department of Medicine, Division of Pulmonary, Critical Care & Sleep Medicine, University of Florida, Gainesville, Florida, USA.
Curr Opin Organ Transplant. 2019 Dec;24(6):694-698. doi: 10.1097/MOT.0000000000000708.
To summarize recent findings linking donor-specific antibodies with innate immunity resulting in chronic allograft rejection.
Studies in recent years highlight the significance of donor-specific antibodies (DSA) in both acute and chronic allograft rejection. Since chronic rejection is the leading cause of graft failure, this review centers on the contribution of three areas of innate immunity of particular recent focus: complement, NK cells, and macrophages. Recent advances indicate the diverse roles that complement components play both in directly initiating allograft injury and indirectly by contributing to enhanced alloreactivity. NK cells also have emerged as an additional innate response that directly links DSA with chronic graft injury. Finally, recent studies identify alternatively activated macrophages as an additional arm of innate immunity contributing to chronic allograft rejection.
Chronic allograft rejection involves a significant contribution of DSA and differing pathways of the innate immune system. However, key issues remain unresolved. First, it is not always clear which of these varied sources of innate immunity contributing to chronic rejection may be antibody dependent. Moreover, it is not yet clear if these innate pathways represent independent routes that contribute to chronic rejection or rather act in concert to mediate allograft injury.
总结近年来将供体特异性抗体与先天免疫联系起来导致慢性移植物排斥的研究进展。
近年来的研究强调了供体特异性抗体（DSA）在急性和慢性移植物排斥中的重要性。由于慢性排斥是移植物失功的主要原因，因此本综述集中讨论了先天免疫三个近期特别关注领域的贡献：补体、NK 细胞和巨噬细胞。最近的进展表明，补体成分在直接引发移植物损伤和通过增强同种反应性间接发挥作用方面具有多种作用。NK 细胞也已成为与慢性移植物损伤直接相关的另一种先天反应。最后，最近的研究确定了另一种先天免疫途径——M2 型巨噬细胞，其在慢性移植物排斥中也发挥作用。
慢性移植物排斥涉及 DSA 和先天免疫系统不同途径的显著贡献。然而，仍有一些关键问题尚未解决。首先，尚不清楚哪些不同的先天免疫来源可能与慢性排斥相关。此外，尚不清楚这些先天途径是否代表独立的导致慢性排斥的途径，还是协同作用以介导移植物损伤。
