Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Poland.
Adv Clin Exp Med. 2020 May;29(5):629-633. doi: 10.17219/acem/121510.
Humoral response beyond human leukocyte antigen (HLA) is of great interest in the transplant community. We decided to summarize the data on a new antigenic target called angiotensin II type 1 receptor (AT1 receptor). Non-HLA antibodies can now be detected in routine clinical care of patients after transplantation, but their role is not fully understood. Numerous analyses showed that non-HLA response may exert a higher risk of allograft rejection and allograft loss independently of the HLA system. Non-HLA response may even have a higher rate of antibody-mediated rejection. Information regarding antigen target, as well as the pathophysiology of its antibodies and diagnostic tools, is essential for a better understanding of non-HLA humoral response. Angiotensin II type 1 receptors are the most recognized target for non-HLA antibodies. Anti-AT1R Abs (anti-angiotensin II type 1-receptor-activating antibodies) may identify renal transplant patients at higher risk of graft rejection and loss. The presence of AT1 receptor expression analyzed together with anti-AT1R Abs should be considered for better transplant immunological risk assessment. Further assessment is required for a better understanding and to create appropriate therapeutic strategies.
在移植领域，人类白细胞抗原 (HLA) 以外的体液反应引起了极大的关注。我们决定总结一种称为血管紧张素 II 型 1 型受体 (AT1 受体) 的新型抗原性靶标的数据。非 HLA 抗体现在可以在移植后患者的常规临床护理中检测到，但它们的作用尚未完全了解。大量分析表明，非 HLA 反应可能独立于 HLA 系统对同种异体移植物排斥和同种异体移植物丢失产生更高的风险。非 HLA 反应甚至可能具有更高的抗体介导的排斥反应率。关于抗原靶标以及其抗体的病理生理学和诊断工具的信息对于更好地理解非 HLA 体液反应至关重要。血管紧张素 II 型 1 型受体是最受认可的非 HLA 抗体靶标。抗 AT1R Abs（抗血管紧张素 II 型 1 型受体激活抗体）可能会识别出同种异体肾移植患者排斥和丢失的风险更高。应考虑分析 AT1 受体表达与抗 AT1R Abs 一起，以进行更好的移植免疫风险评估。需要进一步评估以更好地理解并制定适当的治疗策略。
