Centre de Recherche de l'Hôpital Maisonneuve-Rosemont.
Department of Medicine, Université de Montréal, Montreal, Quebec, Canada.
Curr Opin Nephrol Hypertens. 2021 Nov 1;30(6):584-592. doi: 10.1097/MNH.0000000000000737.
Current immunosuppressive regimens used in kidney transplantation are sometimes ineffective and carry significant risks of morbidity and mortality. Cellular therapies are a promising alternative to prolong graft survival while minimizing treatment toxicity. We review the recently published breakthrough studies using cell therapies in kidney transplantation.
The reviewed phase I and II trials showed that cell therapies are feasible and safe in kidney transplantation, sometimes associated with less infectious complications than traditional regimens. Regulatory T cells and macrophages were added to the induction regimen, allowing for lower immunosuppressive drug doses without higher rejection risk. Regulatory T cells are also a treatment for subclinical rejection on the 6 months biopsy. Other strategies, like bone marrow-derived mesenchymal cells, genetically modified regulatory T cells, and chimerism-based tolerance are also really promising. In addition, to improve graft tolerance, cell therapy could be used to prevent or treat viral infection after transplantation.
Emerging data underline that cell therapy is a feasible and safe treatment in kidney transplantation. Although the evidence points to a benefit for transplant recipients, studies with standardized protocols, representative control groups, and longer follow-up are needed to answer the question definitively and guide future research.
目前用于肾移植的免疫抑制方案有时无效，且具有显著的发病率和死亡率风险。细胞疗法是一种有前途的替代方案，可以延长移植物的存活时间，同时最大限度地降低治疗毒性。我们回顾了最近发表的使用细胞疗法治疗肾移植的突破性研究。
已发表的 I 期和 II 期试验表明，细胞疗法在肾移植中是可行且安全的，有时与传统方案相比，感染并发症更少。调节性 T 细胞和巨噬细胞被添加到诱导方案中，允许减少免疫抑制药物剂量，而不会增加排斥反应风险。调节性 T 细胞也可用于治疗 6 个月活检的亚临床排斥反应。其他策略，如骨髓间充质细胞、基因修饰的调节性 T 细胞和嵌合耐受，也非常有前途。此外，为了提高移植物的耐受性，细胞疗法可用于预防或治疗移植后的病毒感染。
新出现的数据强调细胞治疗是肾移植中一种可行且安全的治疗方法。尽管证据表明对移植受者有益，但需要进行具有标准化方案、代表性对照组和更长随访时间的研究，以明确回答问题并指导未来的研究。
