Department of Surgery.
Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, USA.
Curr Opin Organ Transplant. 2021 Dec 1;26(6):609-614. doi: 10.1097/MOT.0000000000000923.
Transplantation continues to be the only treatment option for end-stage organ failure when other interventions have failed. Although short-term outcomes have improved due to advances in perioperative care, long-term outcomes continue to be adversely affected by chronic rejection. Little is known about the role microbiota play in modulating alloimmune responses and potentially contributing to graft failure. Initial data have identified a correlation between specific changes of the recipient and/or donor microbiota and transplant outcomes. In this review, we will focus on recent findings concerning the complex interplay between microbiota and the innate immune system after heart and lung transplantation.
Gut microbiome derangements in heart failure promote an inflammatory state and have lasting effects on the innate immune system, with an observed association between increased levels of microbiota-dependent metabolites and acute rejection after cardiac transplantation. The lung allograft microbiome interacts with components of the innate immune system, such as toll-like receptor signalling pathways, NKG2C+ natural killer cells and the NLRP3 inflammasome, to alter posttransplant outcomes, which may result in the development of chronic rejection.
The innate immune system is influenced by alterations in the microbiome before and after heart and lung transplantation, thereby offering potential therapeutic targets for prolonging allograft survival.
当其他干预措施失败时，移植仍然是治疗终末期器官衰竭的唯一选择。尽管由于围手术期护理的进步，短期结果得到了改善，但长期结果仍受到慢性排斥的不利影响。关于微生物组在调节同种免疫反应并可能导致移植物衰竭方面的作用知之甚少。初步数据已经确定了受者和/或供者微生物组的特定变化与移植结果之间的相关性。在这篇综述中，我们将重点介绍最近关于心脏和肺移植后微生物组与先天免疫系统之间复杂相互作用的发现。
心力衰竭中肠道微生物组的紊乱会促进炎症状态，并对先天免疫系统产生持久影响，在心脏移植后观察到与依赖微生物的代谢物水平升高相关的急性排斥反应之间存在关联。肺同种异体移植物微生物组与先天免疫系统的成分相互作用，例如 Toll 样受体信号通路、NKG2C+自然杀伤细胞和 NLRP3 炎性体，从而改变移植后的结果，这可能导致慢性排斥反应的发展。
先天免疫系统受到心脏和肺移植前后微生物组变化的影响，从而为延长移植物存活提供了潜在的治疗靶点。
