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基于生物标志物的心脏移植前后感染风险评估。

Biomarker-Based Assessment for Infectious Risk Before and After Heart Transplantation.

机构信息

Parkland Memorial Hospital, Dallas, TX, USA.

Division of Cardiology, University of Texas Southwestern Medical Center, 5959 Harry Hines Jr. Blvd, Dallas, TX, 75235, USA.

出版信息

Curr Heart Fail Rep. 2022 Aug;19(4):236-246. doi: 10.1007/s11897-022-00556-z. Epub 2022 May 21.

DOI:10.1007/s11897-022-00556-z
PMID:35597863
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9124010/
Abstract

PURPOSE OF REVIEW

Survival outcomes for heart transplant recipients have improved in recent decades, but infection remains a significant cause of morbidity and mortality. In this review, we discuss several biological markers, or biomarkers, that may be used to monitor immunologic status in this patient population.

RECENT FINDINGS

While modest, data on the utility of immune biomarkers in heart transplant recipients suggest correlation between low level of immune response and increased infection risk. More novel assays, such as the detection of circulating levels of pathogen cell-free DNA in plasma and the use of Torque teno virus load as a surrogate for net state of immunosuppression, have potential to be additional important biomarkers. Biomarker approaches to individualize immunosuppression therapy among heart transplant recipients is a promising area of medicine. However, additional studies are needed to inform the optimal protocol in which to incorporate these biomarkers into clinical practice.

摘要

目的综述

近几十年来，心脏移植受者的生存率有所提高，但感染仍是发病率和死亡率的重要原因。在这篇综述中，我们讨论了一些可能用于监测该患者人群免疫状态的生物标志物。

最近的发现

虽然数据有限，但免疫生物标志物在心脏移植受者中的应用数据表明，免疫反应水平低与感染风险增加之间存在相关性。更新型的检测方法，如检测血浆中循环病原体无细胞 DNA 的水平以及使用扭结瘤病毒载量作为免疫抑制状态的替代指标，有可能成为其他重要的生物标志物。采用生物标志物方法对心脏移植受者进行个体化免疫抑制治疗是一个很有前途的医学领域。然而，需要进一步的研究来确定将这些生物标志物纳入临床实践的最佳方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/04b9b4437b0c/11897_2022_556_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/2994945b24eb/11897_2022_556_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/3027dc10c780/11897_2022_556_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/cde95ef6777e/11897_2022_556_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/04b9b4437b0c/11897_2022_556_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/2994945b24eb/11897_2022_556_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/3027dc10c780/11897_2022_556_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/cde95ef6777e/11897_2022_556_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cc6/9124010/04b9b4437b0c/11897_2022_556_Fig4_HTML.jpg

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本文引用的文献

1
The International Thoracic Organ Transplant Registry of the International Society for Heart and Lung Transplantation: Twenty-fourth pediatric lung transplantation report - 2021; Focus on recipient characteristics.国际心肺移植学会国际胸科器官移植登记处：2021年第24份小儿肺移植报告；关注受者特征。
J Heart Lung Transplant. 2021 Oct;40(10):1023-1034. doi: 10.1016/j.healun.2021.07.018. Epub 2021 Jul 29.
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Eculizumab for antibody-mediated rejection in heart transplantation: A case-control study.依库珠单抗治疗心脏移植后抗体介导的排斥反应：一项病例对照研究。
Clin Transplant. 2021 Dec;35(12):e14454. doi: 10.1111/ctr.14454. Epub 2021 Sep 23.
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J Clin Microbiol. 2023 Aug 23;61(8):e0185522. doi: 10.1128/jcm.01855-22. Epub 2023 Jul 13.
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Extracellular Vesicles: The Future of Diagnosis in Solid Organ Transplantation?细胞外囊泡：实体器官移植诊断的未来？
Int J Mol Sci. 2023 Mar 7;24(6):5102. doi: 10.3390/ijms24065102.
Torque teno virus loads after kidney transplantation predict allograft rejection but not viral infection.
肾移植后 Torque teno 病毒载量可预测移植物排斥反应，但不能预测病毒感染。
J Clin Virol. 2021 Jul;140:104871. doi: 10.1016/j.jcv.2021.104871. Epub 2021 May 25.
4
OPTN/SRTR 2019 Annual Data Report: Heart.OPTN/SRTR 2019 年度数据报告：心脏
Am J Transplant. 2021 Feb;21 Suppl 2:356-440. doi: 10.1111/ajt.16492.
5
Torque Teno Virus Load Is Associated With Subclinical Alloreactivity in Kidney Transplant Recipients: A Prospective Observational Trial.Torque Teno 病毒载量与肾移植受者亚临床同种异体反应相关：一项前瞻性观察性试验。
Transplantation. 2021 Sep 1;105(9):2112-2118. doi: 10.1097/TP.0000000000003619.
6
Viral load-guided immunosuppression after lung transplantation (VIGILung)-study protocol for a randomized controlled trial.肺移植术后病毒载量引导的免疫抑制（VIGILung）——一项随机对照试验的研究方案
Trials. 2021 Jan 11;22(1):48. doi: 10.1186/s13063-020-04985-w.
7
Budget Impact of Microbial Cell-Free DNA Testing Using the Karius Test as an Alternative to Invasive Procedures in Immunocompromised Patients with Suspected Invasive Fungal Infections.微生物无细胞 DNA 检测（Karius 检测）用于疑似侵袭性真菌感染的免疫功能低下患者替代有创性检查的预算影响。
Appl Health Econ Health Policy. 2021 Mar;19(2):231-241. doi: 10.1007/s40258-020-00611-7. Epub 2020 Sep 17.
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Am J Transplant. 2020 Aug;20(8):2081-2090. doi: 10.1111/ajt.15810. Epub 2020 Mar 8.
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Monitoring cell-mediated immunity during immunosuppression reduction in heart transplant recipients with severe systemic infections.监测严重全身感染的心脏移植受者免疫抑制减少期间的细胞介导免疫。
Clin Transplant. 2020 Mar;34(3):e13809. doi: 10.1111/ctr.13809. Epub 2020 Feb 20.