Chi Mingxuan, Tian Zijun, Ma Kuai, Li Yunlong, Wang Li, Nasser Moussa Ide, Liu Chi
Department of Nephrology, Sichuan Academy of Medical Science and Sichuan Provincial People's Hospital, Sichuan Renal Disease Clinical Research Center, University of Electronic Science and Technology of China, Chengdu, China.
Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.
Immun Ageing. 2022 Nov 16;19(1):58. doi: 10.1186/s12979-022-00313-9.
Immunosenescence is the deterioration of the innate and adaptive immune systems associated with aging and is primarily characterized by a reduction in T cell production and accumulation of atypical subsets. Age-related immunological dysfunction leads to impaired immune protection and persistent low-grade chronic inflammation, resulting in a decreased vaccination response and increased vulnerability to infection, cancer, cardiovascular disease, and autoimmune disease in the elderly. As the elderly constitute a growing proportion of the population with renal disease, immunosenescence is a normal aging process that is prevalent among older people. In addition, immunosenescence seems to be more pronounced in patients with kidney diseases than in healthy controls, as shown by severe chronic inflammation, accumulation of immune cells with the senescent phenotype (CD28 T cells, CD14CD16 monocytes), and proinflammatory cytokine production. Immunosenescence inhibits immunological clearance and renal tissue regeneration, thereby increasing the risk of permanent renal damage, infection, and cardiovascular events in patients with kidney disease, lowering the prognosis, and even influencing the efficacy of renal replacement treatment. Biological drugs (senomorphics and senolytics) target the aging immune system and exert renoprotective effects. This review aims to emphasize the features of immunosenescence and its influence on kidney diseases and immunotherapy, highlighting the future directions of kidney disease treatment using senescence-focused techniques.
免疫衰老指的是与衰老相关的先天性和适应性免疫系统的衰退，其主要特征是T细胞生成减少以及非典型亚群的积累。与年龄相关的免疫功能障碍会导致免疫保护受损和持续性低度慢性炎症，进而使老年人的疫苗接种反应降低，对感染、癌症、心血管疾病和自身免疫性疾病的易感性增加。随着老年人在肾病患者群体中所占比例不断上升，免疫衰老是一种在老年人中普遍存在的正常衰老过程。此外，如严重的慢性炎症、具有衰老表型的免疫细胞（CD28 T细胞、CD14CD16单核细胞）的积累以及促炎细胞因子的产生所示，免疫衰老在肾病患者中似乎比在健康对照者中更为明显。免疫衰老会抑制免疫清除和肾组织再生，从而增加肾病患者永久性肾损伤、感染和心血管事件的风险，降低预后，甚至影响肾脏替代治疗的疗效。生物药物（衰老调节剂和衰老溶解剂）针对衰老的免疫系统发挥肾脏保护作用。本综述旨在强调免疫衰老的特征及其对肾病和免疫治疗的影响，突出以衰老为重点的技术在肾病治疗中的未来方向。
