Division of Abdominal Transplantation, Department of Surgery, Stanford University, Stanford, CA.
Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
Transplantation. 2024 Jul 1;108(7):1509-1523. doi: 10.1097/TP.0000000000004838. Epub 2023 Nov 13.
Aging of the world population significantly impacts healthcare globally and specifically, the field of transplantation. Together with end-organ dysfunction and prolonged immunosuppression, age increases the frequency of comorbid chronic diseases in transplant candidates and recipients, contributing to inferior outcomes. Although the frequency of death increases with age, limited use of organs from older deceased donors reflects the concerns about organ durability and inadequate function. Cellular senescence (CS) is a hallmark of aging, which occurs in response to a myriad of cellular stressors, leading to activation of signaling cascades that stably arrest cell cycle progression to prevent tumorigenesis. In aging and chronic conditions, senescent cells accumulate as the immune system's ability to clear them wanes, which is causally implicated in the progression of chronic diseases, immune dysfunction, organ damage, decreased regenerative capacity, and aging itself. The intimate interplay between senescent cells, their proinflammatory secretome, and immune cells results in a positive feedback loop, propagating chronic sterile inflammation and the spread of CS. Hence, senescent cells in organs from older donors trigger the recipient's alloimmune response, resulting in the increased risk of graft loss. Eliminating senescent cells or attenuating their inflammatory phenotype is a novel, potential therapeutic target to improve transplant outcomes and expand utilization of organs from older donors. This review focuses on the current knowledge about the impact of CS on circulating immune cells in the context of organ damage and disease progression, discusses the impact of CS on abdominal solid organs that are commonly transplanted, and reviews emerging therapies that target CS.
全球人口老龄化对全球医疗保健产生重大影响,特别是在移植领域。随着终末器官功能障碍和长期免疫抑制,年龄增加了移植候选人和受者合并慢性疾病的频率,导致预后较差。尽管随着年龄的增长,死亡频率增加,但老年已故供者器官的使用受限反映了对器官耐久性和功能不足的担忧。细胞衰老(CS)是衰老的标志,它是对多种细胞应激的反应,导致信号级联的激活,从而稳定地阻止细胞周期进程以防止肿瘤发生。在衰老和慢性疾病中,衰老细胞的积累随着免疫系统清除它们的能力下降而增加,这与慢性疾病的进展、免疫功能障碍、器官损伤、再生能力下降和衰老本身有关。衰老细胞及其促炎分泌组与免疫细胞之间的密切相互作用导致正反馈循环,促进慢性无菌炎症和 CS 的传播。因此,老年供者器官中的衰老细胞触发受者的同种免疫反应,导致移植物丢失的风险增加。消除衰老细胞或减弱其炎症表型是改善移植结果和扩大老年供者器官使用的新的潜在治疗靶点。这篇综述重点介绍了 CS 对器官损伤和疾病进展背景下循环免疫细胞的影响的最新知识,讨论了 CS 对常见移植的腹部实体器官的影响,并回顾了靶向 CS 的新兴治疗方法。