Knoedler Leonard, Dean Jillian, Diatta Fortunay, Thompson Noelle, Knoedler Samuel, Rhys Richmond, Sherwani Khalil, Ettl Tobias, Mayer Simon, Falkner Florian, Kilian Katja, Panayi Adriana C, Iske Jasper, Safi Ali-Farid, Tullius Stefan G, Haykal Siba, Pomahac Bohdan, Kauke-Navarro Martin
Department of Plastic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany.
Division of Plastic Surgery, Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, United States.
Front Immunol. 2024 Apr 8;15:1372862. doi: 10.3389/fimmu.2024.1372862. eCollection 2024.
Balancing the immune response after solid organ transplantation (SOT) and vascularized composite allotransplantation (VCA) remains an ongoing clinical challenge. While immunosuppressants can effectively reduce acute rejection rates following transplant surgery, some patients still experience recurrent acute rejection episodes, which in turn may progress to chronic rejection. Furthermore, these immunosuppressive regimens are associated with an increased risk of malignancies and metabolic disorders. Despite significant advancements in the field, these IS related side effects persist as clinical hurdles, emphasizing the need for innovative therapeutic strategies to improve transplant survival and longevity. Cellular therapy, a novel therapeutic approach, has emerged as a potential pathway to promote immune tolerance while minimizing systemic side-effects of standard IS regiments. Various cell types, including chimeric antigen receptor T cells (CAR-T), mesenchymal stromal cells (MSCs), regulatory myeloid cells (RMCs) and regulatory T cells (T), offer unique immunomodulatory properties that may help achieve improved outcomes in transplant patients. This review aims to elucidate the role of cellular therapies, particularly MSCs, T cells, T, RMCs, macrophages, and dendritic cells in SOT and VCA. We explore the immunological features of each cell type, their capacity for immune regulation, and the prospective advantages and obstacles linked to their application in transplant patients. An in-depth outline of the current state of the technology may help SOT and VCA providers refine their perioperative treatment strategies while laying the foundation for further trials that investigate cellular therapeutics in transplantation surgery.
平衡实体器官移植（SOT）和血管化复合组织异体移植（VCA）后的免疫反应仍然是一个持续存在的临床挑战。虽然免疫抑制剂可以有效降低移植手术后的急性排斥反应率，但一些患者仍会经历反复的急性排斥反应发作，进而可能发展为慢性排斥反应。此外，这些免疫抑制方案与恶性肿瘤和代谢紊乱风险增加有关。尽管该领域取得了重大进展，但这些与免疫抑制相关的副作用仍然是临床障碍，这突出了需要创新治疗策略来提高移植存活率和寿命。细胞疗法作为一种新型治疗方法，已成为促进免疫耐受同时最小化标准免疫抑制方案全身副作用的潜在途径。包括嵌合抗原受体T细胞（CAR-T）、间充质基质细胞（MSCs）、调节性髓样细胞（RMCs）和调节性T细胞（Tregs）在内的各种细胞类型具有独特的免疫调节特性，可能有助于改善移植患者的预后。本综述旨在阐明细胞疗法，特别是MSCs、Tregs、RMCs、巨噬细胞和树突状细胞在SOT和VCA中的作用。我们探讨了每种细胞类型的免疫学特征、它们的免疫调节能力以及与它们在移植患者中应用相关的潜在优势和障碍。对该技术当前状态的深入概述可能有助于SOT和VCA提供者完善其围手术期治疗策略，同时为进一步研究移植手术中细胞疗法的试验奠定基础。
