Nassar Anthony, Cashman Katharine, Rao Shreya, Dagher Maribel, O'Brien Connor, Afif John, Cravedi Paolo, Azzi Jamil R
Transplantation Research Center, Renal Division, Brigham and Women's Hospital, Boston, MA, United States.
Division of Nephrology, Department of Medicine, Translational Transplant Research Center, Immunology Institute, Icahn School of Medicine at Mount Sinai, New York, NY, United States.
Front Transplant. 2023 Jun 8;2:1148725. doi: 10.3389/frtra.2023.1148725. eCollection 2023.
The current tools for diagnosing and monitoring native kidney diseases as well as allograft rejection in transplant patients are suboptimal. Creatinine and proteinuria are non-specific and poorly sensitive markers of injury. Tissue biopsies are invasive and carry potential complications. In this article, we overview the different techniques of liquid biopsy and discuss their potential to improve patients' kidney health. Several diagnostic, predictive, and prognostic biomarkers have been identified with the ability to detect and monitor the activity of native kidney diseases as well as early and chronic allograft rejection, such as donor-derived cell-free DNA, exosomes, messenger RNA/microsomal RNA, proteomics, and so on. While the results are encouraging, additional research is still needed as no biomarker appears to be perfect for a routine application in clinical practice. Despite promising advancements in biomarkers, the most important issue is the lack of standardized pre-analytical criteria. Large validation studies and uniformed standard operating procedures are required to move the findings from bench to bedside. Establishing consortia such as the Liquid Biopsy Consortium for Kidney Diseases can help expedite the research process, allow large studies to establish standardized procedures, and improve the management and outcomes of kidney diseases and of kidney transplant recipients.
目前用于诊断和监测移植患者的自身肾脏疾病以及同种异体移植排斥反应的工具并不理想。肌酐和蛋白尿是损伤的非特异性且敏感性较差的标志物。组织活检具有侵入性且存在潜在并发症。在本文中，我们概述了液体活检的不同技术，并讨论了它们改善患者肾脏健康的潜力。已经鉴定出几种诊断、预测和预后生物标志物，它们能够检测和监测自身肾脏疾病的活动以及早期和慢性同种异体移植排斥反应，例如供体来源的游离DNA、外泌体、信使RNA/微小RNA、蛋白质组学等。虽然结果令人鼓舞，但仍需要更多研究，因为似乎没有一种生物标志物在临床实践中的常规应用中是完美的。尽管生物标志物取得了有前景的进展，但最重要的问题是缺乏标准化的分析前标准。需要进行大型验证研究和统一的标准操作程序，以便将研究结果从实验室应用到临床。建立诸如肾脏疾病液体活检联盟这样的联合体有助于加快研究进程，使大型研究能够建立标准化程序，并改善肾脏疾病和肾移植受者患者的管理及治疗效果。
