Russell P S, Colvin R B, Cosimi A B
Annu Rev Med. 1984;35:63-81. doi: 10.1146/annurev.me.35.020184.000431.
Extensive experience with antibodies to lymphocytes for immunosuppression suggested the need for better means of evaluating alterations of peripheral blood lymphocytes during treatment. Improved immunosuppression was also anticipated if more precise control of selected lymphocyte populations could be achieved. The advent of monoclonal antibodies has permitted progress in both of these areas. For evaluation of the immune status of patients, the ratio between the numbers of the subclass of T lymphocytes having helper/inducer properties and those having suppressor/cytotoxic activity (OKT4+/OKT8+ cells) has been explored. Transplant rejection is more common in the presence of normal cell ratios than when ratios are reversed. In the former situation, however, when rejection occurs it is much more readily reversed than in the latter. Monoclonal antibodies have been used to treat transplant rejection in both nonhuman primates and in patients. Patient trials have so far been confined to the use of the pan-T-cell antibody OKT3. This has proved to be the most effective agent available for the reversal of acute cellular rejection in human kidney transplants. The problems of recurrent rejection activity after treatment and of antibody formation to the monoclonal antibody itself are being examined.
在使用淋巴细胞抗体进行免疫抑制方面的广泛经验表明，需要有更好的方法来评估治疗期间外周血淋巴细胞的变化。如果能够对选定的淋巴细胞群体进行更精确的控制，预计免疫抑制效果也会得到改善。单克隆抗体的出现使得在这两个领域都取得了进展。为了评估患者的免疫状态，人们研究了具有辅助/诱导特性的T淋巴细胞亚类数量与具有抑制/细胞毒性活性的T淋巴细胞亚类数量之比（OKT4+/OKT8+细胞）。在细胞比例正常的情况下，移植排斥比比例相反时更为常见。然而，在前一种情况下，当发生排斥时，比在后一种情况下更容易逆转。单克隆抗体已被用于治疗非人类灵长类动物和患者的移植排斥反应。到目前为止，患者试验仅限于使用全T细胞抗体OKT3。事实证明，这是用于逆转人类肾移植急性细胞排斥反应的最有效药物。目前正在研究治疗后排斥反应复发的问题以及针对单克隆抗体本身产生抗体的问题。
