Free-Circulating Nucleic Acids as Biomarkers in Patients After Solid Organ Transplantation.

IF 1.1 4区 医学 Q3 SURGERY Annals of Transplantation Pub Date : 2023-08-15 DOI:10.12659/AOT.939750
Joanna Raszeja-Wyszomirska, Michał Macech, Monika Kolanowska, Marek Krawczyk, Sławomir Nazarewski, Anna Wójcicka, Jolanta Małyszko
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Abstract

A number types of extracellular DNA (eg, cell-free, cfDNA) circulate in human blood, including mitochondrial, transcriptome, and regulatory DNA, usually at low concentrations. Larger amounts of cfDNA appear in any inflammatory condition, including organ damage due to a variety of reasons. The role of cfDNA in solid organ transplantation is discussed in this review as a valuable additional tool in the standard of care of transplant patients. Post-transplant monitoring requires the use of high-quality biomarkers for early detection of graft damage or rejection to be able to apply early therapeutic intervention. CfDNA complements the traditional monitoring strategies, being a risk stratification tool and an important prognostic marker. However, improving the sensitivity and specificity of cfDNA detection is necessary to facilitate personalized patient management, warranting further research in terms of measurement, test standardization, and storage, processing, and shipping. A diagnostic test (Allosure, CareDx, Inc., Brisbane, CA) for kidney, heart and lung transplant patients is now commercially available, and validation for other organs (eg, liver) is pending. To date, donor-derived cfDNA in combination with other biomarkers appears to be a promising tool in graft rejection as it is minimally invasive, time-sensitive, and cost-effective. However, improvement of sensitivity and specificity is required to facilitate personalized patient management. Whether it could be an alternate to graft biopsy remains unclear.

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游离循环核酸作为实体器官移植后患者的生物标志物。
许多类型的细胞外DNA(如游离细胞DNA、cfDNA)在人体血液中循环,包括线粒体、转录组和调控DNA,通常浓度较低。大量的cfDNA出现在任何炎症情况下,包括由于各种原因造成的器官损伤。本综述讨论了cfDNA在实体器官移植中的作用,作为移植患者标准护理中有价值的附加工具。移植后监测需要使用高质量的生物标志物来早期检测移植物损伤或排斥反应,以便能够进行早期治疗干预。CfDNA是对传统监测策略的补充,是一种风险分层工具和重要的预后标志物。然而,提高cfDNA检测的灵敏度和特异性对于促进患者的个性化管理是必要的,需要在测量、测试标准化以及储存、处理和运输方面进行进一步的研究。一种用于肾脏、心脏和肺移植患者的诊断测试(Allosure, CareDx, Inc., Brisbane, CA)现已上市,用于其他器官(如肝脏)的验证尚待验证。迄今为止,供体衍生的cfDNA与其他生物标志物联合使用似乎是治疗移植物排斥反应的一种很有前途的工具,因为它具有微创性、时间敏感性和成本效益。然而,需要提高敏感性和特异性,以促进患者的个性化管理。是否可以作为移植物活检的替代方法尚不清楚。
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来源期刊
CiteScore
2.50
自引率
0.00%
发文量
79
审稿时长
>12 weeks
期刊介绍: Annals of Transplantation is one of the fast-developing journals open to all scientists and fields of transplant medicine and related research. The journal is published quarterly and provides extensive coverage of the most important advances in transplantation. Using an electronic on-line submission and peer review tracking system, Annals of Transplantation is committed to rapid review and publication. The average time to first decision is around 3-4 weeks. Time to publication of accepted manuscripts continues to be shortened, with the Editorial team committed to a goal of 3 months from acceptance to publication. Expert reseachers and clinicians from around the world contribute original Articles, Review Papers, Case Reports and Special Reports in every pertinent specialty, providing a lot of arguments for discussion of exciting developments and controversies in the field.
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