The current state of tolerance induction in vascularized composite allotransplantation.

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-12-01 Epub Date: 2024-09-20 DOI:10.1097/MOT.0000000000001176
Caitlin M Blades, Christene A Huang, David W Mathes
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Abstract

Purpose of review: Significant advancements have been made in the field of vascularized composite allotransplantation (VCA); however, like solid organ transplantation, bypassing the recipient's immune response remains a significant obstacle to long-term allograft survival. Therefore, strategies to overcome acute and chronic rejection and minimize immunosuppressive therapy are crucial for the future of VCA. This review highlights recent attempts to induce tolerance in VCA and discusses key findings through a clinical lens.

Recent findings: Promising VCA tolerance protocols are being investigated, with five recent studies illustrating various successes. These preclinical approaches demonstrate a correlation between the presence of donor-derived T cells and VCA tolerance, the importance of using clinically available reagents within preclinical protocols, and the ability to induce sustained tolerance through nonmyeloablative methods. Furthermore, environmental factors, such as NB-UVB light are being investigated for their immunomodulation properties and may influence VCA graft rejection.

Summary: To widen the scope of VCA, minimization of immunosuppression is needed. Overall, tolerance induction protocols should have a low-toxicity level, minimally invasive induction therapies, and utilize short-term immunosuppressive medications. By examining the milestones of recent studies, researchers can gain new technical approaches to immune modulation and make data-driven amendments to tolerance protocols in preparation for clinical translation.

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血管化复合异体移植的耐受诱导现状。
综述目的:血管化复合异体移植(VCA)领域取得了重大进展;然而,与实体器官移植一样,绕过受体的免疫反应仍然是异体移植长期存活的重大障碍。因此,克服急性和慢性排斥反应并尽量减少免疫抑制治疗的策略对 VCA 的未来至关重要。本综述重点介绍了最近在诱导 VCA 耐受方面所做的尝试,并从临床角度讨论了主要发现:目前正在研究前景看好的 VCA 耐受方案,最近的五项研究表明取得了各种成功。这些临床前方法证明了供体源性 T 细胞的存在与 VCA 耐受之间的相关性、在临床前方案中使用临床可用试剂的重要性,以及通过非髓鞘消融方法诱导持续耐受的能力。此外,目前正在研究环境因素(如 NB-UVB 光)的免疫调节特性,这些因素可能会影响 VCA 移植排斥反应。总体而言,耐受诱导方案应具有低毒性、微创诱导疗法和使用短期免疫抑制药物。通过研究近期研究的里程碑,研究人员可以获得新的免疫调节技术方法,并根据数据对耐受方案进行修正,为临床转化做好准备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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