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Gain-of-function and origin of Covid19 Covid19的功能获得和起源
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-03-01 DOI: 10.1016/j.lpm.2023.104167
Patrick Berche

In nature, wild viruses adapted for transmission circulate in many animal species (bats, birds, primates…). Contamination of other animals, including humans, may occur by crossing of the species barrier. Genetic manipulations have been carried out on wild viruses to favor the species jumping and to increase of viral virulence. The aim was to identify the critical genes for pathogenicity. This has been mainly performed on potentially epidemic pathogens, as Myxovirus influenzae of avian flu and coronaviruses of SARS and MERS epidemics. These dangerous experiments were subject to a moratorium in the United States (2014–2017). Three years after the emergence of Covid-19, the origin of du SARS-CoV2 remains a mystery. Covid19 appeared in Wuhan, officially in December 2019, but probably during the autumn 2019. The virus was identified in January 2020. It belongs to the genus Betacoronavirus (subgenus Sarbecovirus). It was at once highly contagious. In addition, the primary isolates were genetically very homogeneous, differing only by two nucleotides without evidence for adaptive mutations. In addition, the Spike protein, a major virulence factor, has a furin site, not found in any other known sarbecovirus. Unlike the SARS and MERS epidemics, no intermediate host has been detected so far. Finally, no other outbreaks were reported at the beginning of the pandemic outside of Wuhan, contrary to what happened with the emergence of SARS (2002) and H7N9 avian influenza (2013). Today, there are two scenarios to explain the emergence of SARS-CoV2. Proponents of the natural origin argue that the bat virus might have directly infected humans, spreading silently at a low level in humans for years, without eliminating the existence of undetected intermediate hosts. This does not explain the origin in Wuhan, far away from the natural virus reservoirs. The furin site would have arisen spontaneously from other coronaviruses. The alternative scenario is that of a laboratory accident after gain-of-function manipulations from a SARS-like virus, or even the occurrence of a human contamination by a natural CoV virus grown on cells in Wuhan.

This article is an update to the Quarterly Medical Review (QMR) devoted to the history of modern pandemics. To access this QMR contents, please go here: https://www.sciencedirect.com/journal/la-presse-medicale/vol/51/issue/3

在自然界中,适应传播的野生病毒在许多动物物种(蝙蝠、鸟类、灵长类动物…)中传播。跨越物种屏障可能会对包括人类在内的其他动物造成污染。已经对野生病毒进行了基因操作,以利于物种跳跃并增加病毒毒力。目的是鉴定致病性的关键基因。这主要针对潜在的流行病病原体,如禽流感的粘液病毒流感嗜血杆菌以及SARS和MERS流行病的冠状病毒。这些危险的实验在美国被暂停(2014-2017)。新冠肺炎出现三年后,du SARS-CoV2的起源仍然是个谜。2019冠状病毒病于2019年12月在武汉正式出现,但可能在2019年秋季。该病毒于2020年1月被发现。它属于Betacoronavirus属(Sarbecovirus亚属)。它的传染性很强。此外,原代分离株在基因上非常同源,仅相差两个核苷酸,没有适应性突变的证据。此外,刺突蛋白是一种主要的毒力因子,它有一个弗林蛋白位点,在任何其他已知的沙贝病毒中都没有发现。与SARS和MERS疫情不同,到目前为止还没有发现中间宿主。最后,与SARS(2002年)和H7N9禽流感(2013年)的出现相反,在疫情开始时,武汉以外没有其他疫情报告。今天,有两种情况可以解释严重急性呼吸系统综合征冠状病毒2型的出现。自然起源的支持者认为,蝙蝠病毒可能直接感染了人类,多年来在人类中以低水平无声传播,而没有消除未被发现的中间宿主的存在。这并不能解释起源于远离天然病毒库的武汉。弗林位点可能是由其他冠状病毒自发产生的。另一种情况是,在SARS样病毒获得功能操作后发生实验室事故,甚至是武汉细胞上生长的天然冠状病毒污染人类。本文是《季度医学评论》(QMR)的更新,专门报道现代流行病的历史。要访问此QMR内容,请访问此处:https://www.sciencedirect.com/journal/la-presse-medicale/vol/51/issue/3
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引用次数: 0
Clinical pharmacology of antidiabetic drugs: What can be expected of their use? 抗糖尿病药物的临床药理学:它们的使用有什么预期?
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-03-01 DOI: 10.1016/j.lpm.2022.104158
André J. Scheen

The pharmacotherapy of type 2 diabetes mellitus (T2DM) has markedly evolved in the last two decades. Classical antidiabetic agents (sulphonylureas, metformin, insulin) are now in competition with new glucose-lowering medications. Alpha-glucosidase inhibitors and thiazolidinediones (glitazones) were not able to replace older agents, because of insufficient efficacy and/or poor tolerability/safety. In contrast, incretin-based therapies, both dipeptidyl peptidase-4 inhibitors (DPP-4is or gliptins, oral agents) and glucagon-like peptide-1 receptor agonists (GLP-1RAs, subcutaneous injections) are a major breakthrough in the management of T2DM. Because they are not associated with hypoglycaemia and weight gain, DPP-4is tend to replace sulphonylureas as add-on to metformin while GLP-1RAs tend to replace basal insulin therapy after failure of oral therapies. Furthermore, placebo-controlled cardiovascular outcome trials demonstrated neutrality for DPP-4is, but cardiovascular protection for GLP-1RAs in patients with T2DM at high cardiovascular risk. More recently sodium-glucose cotransporter 2 inhibitors (SGLT2is or gliflozins, oral agents) also showed cardiovascular protection, especially a reduction in hospitalization for heart failure, as well as a renal protection in patients with and without T2DM, at high cardiovascular risk, with established heart failure and/or with chronic kidney disease. Thus, GLP-1RAs and SGLT2is are now considered as preferred drugs in T2DM patients with or at high risk of atherosclerotic cardiovascular disease whereas SGLT2is are more specifically recommended in patients with or at risk of heart failure and renal (albuminuric) disease. The management of T2DM is moving from a glucocentric approach to a broader strategy focusing on all risk factors, including overweight/obesity, and to an organ-disease targeted personalized approach.

2型糖尿病(T2DM)的药物治疗在过去二十年中有了显著的发展。经典的抗糖尿病药物(磺脲类、二甲双胍、胰岛素)现在正在与新的降糖药物竞争。由于疗效不足和/或耐受性/安全性差,α-葡萄糖苷酶抑制剂和噻唑烷二酮(格列达松)无法取代较老的药物。相比之下,基于肠促胰岛素的治疗,二肽基肽酶-4抑制剂(DPP-4is或格列汀,口服制剂)和胰高血糖素样肽-1受体激动剂(GLP-1RA,皮下注射)是T2DM治疗的重大突破。由于DPP-4is与低血糖和体重增加无关,DPP-4i倾向于取代磺脲类药物作为二甲双胍的补充药物,而GLP-1RA倾向于在口服治疗失败后取代基础胰岛素治疗。此外,安慰剂对照心血管结果试验证明DPP-4is是中性的,但GLP-1RA对心血管风险高的T2DM患者的心血管保护作用。最近,钠-葡萄糖协同转运蛋白2抑制剂(SGLT2is或gliflozins,口服制剂)也显示出心血管保护作用,特别是减少了心力衰竭的住院治疗,以及对患有和不患有T2DM、心血管风险高、已确诊心力衰竭和/或慢性肾病的患者的肾脏保护作用。因此,GLP-1RA和SGLT2is现在被认为是患有动脉粥样硬化性心血管疾病或有动脉粥样硬化性心血管病高风险的T2DM患者的首选药物,而SGLT2is更特别地被推荐用于患有心力衰竭和肾脏(白蛋白尿)疾病或有其风险的患者。T2DM的管理正在从以血糖为中心的方法转向更广泛的策略,重点关注所有风险因素,包括超重/肥胖,并转向以器官疾病为目标的个性化方法。
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引用次数: 6
Renal hemodynamic changes in patients with type 2 diabetes and their clinical impact 2型糖尿病患者肾脏血液动力学变化及其临床影响。
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2023-03-01 DOI: 10.1016/j.lpm.2023.104175
Pierre-Jean Saulnier , Petter Bjornstad

The dysfunction of the internal mechanics within the kidney's filtering units, known as glomeruli, has been linked to the emergence and progression of diabetic kidney disease (DKD). To better understand this crucial aspect of kidney function and the pathology of DKD, a variety of methods are employed in research, from the introduction of external compounds, such as inulin, iohexol, iothalamate and p-aminohippurate, to cutting-edge imaging techniques and computational analysis.

Given the significance of intraglomerular hemodynamic dysfunction in the pathogenesis and treatment of DKD, it is essential to thoroughly examine the available data on this topic. Accordingly, the aim of this review is to provide a comprehensive appraisal of the role of intraglomerular hemodynamic dysfunction in the development of DKD and the effects of current therapies used to mitigate DKD. Through this analysis, we can gain a deeper understanding of the complex pathogenesis of DKD and potentially discover new avenues for tailored therapeutic management of patients with DKD.

肾脏过滤单元(即肾小球)内部机制的功能障碍与糖尿病肾病(DKD)的出现和进展有关。为了更好地了解肾功能的这一关键方面和DKD的病理学,在研究中采用了多种方法,从引入菊粉、碘海醇、iothalamate和对氨基hippurate等外部化合物,到尖端的成像技术和计算分析。鉴于肾小球内血液动力学功能障碍在DKD的发病机制和治疗中的重要性,有必要彻底检查有关该主题的可用数据。因此,本综述的目的是对肾小球内血液动力学功能障碍在DKD发展中的作用以及目前用于缓解DKD的治疗效果进行全面评估。通过这一分析,我们可以更深入地了解DKD的复杂发病机制,并有可能发现针对性治疗DKD患者的新途径。
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引用次数: 1
Unraveling complexity of antibody-mediated rejections, the mandatory way towards an accurate diagnosis and a personalized treatment 揭示抗体介导的排斥反应的复杂性,是准确诊断和个性化治疗的必由之路
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104141
Philippe Gatault, Matthias Büchler

Antibody-mediated rejection (ABMR) remains one of the most challenging issues after organ transplantation and particularly after kidney transplantation. Despite many progresses during the last decade, ABMR is still the main cause of kidney graft loss and this all over the post- transplant period.

In this review, we describe the recent knowledge about molecular and cellular mechanisms involved in ABMR. We focused our report on the role of the complement pathway in the process of ABMR and we give some insights into the role of inflammatory cells, NK lymphocytes and the role of endothelial cells. We further describe the potential role of non-HLA antibodies, of which the importance has been increasingly emphasized in recent years.

Overall, this report could be of interest for all physicians who are working in the field of organ transplantation or who are working in the field of immunology. It gives essential information to understand new diagnosis advances and further therapeutic approaches.

Antibody-mediated rejection (ABMR) is the leading cause of graft failure ([1,2]). In contrast to T-cell mediated rejection usually sensitive to steroids, active ABMR remains a therapeutic challenge. ABMR diagnosis relies on the presence of renal injuries and donor-specific antibodies (DSA) (HLA and non HLA antibodies) with sometimes the evidence of interaction between DSA and graft endothelium. Regularly revised during expert conferences, ABMR definition is currently categorized as active or chronic active. [3] The emergence of validated molecular assays targeting a better phenotyping of ABMR and the recent advances regarding the detrimental effect of DSA directed against minor antigens open the way to a better assessment of the heterogeneity of ABMR. In this review, we will address new aspects of ABMR regarding its mechanisms, diagnosis and treatments.

抗体介导的排斥反应(ABMR)仍然是器官移植尤其是肾移植后最具挑战性的问题之一。尽管在过去十年中取得了许多进展,但ABMR仍然是肾移植损失的主要原因,并且在移植后的整个时期都是如此。在这篇综述中,我们介绍了ABMR的分子和细胞机制的最新知识。我们的报告重点关注了补体通路在ABMR过程中的作用,并对炎症细胞、NK淋巴细胞和内皮细胞的作用给出了一些见解。我们进一步描述了非hla抗体的潜在作用,其重要性近年来日益强调。总的来说,这份报告可能对所有在器官移植领域工作的医生或在免疫学领域工作的医生感兴趣。它提供了必要的信息,以了解新的诊断进展和进一步的治疗方法。抗体介导的排斥反应(ABMR)是移植失败的主要原因([1,2])。与通常对类固醇敏感的t细胞介导的排斥反应相反,活性ABMR仍然是一个治疗挑战。ABMR诊断依赖于肾损伤和供体特异性抗体(DSA) (HLA和非HLA抗体)的存在,有时DSA和移植物内皮之间存在相互作用的证据。在专家会议期间定期修订,ABMR定义目前分为活跃型和慢性活跃型。[3]针对更好的ABMR表型的有效分子检测方法的出现,以及针对次要抗原的DSA的有害影响的最新进展,为更好地评估ABMR的异质性开辟了道路。在这篇综述中,我们将探讨ABMR在其机制、诊断和治疗方面的新进展。
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引用次数: 1
What's new in transplantation? 移植有什么新进展?
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104148
Yvon Lebranchu
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引用次数: 0
From islet of Langerhans transplantation to the bioartificial pancreas 从朗格汉斯胰岛移植到生物人工胰腺
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104139
Thierry Berney , Charles H. Wassmer , Fanny Lebreton , Kevin Bellofatto , Laura Mar Fonseca , Juliette Bignard , Reine Hanna , Andrea Peloso , Ekaterine Berishvili

Type 1 diabetes is a disease resulting from autoimmune destruction of the insulin-producing beta cells in the pancreas. When type 1 diabetes develops into severe secondary complications, in particular end-stage nephropathy, or life-threatening severe hypoglycemia, the best therapeutic approach is pancreas transplantation, or more recently transplantation of the pancreatic islets of Langerhans. Islet transplantation is a cell therapy procedure, that is minimally invasive and has a low morbidity, but does not display the same rate of functional success as the more invasive pancreas transplantation because of suboptimal engraftment and survival. Another issue is that pancreas or islet transplantation (collectively known as beta cell replacement therapy) is limited by the shortage of organ donors and by the need for lifelong immunosuppression to prevent immune rejection and recurrence of autoimmunity.

A bioartificial pancreas is a construct made of functional, insulin-producing tissue, embedded in an anti-inflammatory, immunomodulatory microenvironment and encapsulated in a perm-selective membrane allowing glucose sensing and insulin release, but isolating from attacks by cells of the immune system. A successful bioartificial pancreas would address the issues of engraftment, survival and rejection. Inclusion of unlimited sources of insulin-producing cells, such as xenogeneic porcine islets or stem cell-derived beta cells would further solve the problem of organ shortage.

This article reviews the current status of clinical islet transplantation, the strategies aiming at developing a bioartificial pancreas, the clinical trials conducted in the field and the perspectives for further progress.

1型糖尿病是一种由自身免疫破坏胰腺中产生胰岛素的细胞引起的疾病。当1型糖尿病发展为严重的继发性并发症,特别是终末期肾病或危及生命的严重低血糖时,最好的治疗方法是胰腺移植,或最近的朗格汉斯胰岛移植。胰岛移植是一种细胞治疗方法,具有微创性和低发病率,但由于植入和存活欠佳,其功能成功率不如更具侵入性的胰腺移植。另一个问题是胰腺或胰岛移植(统称为β细胞替代疗法)受到器官供体短缺和需要终身免疫抑制以防止免疫排斥和自身免疫复发的限制。生物人工胰腺是一种由功能性胰岛素生成组织构成的结构,嵌入抗炎、免疫调节的微环境中,并被包裹在热选择性膜中,允许葡萄糖感知和胰岛素释放,但与免疫系统细胞的攻击隔离。一个成功的生物人工胰腺将解决移植、存活和排斥等问题。包括无限来源的胰岛素生成细胞,如异种猪胰岛或干细胞衍生的β细胞,将进一步解决器官短缺的问题。本文综述了胰岛移植的临床研究现状、发展生物人工胰腺的策略、临床研究进展及未来发展的展望。
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引用次数: 3
COVID-19 and kidney transplantation COVID-19与肾移植
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104146
Sophie Caillard , French Registry of Solid Organ Transplant Patients COVID-19

The COVID-19 pandemic affects the transplant recipients since March 2020. Transplant centers quickly organized themselves to optimize the management of the immunocompromised patients and to progress in the knowledge of this new disease. To this end, a French Registry was created, which includes all solid organ transplant patients who have developed a SARS Cov2 infection. Numerous studies have been carried out using these data to describe this new disease in transplant patients, to characterize its clinical and biological risk factors and to define its prognosis. The 60 days-mortality of transplant patients hospitalized for COVID-19 was evaluated at 23% and renal failure plays a major role in the poor prognosis in addition to the classical risk factors described in the general population. The advent of vaccination has been a great relief but transplanted patients have shown a poor vaccine response keeping them at risk of severe disease even after an adapted vaccination scheme. Specific strategies was proposed in this particularly fragile population like increasing vaccine doses or using anti SARS Cov-2 monoclonal antibodies.

自2020年3月以来,COVID-19大流行影响了移植接受者。移植中心迅速组织起来,优化免疫功能低下患者的管理,并在这种新疾病的知识方面取得进展。为此,法国建立了一个登记处,其中包括所有感染SARS冠状病毒的实体器官移植患者。利用这些数据进行了大量研究,以描述移植患者的这种新疾病,确定其临床和生物学危险因素,并确定其预后。因COVID-19住院的移植患者的60天死亡率评估为23%,除一般人群中描述的经典危险因素外,肾功能衰竭在预后不良中起主要作用。疫苗接种的出现是一种极大的缓解,但移植患者表现出较差的疫苗反应,使他们即使在经过调整的疫苗接种方案后仍有严重疾病的风险。针对这一特别脆弱的人群提出了具体的策略,如增加疫苗剂量或使用抗SARS Cov-2单克隆抗体。
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引用次数: 621
Machine learning in lung transplantation: Where are we? 机器学习在肺移植中的应用:进展如何?
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104140
Evgeni Mekov , Viktoria Ilieva

Lung transplantation has been accepted as a viable treatment for end-stage respiratory failure. While regression models continue to be a standard approach for attempting to predict patients’ outcomes after lung transplantation, more sophisticated supervised machine learning (ML) techniques are being developed and show encouraging results. Transplant clinicians could utilize ML as a decision-support tool in a variety of situations (e.g. waiting list mortality, donor selection, immunosuppression, rejection prediction). Although for some topics ML is at an advanced stage of research (i.e. imaging and pathology) there are certain topics in lung transplantation that needs to be aware of the benefits it could provide.

肺移植已被认为是治疗终末期呼吸衰竭的可行方法。虽然回归模型仍然是预测肺移植后患者预后的标准方法,但更复杂的监督机器学习(ML)技术正在开发中,并显示出令人鼓舞的结果。移植临床医生可以在各种情况下(如等待名单死亡率、供体选择、免疫抑制、排斥预测)利用ML作为决策支持工具。尽管对于某些主题,ML处于研究的高级阶段(即影像学和病理学),但在肺移植的某些主题中,需要意识到它可以提供的好处。
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引用次数: 3
New immunosuppressive agents in transplantation 移植中新的免疫抑制剂
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104142
Delphine Kervella , Gilles Blancho

Immunosuppressive agents have enabled the development of allogenic transplantation during the last 40 years, allowing considerable improvement in graft survival. However, several issues remain such as the nephrotoxicity of calcineurin inhibitors, the cornerstone of immunosuppressive regimens and/or the higher risk of opportunistic infections and cancers. Most immunosuppressive agents target T cell activation and may not be efficient enough to prevent allo-immunization in the long term. Finally, antibody mediated rejection due to donor specific antibodies strongly affects allograft survival.

Many drugs have been tested in the last decades, but very few have come to clinical use. The most recent one is CTLA4-Ig (belatacept), a costimulation blockade molecule that targets the second signal of T cell activation and is associated with a better long term kidney function than calcineurin inhibitors, despite an increased risk of acute cellular rejection.

The research of new maintenance long-term immunosuppressive agents focuses on costimulation blockade. Agents inhibiting CD40-CD40 ligand interaction may enable a good control of both T cells and B cells responses. Anti-CD28 antibodies may promote regulatory T cells. Agents targeting this costimulation pathways are currently evaluated in clinical trials.

Immunosuppressive agents for ABMR treatment are scarce since anti-CD20 agent rituximab and proteasome inhibitor bortezomib have failed to demonstrate an interest in ABMR. New drugs focusing on antibodies removal (imlifidase), B cell and plasmablasts (anti-IL-6/IL-6R, anti-CD38…) and complement inhibition are in the pipeline, with the challenge of their evaluation in such a heterogeneous pathology.

在过去的40年里,免疫抑制剂使同种异体移植的发展成为可能,使移植物的存活率大大提高。然而,一些问题仍然存在,如钙调磷酸酶抑制剂的肾毒性,免疫抑制方案的基础和/或机会性感染和癌症的高风险。大多数免疫抑制剂的目标是T细胞活化,可能不足以有效地阻止长期的同种异体免疫。最后,由于供体特异性抗体引起的抗体介导的排斥反应强烈影响同种异体移植物的存活。在过去的几十年里,许多药物都经过了测试,但很少有药物进入临床应用。最近的一个是CTLA4-Ig (belatacept),这是一种共刺激阻断分子,靶向T细胞激活的第二信号,尽管急性细胞排斥反应的风险增加,但与钙调磷酸酶抑制剂相比,它具有更好的长期肾功能。新型维护性长效免疫抑制剂的研究重点是共刺激阻断。抑制CD40-CD40配体相互作用的药物可以很好地控制T细胞和B细胞的反应。抗cd28抗体可促进调节性T细胞。针对这种共刺激途径的药物目前正在临床试验中进行评估。由于抗cd20药物利妥昔单抗和蛋白酶体抑制剂硼替佐米未能表现出对ABMR的兴趣,因此用于ABMR治疗的免疫抑制剂很少。针对抗体去除(imlifidase)、B细胞和细胞质母细胞(抗il -6/IL-6R、抗cd38…)和补体抑制的新药正在开发中,但它们在这种异质性病理中的评估面临挑战。
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引用次数: 2
How to improve results after DCD (donation after circulation death) 如何提高循环死亡后捐献的效果
IF 2.7 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL Pub Date : 2022-12-01 DOI: 10.1016/j.lpm.2022.104143
Maryne Lepoittevin , Sébastien Giraud , Thomas Kerforne , Géraldine Allain , Raphaël Thuillier , Thierry Hauet

The shortage of organs for transplantation has led health professionals to look for alternative sources of donors. One of the avenues concerns donors who have died after circulatory arrest. This is a special situation because the organs from these donors are exposed to warm ischaemia-reperfusion lesions that are unavoidable during the journey of the organs from the donor to the moment of transplantation in the recipient. We will address and discuss the key issues from the perspective of team organization, legislation and its evolution, and the ethical framework. In a second part, the avenues to improve the quality of organs will be presented following the itinerary of the organs between the donor and the recipient. The important moments from the point of view of therapeutic strategy will be put into perspective. New connections between key players involved in pathophysiological mechanisms and implications for innate immunity and injury processes are among the avenues to explore. Technological developments to improve the quality of organs from these recipients will be analyzed, such as perfusion techniques with new modalities of temperatures and oxygenation. New molecules are being investigated for their potential role in protecting these organs and an analysis of potential prospects will be proposed. Finally, the important perspectives that seem to be favored will be discussed in order to reposition the use of deceased donors after circulatory arrest. The use of these organs has become a routine procedure and improving their quality and providing the means for their evaluation is absolutely inevitable.

用于移植的器官短缺导致卫生专业人员寻找其他供体来源。其中一条途径涉及到在循环系统停止后死亡的捐赠者。这是一种特殊情况,因为来自这些供体的器官在从供体到移植到受体的过程中不可避免地会受到热缺血再灌注损伤。我们将从团队组织,立法及其演变以及道德框架的角度来解决和讨论关键问题。在第二部分中,提高器官质量的途径将按照器官在供体和受者之间的行程进行介绍。从治疗策略的角度来看,重要的时刻将被放到正确的角度。参与病理生理机制的关键参与者之间的新联系以及对先天免疫和损伤过程的影响是探索的途径之一。将分析提高这些受者器官质量的技术发展,例如具有新温度和氧合模式的灌注技术。新分子在保护这些器官方面的潜在作用正在研究中,并将对其潜在前景进行分析。最后,将讨论似乎受到青睐的重要观点,以便在循环停止后重新定位使用已故捐赠者。这些器官的使用已成为一种常规程序,提高其质量并为其评估提供手段是绝对不可避免的。
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引用次数: 1
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