在人肝移植中,分辨不同类型的排斥的分子签名
Bastian Engel1, Ahmed Alaswad2, Alejandro Campos-Murguia3
1Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany; PRACTIS & CORE100Pilot Clinician Scientist Programs, Dean's Office for Academic Career Development, Hannover Medical School, Hannover, Germany; MHH Transplant Center, Hannover Medical School, Hannover, Germany.
Journal of hepatology
|July 16, 2025
概括
肝移植 (LT) 后的慢性抗体中介排斥 (cAMR) 有着独特的分子特征. 这种经常通过监测活检检测到的亚临床排斥与纤维化和移植失败的高风险有关.
科学领域:
- 移植免疫学 移植免疫学
- 分子生物学分子生物学
- 胃肠病学 胃肠病学
背景情况:
- 慢性抗体中介排斥 (cAMR) 在肝移植 (LT) 中的作用是有争议的,由于亚临床表现,经常错过.
- 监测活检 (svLbx) 对于检测cAMR至关重要,这可能导致移植损伤和不良结果.
- 之前的研究已经在固体器官移植中表征了T细胞介导排斥 (TCMR) 的分子变化.
研究的目的:
- 在肝移植接受者中识别慢性AMR (cAMR) 的独特分子特征.
- 为了区分cAMR与其他排斥类型和非排斥移植损伤.
- 建立用于早期检测和cAMR风险分层的分子标记.
主要方法:
- 大量RNA测序是在发现和验证队列 (n=158总数) 的肝脏活检上进行的.
- 分析包括来自潜在生物存储库的指示和监测活检.
- 差异基因表达 (DEG) 分析比较了cAMR,临床TCMR,亚临床TCMR和没有排斥的表型.
主要成果:
- 慢性AMR在19%的LT接受者中被发现具有捐赠者特异性抗体,通常具有正常的肝酶.
- cAMR在纤维生成,补充激活和TNFα信号通路中表现出独特的DEG.
- 在40-50%的病例中,cAMR与随后的肝硬化有关,与临床TCMR不同.
- 亚临床TCMR分子概况与没有组织学排斥的分子概况相似.
结论:
- 鉴定了LT后cAMR的一个独特的转录组形状,涉及炎症和纤维基因通路.
- 这种分子特征与肝移植失败的显著风险有关.
- 这些发现支持监测活检检测纤维化相关的cAMR,并可能有助于未来的差异诊断.
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