抗体诱导疗法在器官移植领域的临床应用

Induction therapy with antibodies in organ transplantation

近年来抗体诱导疗法的应用越来越广泛,2009年美国肾移植数据统计分析报告显示,83%肾移植受者接受诱导疗法。随着生物学技术的不断进步,用于诱导治疗的生物制剂经历了3个不同时期。目前除了预防急性排斥反应、增强免疫抑制,诱导疗法还作为免疫抑制剂联合应用中的一部分,旨在减少维持期的药物剂量和毒副作用。目前临床批准使用的诱导治疗制剂包括了以抗淋巴细胞球蛋白为代表的多克隆抗体、以抗CD3+T淋巴细胞单克隆抗体和IL-2受体阻断剂为代表的单克隆抗体,还有一些进入移植临床试验阶段的制剂,如抗CD20单克隆抗体和抗CD52单克隆抗体等。我国2010年版《临床诊疗指南——器官移植学分册》明确了诱导疗法的应用原则和诱导抗体选择原则。最后提出,除了药物,能降低受者T淋巴细胞对异基因抗原识别过程导致的免疫应答反应、最大限度地降低临床排斥反应所采取的手段,都可以作为诱导治疗。

With more understanding of acute rejection factors affecting long-term survival of allografts,antibody induction therapy has been extensively accepted in the field of transplantation in recentyears.In 2009,United Network of Organ Sharing data showed that 83% of renal transplant recipients received antibody induction therapy as a prophylactic treatment for preventing acute rejection.The development of induction therapy has entered into a new phase as advances in biological technology.In clinical practice,the use of induction therapy is not only to prevent acute rejection,but also to reduce conventional immunosuppressants doses and their toxitic and adverse effects.Agentsthat have been given approval for using on patients included polyclonal and monoclonal antibodies as exemplified by anti-thymocyteglobulin and anti-CD3 antibody.Some other induction antibodies that have been proceeded into clinical trial included anti-CD20 monoclonal antibody（rituxin） and anti-CD52 monoclonal antibody（alemtuzumab）.In 2010,Chinese Medical Association the Branch of Organ Transplantation Society establishedorgan transplantation clinical practice guidelines,in which recommendations for induction therapy in transplantation is given in detail.We presented the concepts of ＂broad definition of induction therapy＂ and ＂chronic induction＂.Both of them aim to decrease immune response of T cells when allogenicantigens appear in transplant recipients and to prevent acute and chronic rejection.