GcfDNA在移植术后监测中的研究进展

Research Progress of GcfDNA in Monitoring after Transplantation

随着器官移植技术的不断发展,受体患者生存质量也得到不断提高,急性排斥反应的预测和免疫抑制剂的不良作用成为亟待解决的重要问题。如Immu Know、人类白细胞抗原检测、供体特异性抗体(DSA)检测、治疗药物监测(TDM)等方法被提出,用来针对移植患者进行急性排斥反应的预测和个体化免疫方案的设计,但仍存在许多不足。基因组移植中测量循环系统移植物来源的游离DNA(Gcf DNA),有望成为提高器官移植后移植物和受体患者存活率的方法,做到对急性排斥反应的预测和及时治疗。近年来的研究发现,不需要供体患者的DNA组,也可以量化患者Gcf DNA的比值,适用于各种接受器官移植的患者,实现早期、敏感、特异性、低成本的评估移植物的状态,从而调整个体化的免疫抑制剂(ISDs)水平,包括抑制排斥反应所需最低的ISDs水平,现通过对比目前主要移植术后免疫评估方法,阐述Gcf DNA的应用价值、研究现状和方向。

With the continuous development of organ transplantation technology,the quality of life of recipient patients has been continuously improved. However,the prediction of acute rejection and the toxic and adverse effects of immunosuppressive agents remain important issues to be resolved. Many methods such as Immu Know,human lymphocyte antigen（ HLA detection,donor specific antibody（ DSA） detection,therapeutic drug monitoring（ TDM）,etc. have been proposed to predict the acute rejection of transplant patients and to design individualized immunization protocols,but there are still many deficiencies. Because organ transplants are also genome transplants,measurement of graft-derived cell-free DNA（ Gcf DNA） has shown promise as a way to improve both graft and recipient outcomes after solid organ transplantation through the early detection of severe graft injury,enabling an early intervention. Recent studies discovered a procedure which can realize rapid quantification of Gcf DNA percentages without requiring donor DNA,and therefore can be applied to any organ donor/recipient pair. This method allows for the early,sensitive,specific,and cost-effective direct assessment of graft integrity and can be used to define individual responses to ISDs including the minimal ISD exposures necessary to prevent rejection. Here,by comparing existing methods of immunization assessment after transplantation,is to elaborate the applicative value,research status and development direction of Gcf DNA.