贝拉西普——抗排斥反应战场上的新武器

Belatacept:a new weapon in anti-rejection battlefield

贝拉西普作为针对CD28受体的共刺激阻滞剂,已在欧美国家获批并应用于器官移植排斥反应的治疗。贝拉西普已被证实较钙调磷酸酶抑制剂(CNI)可更好地提高受者及移植物的长期存活率,并改善移植物功能,但同时也存在排斥反应发生率较高的问题。鉴于此,移植工作者尝试优化贝拉西普免疫抑制方案,并取得了较好的临床疗效。诚然,贝拉西普已被证实对于记忆性T细胞的作用欠佳,但因其特异性针对免疫细胞及不良反应小的特点,在探索新的共刺激分子靶点以优化免疫抑制方案上仍具有潜在价值。本文从共刺激阻滞剂的问世、贝拉西普的临床疗效及临床应用、引起贝拉西普耐药性排斥反应的“元凶”等方面进行综述。

As a co-stimulatory blocker against CD28 receptor,belatacept has been approved and applied to the treatment of rejection in organ transplantation in Europe and America.Belatacept has been proven to outperform calcineurin inhibitor(CNI)in improving the long-term survival rate of recipients and grafts,and enhancing graft function.Nevertheless,it might cause a high incidence of rejection.To resolve this issue,transplant workers have attempted to optimize belatacept immunosuppressive regimen and achieved good clinical efficacy.Although belatacept has been proven to exert poor effect on memory T cells,it has potential value in exploring new co-stimulatory molecular targets to optimize immunosuppressive regimes due to its specificity for immune cells and mild adverse effects.In this article,the advent of co-stimulatory blocker,clinical efficacy and application of belatacept,and the causes of belatacept-resistant rejection were reviewed.