排斥反应在同种异体气管移植物中的研究进展
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摘要
气管的一些良性或恶性病变从理论上说是可以通过简单的手术切除,并将断端进行端端吻合来治疗的。然而这仅限于病损长度不超过成人气管长度的50%、小孩气管长度的30%。对大多患者而言,可以进行气管移植替代。然而气管移植有诸多问题有待解决,例如免疫排斥、再血管化、感染、肉芽组织增生等方面的问题。本文主要针对如何用不同的降低免疫排斥反应的方法来阐述免疫排斥反应在同种异体气管移植物领域的研究进展及应用现状。
A variety of benign and malignant disorders affecting the trachea can theoretically be treated by simple resection and subsequent end-to-end anastomosis of remained trachea. Unfortunately, it is feasible only when the affected tracheal length does not exceed 50% of the entire length in adults and about 30% in children. Tracheal transplantation may be a treatment option for those patients, but still has many problems to be solved, such as immunological rejection, revascularization, infection and granulation tissue hyperplasia. This review focuses on how to use different methods to inhibit immunological rejection of tracheal transplantation, and current research progress of immunological rejection in tracheal allograft.
A variety of benign and malignant disorders affecting the trachea can theoretically be treated by simple resection and subsequent end-to-end anastomosis of remained trachea. Unfortunately, it is feasible only when the affected tracheal length does not exceed 50% of the entire length in adults and about 30% in children. Tracheal transplantation may be a treatment option for those patients, but still has many problems to be solved, such as immunological rejection, revascularization, infection and granulation tissue hyperplasia. This review focuses on how to use different methods to inhibit immunological rejection of tracheal transplantation, and current research progress of immunological rejection in tracheal allograft.
引文
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2 Steger V,Hampel M,Trick I,et al.Clinical tracheal replacement:transplantation,bioprostheses and artii cial grat s.Expert Rev Med Devices,2008,5(5):605-612.
3 Klepetko W,Marta GM,Wisser W,et al.Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograt.h orac Cardiovasc Surg,2004,127(3):862-867.
4 Rees LE,Ayoub O,Haverson K,et al.Differential major histocompatibility complex class II locus expression on human laryngeal epithelium.Clin Exp Immunol,2003,134(3):497-502.
5 Yokomise H,Inui K,Wada H,et al.High-dose irradiation prevents rejection of canine tracheal allografts.Thorac Cardiovasc Surg,1994,107(6):1391-1397.
6 Yokomise H,Inui K,Wada H,et al.h e infeasibility of using tenring irradiated grafts for tracheal allotransplantation even with omentopexy.Surg Today,1996,26(6):427-430.
7 Makris D,Holder-Espinasse M,Wurtz A,et al.Tracheal replacement with cryopreserved allogenic aorta.Chest,2010,137(1):60-67.
8 Radu DM,Seguin A,Bruneval P,et al.Bronchial replacement with arterial allograt s.Ann h orac Surg,2010,90(1):252-258.
9 Martinod E,Radu DM,Chouahnia K,et al.Human Transplantation of a biologic airway substitute in conservative lung cancer surgery.Ann h orac Surg,2011,91(3):837-842.
10 Tojo T,Kitamura S,Gojo S,et al.Epithelial regeneration and preservation of tracheal cartilage after tracheal replacement with cryopreserved allograft in the rat.Thorac Cardiovasc Surg,1998,116 (4 ):624-627.
11 Mukaida T,Shimizu N,Aoe M,et al.Experimental study of tracheal allotransplantation with cryopreserved grafts.Thorac Cardiovasc Surg,1998,116(2):262-266.
12 Macchiarini P,Jungebluth P,Go T,et al.Clinical transplantation of a tissue-engineered airway.Lancet,2008,372(9655):2023-2030.
13 Crapo PM,Gilbert TW,Badylak SF.An overview of tissue and whole organ decellularization processes.Biomaterials,2011,32(12):3233-3243.
14 Jungebluth P,Go T,Asnaghi A,et al.Structural and morphological evaluation of a novel enzymatic detergent tissue engineered tracheal tubular matrix.h orac Cardiovasc Surg,2009,138(3):586-593.
15 Go T,Jungebluth P,Baiguero S,et al.Both epithelial cells and mesenchymal stem cell-derived chondrocytes contribute to the survival of tissue-engineered airway transplants in pigs.Thorac Cardiovasc Surg,2010,139(2):437-443.
16 孙飞,潘枢,史宏灿.去污剂-联合酶法行兔脱细胞组织工程气管制备及性能评价.中华胸心血管外科杂志,2014,30(1):38-55.
17 章方彪,张卫东,史宏灿.细胞外基质在长段气管病损治疗中的应用与研究进展.中国胸心血管外科临床杂志,2013,20(3):334-337.
18 B a i g u e r a S,G o n f i o t t i A,J a u s M,e t a l.D e v e l o p m e n t o f bioengineered human larynx.Biomaterials,2011,32(19):4433-4442.
19 Gilbert TW,Sellaro TL,Badylak SF.Decellularization of tissues and organs.Biomaterials,2006,27(19):3675-3683.
20 Delaere PR,Hermans R.Clinical transplantation of a tissueengineered airway.Lancet,2009,3739(9665):717-718.
21 Pierre D,Jan V,Geert V,et al.Tracheal allotransplantation at er withdrawal of immunosuppressive therapy.N Engl J Med,2010,362(2):138-145.
22 Shalev I,Schmelzle M,Robson SC,et al.Making sense of regulatory T cell suppressive function.Semin Immunol,2011,23(4):282-292.
23 Sojka DK,Huang YH,Fowell DJ.Mechanisms of regulatory T-cell suppression-a diverse arsenal for a moving target.Immunology,2008,124(1):13-22.
24 Wood KJ,Sakaguchi S.Regulatory T cells in transplantation tolerance.Nat Rev Immunol,2003,3(3):199-210.
25 Kang SM,Tang Q,Bluestone JA.CD4+CD25+regulatory T cells in transplantation:progress,challenges and prospects.Am J Transplant,2007,7(6):1457-1463.
26 Li W,Carper K,Zheng XX,et al.h e role of Foxp3t regulatory T cells in liver transplant tolerance.Transplant Proc,2006,38(10):3205-3206.
27 Long E,Wood K J.Regulatory T cells in transplantation:transferring mouse studies to the clinic.Transplantation,2009,88(9):1050-1056.
28 Bluestone JA,Tang Q.h erapeutic vaccination using CD4+CD25+antigen-specii c regulatory T cells.Proc Natl Acad Sci USA,2004,101 (Suppl 2):14622-14626.
29 Sugimoto K,Itoh T,Takita M,et al.Improving allogeneic islet transplantation by suppressing Th17 and enhancing Treg with histone deacetylase inhibitors.Transpl Int,2014,27(4):408-415.
30 Pasquet L,Douet JY,Sparwasser T,et al.Long term prevention of chronic allograt rejection by regulatory T cell immunotherapy involves host Foxp3-expressing T cells.Blood,2013,121(21):4303-4310.
31 Haag J,Baiguera S,Jungebluth P,et al.Biomechanical and angiogenic properties of tissue-engineered rat trachea using genipin crosslinked decellularized tissue.Biomaterials,2012,33(3):780-789.
2 Steger V,Hampel M,Trick I,et al.Clinical tracheal replacement:transplantation,bioprostheses and artii cial grat s.Expert Rev Med Devices,2008,5(5):605-612.
3 Klepetko W,Marta GM,Wisser W,et al.Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograt.h orac Cardiovasc Surg,2004,127(3):862-867.
4 Rees LE,Ayoub O,Haverson K,et al.Differential major histocompatibility complex class II locus expression on human laryngeal epithelium.Clin Exp Immunol,2003,134(3):497-502.
5 Yokomise H,Inui K,Wada H,et al.High-dose irradiation prevents rejection of canine tracheal allografts.Thorac Cardiovasc Surg,1994,107(6):1391-1397.
6 Yokomise H,Inui K,Wada H,et al.h e infeasibility of using tenring irradiated grafts for tracheal allotransplantation even with omentopexy.Surg Today,1996,26(6):427-430.
7 Makris D,Holder-Espinasse M,Wurtz A,et al.Tracheal replacement with cryopreserved allogenic aorta.Chest,2010,137(1):60-67.
8 Radu DM,Seguin A,Bruneval P,et al.Bronchial replacement with arterial allograt s.Ann h orac Surg,2010,90(1):252-258.
9 Martinod E,Radu DM,Chouahnia K,et al.Human Transplantation of a biologic airway substitute in conservative lung cancer surgery.Ann h orac Surg,2011,91(3):837-842.
10 Tojo T,Kitamura S,Gojo S,et al.Epithelial regeneration and preservation of tracheal cartilage after tracheal replacement with cryopreserved allograft in the rat.Thorac Cardiovasc Surg,1998,116 (4 ):624-627.
11 Mukaida T,Shimizu N,Aoe M,et al.Experimental study of tracheal allotransplantation with cryopreserved grafts.Thorac Cardiovasc Surg,1998,116(2):262-266.
12 Macchiarini P,Jungebluth P,Go T,et al.Clinical transplantation of a tissue-engineered airway.Lancet,2008,372(9655):2023-2030.
13 Crapo PM,Gilbert TW,Badylak SF.An overview of tissue and whole organ decellularization processes.Biomaterials,2011,32(12):3233-3243.
14 Jungebluth P,Go T,Asnaghi A,et al.Structural and morphological evaluation of a novel enzymatic detergent tissue engineered tracheal tubular matrix.h orac Cardiovasc Surg,2009,138(3):586-593.
15 Go T,Jungebluth P,Baiguero S,et al.Both epithelial cells and mesenchymal stem cell-derived chondrocytes contribute to the survival of tissue-engineered airway transplants in pigs.Thorac Cardiovasc Surg,2010,139(2):437-443.
16 孙飞,潘枢,史宏灿.去污剂-联合酶法行兔脱细胞组织工程气管制备及性能评价.中华胸心血管外科杂志,2014,30(1):38-55.
17 章方彪,张卫东,史宏灿.细胞外基质在长段气管病损治疗中的应用与研究进展.中国胸心血管外科临床杂志,2013,20(3):334-337.
18 B a i g u e r a S,G o n f i o t t i A,J a u s M,e t a l.D e v e l o p m e n t o f bioengineered human larynx.Biomaterials,2011,32(19):4433-4442.
19 Gilbert TW,Sellaro TL,Badylak SF.Decellularization of tissues and organs.Biomaterials,2006,27(19):3675-3683.
20 Delaere PR,Hermans R.Clinical transplantation of a tissueengineered airway.Lancet,2009,3739(9665):717-718.
21 Pierre D,Jan V,Geert V,et al.Tracheal allotransplantation at er withdrawal of immunosuppressive therapy.N Engl J Med,2010,362(2):138-145.
22 Shalev I,Schmelzle M,Robson SC,et al.Making sense of regulatory T cell suppressive function.Semin Immunol,2011,23(4):282-292.
23 Sojka DK,Huang YH,Fowell DJ.Mechanisms of regulatory T-cell suppression-a diverse arsenal for a moving target.Immunology,2008,124(1):13-22.
24 Wood KJ,Sakaguchi S.Regulatory T cells in transplantation tolerance.Nat Rev Immunol,2003,3(3):199-210.
25 Kang SM,Tang Q,Bluestone JA.CD4+CD25+regulatory T cells in transplantation:progress,challenges and prospects.Am J Transplant,2007,7(6):1457-1463.
26 Li W,Carper K,Zheng XX,et al.h e role of Foxp3t regulatory T cells in liver transplant tolerance.Transplant Proc,2006,38(10):3205-3206.
27 Long E,Wood K J.Regulatory T cells in transplantation:transferring mouse studies to the clinic.Transplantation,2009,88(9):1050-1056.
28 Bluestone JA,Tang Q.h erapeutic vaccination using CD4+CD25+antigen-specii c regulatory T cells.Proc Natl Acad Sci USA,2004,101 (Suppl 2):14622-14626.
29 Sugimoto K,Itoh T,Takita M,et al.Improving allogeneic islet transplantation by suppressing Th17 and enhancing Treg with histone deacetylase inhibitors.Transpl Int,2014,27(4):408-415.
30 Pasquet L,Douet JY,Sparwasser T,et al.Long term prevention of chronic allograt rejection by regulatory T cell immunotherapy involves host Foxp3-expressing T cells.Blood,2013,121(21):4303-4310.
31 Haag J,Baiguera S,Jungebluth P,et al.Biomechanical and angiogenic properties of tissue-engineered rat trachea using genipin crosslinked decellularized tissue.Biomaterials,2012,33(3):780-789.