Publication: Análisis de la respuesta inmune local y periférica en el trasplante intestinal
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2019-02-14
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Universidad Complutense de Madrid
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Abstract
La monitorización de la integridad tisular y funcional del trasplante intestinal (TxI) se basa principalmente en el examen endoscópico e histológico del injerto; sin embargo, estos procedimientos no siempre son suficientes para identificar de forma precisa y temprana acontecimientos que ponen en riesgo su supervivencia. Por ello, resulta necesaria la búsqueda de biomarcadores, preferiblemente predictivos, así como la profundización en los mecanismos celulares y moleculares de los procesos de adaptación, tolerancia y rechazo. El rechazo es uno de los mayores inconvenientes para la supervivencia del injerto. Muchos de los episodios son refractarios a los tratamientos que se centran en los mecanismos celulares del rechazo, lo que sugiere la existencia de un componente inmune humoral responsable también del daño del injerto. La identificación de esta respuesta humoral en el TxI resulta compleja, ya que no existe un consenso en los criterios histológicos diagnósticos al respecto. La presencia de anticuerpos anti-HLA donante específicos (DSA) en el receptor, que es otro de los criterios diagnósticos de rechazo humoral en muchos trasplantes de órgano sólido, viene siendo analizada en los últimos años en el TxI, si bien la experiencia en este campo sigue siendo limitada y muchos de los resultados son todavía controvertidos..
The monitoring of tissular and functional integrity of intestinal transplantation (ITx) is mainly based on endoscopic and histological examination of the graft. However, these procedures are not always sufficient for an accurate and early identification of events that put their survival at risk. For this reason, it is necessary the search of biomarkers preferably predictive, as well as the deepening in the cellular and molecular mechanisms of adaptation, tolerance and rejection. Rejection is one of the biggest drawbacks to graft survival. Many of the episodes are refractory to the treatments that focus on the cellular mechanisms of rejection, suggesting the existence of a humoral immune component also responsible for graft damage. The identification of this humoral response in the ITx is challenging, since there is no consensus on the histological diagnostic criteria in this regard. The presence of donor- specific anti-HLA antibodies (DSA) in the receptor, which is a diagnostic criterion for humoral rejection in many solid organ transplants, has been analyzed in the recent years in ITx, although the experience remains limited and some results are still controversial...
The monitoring of tissular and functional integrity of intestinal transplantation (ITx) is mainly based on endoscopic and histological examination of the graft. However, these procedures are not always sufficient for an accurate and early identification of events that put their survival at risk. For this reason, it is necessary the search of biomarkers preferably predictive, as well as the deepening in the cellular and molecular mechanisms of adaptation, tolerance and rejection. Rejection is one of the biggest drawbacks to graft survival. Many of the episodes are refractory to the treatments that focus on the cellular mechanisms of rejection, suggesting the existence of a humoral immune component also responsible for graft damage. The identification of this humoral response in the ITx is challenging, since there is no consensus on the histological diagnostic criteria in this regard. The presence of donor- specific anti-HLA antibodies (DSA) in the receptor, which is a diagnostic criterion for humoral rejection in many solid organ transplants, has been analyzed in the recent years in ITx, although the experience remains limited and some results are still controversial...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Inmunología, Oftalmología y Otorrinolaringología, leída el 11-12-2018