背景:肝移植是终末期肝病患者的救命疗法,但是急性细胞排斥反应(ACR)和移植并发症仍然是术后的重大挑战。早期和准确的诊断对于及时干预和改善患者预后至关重要。但是他们的诊断目前依赖于侵入性活检取样,从而促使人们寻找非侵入性生物标志物。MicroRNA(miRNA)已成为各种病理条件下有希望的生物标志物,及其在诊断肝移植后急性细胞排斥反应中的潜在用途已引起人们的极大兴趣。
方法:本系统综述PubMed,WebofScience,ClinicalTrials.gov注册表分析了探索miRNA作为肝移植中ACR和移植物功能障碍的生物标志物的研究(PROSPEROIDCRD42023465278)。采用Cochrane协作工具评估偏倚风险。人口数据,鉴定了miRNA及其动态调控,以及事件预测进行了比较。数据提取和质量评估由两名审阅者独立进行。
结果:本系统综述包括13项研究。各种研究的miRNA与急性细胞排斥反应相关上调,像miR-122,miR-155,miR-181,miR-483-3p,和miR-885-5p,展示了巨大的生物标志物潜力。此外,几项研究进行了靶基因分析,揭示与ACR相关的细胞机制的见解。此外,各种miRNA还能够预测移植后的不同器官并发症,扩大他们的多功能性。剩下的挑战包括miRNA分析的标准化,功能验证的需要,以及长期研究的必要性。
结论:结果突出了miRNA作为特异性,肝移植后ACR和移植物功能障碍的非侵入性生物标志物。然而,需要进一步的研究来验证这些发现,并建立标准化的诊断小组,以将其纳入临床实践,并在未来探索基于miRNA的治疗方法.
BACKGROUND: Liver transplantation is a life-saving therapy for end-stage liver disease patients, but acute cellular rejection (ACR) and graft complications remain significant postoperative challenges. Early and accurate diagnosis is crucial for timely intervention and improved patient outcomes, but their diagnosis rely currently on invasive biopsy sampling, thus prompting the search for non-invasive Biomarkers. MicroRNA (miRNA) have emerged as promising biomarkers in various pathological conditions, and their potential utility in diagnosing acute cellular rejection after liver transplantation has gained significant interest.
METHODS: This systematic
review of PubMed, Web of Science, and the ClinicalTrials.gov registry analyzes studies exploring miRNA as biomarkers for ACR and graft dysfunction in liver transplantation (PROSPERO ID CRD42023465278). The Cochrane Collaboration tool for assessing risk of bias was employed. Population data, identified miRNA and their dynamic regulation, as well as event prediction were compared. Data extraction and quality assessment were performed independently by two reviewers.
RESULTS: Thirteen studies were included in this systematic
review. Various investigated miRNAs were upregulated in association with acute cellular rejection, like miR-122, miR-155, miR-181, miR-483-3p, and miR-885-5p, demonstrating great biomarker potential. Additionally, several studies conducted target gene analysis, revealing insights into cellular mechanisms linked to ACR. Moreover, various miRNA were also capable of predicting different organ complications following transplantation, expanding their versatility. Remaining challenges include the standardization of miRNA profiling, the need for functional validation, and the necessity for long-term studies.
CONCLUSIONS: The results highlight the potential of miRNA as specific, non-invasive biomarkers for ACR and graft dysfunction following liver transplantation. However, further research is needed to validate these findings and establish standardized diagnostic panels to incorporate them into clinical practice and explore miRNA-based therapies in the future.