巨噬细胞与肾移植

肾移植是终末期肾病患者的最佳治疗方案，但移植肾远期存活仍是临床上面临的重要难题。肾缺血-再灌注损伤（IRI）和移植肾排斥反应被认为是影响移植肾远期存活的重要因素，受固有免疫和适应性免疫细胞调控。巨噬细胞是固有免疫细胞中一种，可协助启动适应性免疫，分为M1型巨噬细胞、M2型巨噬细胞和调节性巨噬细胞。先前研究揭示M1型巨噬细胞加重肾IRI和急性T细胞介导的排斥反应（TCMR）；而M2型巨噬细胞减轻肾IRI和急性TCMR，但与抗体介导的排斥反应（AMR）呈正相关；调节性巨噬细胞是巨噬细胞一种特殊亚群，可诱导移植免疫耐受，具有极大临床应用前景和基础科研价值。本文述评了巨噬细胞分型、巨噬细胞与肾IRI、移植肾排斥反应及调节性巨噬细胞与免疫耐受的关系，并分析了其可能作用机制，以期诱导巨噬细胞亚型改变或清除特定亚型巨噬细胞，进而改善移植预后及移植肾远期存活。

Macrophages and kidney transplantation

Kidney transplantation is the optimal treatment for patients with end-stage renal disease, whereas long-term survival of renal allografts remains a challenging issue. Renal ischemia-reperfusion injury (IRI) and rejection of renal allografts are considered as important influencing factors of long-term survival of renal allografts, which are regulated by innate and adaptive immune cells. Macrophages are one type of innate immune cells that could assist initiating adaptive immunity and are divided into M1, M2 and regulatory macrophages. Previous studies have revealed that M1 macrophages may aggravate renal IRI and acute T cell-mediated rejection (TCMR). However, M2 macrophages may mitigate renal IRI and acute TCMR, whereas it is positively correlated with antibody-mediated rejection (AMR). Regulatory macrophages are a special subgroup of macrophages, which may induce immune tolerance in organ transplantation and have promising clinical application prospects and basic scientific research value. In this article, the relationship among macrophage typing, macrophages and renal IRI, rejection of renal allografts, regulatory macrophages and immune tolerance was reviewed, and the potential mechanism was analyzed, aiming to induce changes in macrophage subtypes or eliminate specific subtypes of macrophages, thereby improving clinical prognosis of the recipients and long-term survival of renal allografts.