ГЕНЕТИЧЕСКИЕ БИОМАРКЕРЫ ОСТРОГО ОТТОРЖЕНИЯ ТРАНСПЛАНТАТА ПОСЛЕ ТРАНСПЛАНТАЦИИ СЕРДЦА
Трансплантация сердца является стандартом лечения терминальной сердечной недостаточности, резистентной к медикаментозной терапии. Пациенты после трансплантации сердца подвергаются риску развития различных осложнений во время наблюдения. Распространенные осложнения включают раннюю недостаточность аллотрансплантата, острое отторжение трансплантата, коронарную васкулопатию аллотрансплантата, почечную недостаточность, инфекции и рак. Причины вторичной дисфункции трансплантата необходимо учитывать после первой недели трансплантации. На сегодняшний день, гистологическая стратификация острого отторжения при помощи эндомиокардиальной биопсии с гистопатологией является стандартным методом диагностики острого отторжения, оценки его тяжести и ответа на терапию. К сожалению, этот метод инвазивный и имеет некоторые ограничения. В дополнение к этому острое отторжение имеет два фенотипа: острое клеточное отторжение и антитело-опосредованное отторжение, что затрудняет постановку гистопатологического диагноза. Вторичные негенетические методы мониторинга сердечного отторжения могут включать эхокардиографию, МРТ сердца, тропонин и другие методы. Надежный неинвазивный маркер для выявления острого отторжения до развития дисфункции трансплантата, возможно, приведет к лучшим результатам для тех пациентов, у которых есть вероятность развития отторжения аллотрансплантата. В нашем обзоре мы собрали последние данные о генетических неинвазивных биомаркерах, включая внеклеточную ДНК донорского происхождения, метилирование ДНК, профилирование экспрессии генов РНК (матричная РНК) и микро-РНК. Анализ метилирования внеклеточной ДНК может помочь различить различные типы острого отторжения. Метод микро-РНК может сыграть важную роль в будущем как цель разработки иммунодепрессантов. В основе анализа внеклеточной ДНК донорского происхождения лежит обнаружение однонуклеотидных полиморфизмов, отличающих ДНК донора от ДНК реципиента. Фракция внеклеточной ДНК донора быстро снижается после трансплантации и увеличивается только в случае острого отторжения или повреждения миокарда. Таким образом, генетические неинвазивные методы играют ключевую роль в оценке и мониторинге отторжения сердечного аллотрансплантата. Анализ статей установил, что неинвазивные методы на основе ДНК минимизируют риски инвазивных процедур. Это безопасный, удобный и точный метод диагностики сердечной недостаточности после трансплантации сердца.
Ключевые слова: трансплантация сердца, острое отторжение трансплантата, генетические биомаркеры, внеклеточная ДНК донорского происхождения, экономическая эффективность
Миргуль Ф. Баянова1, https://orcid.org/0000-0002-6167-5357
Алия Т. Аскербекова1, https://orcid.org/0009-0005-3213-7073
Ляззат К. Назарова1, https://orcid.org/0000-0002-3325-5240
Айжан Б. Абдикадирова1, https://orcid.org/0000-0002-1951-2837
Малика Е. Сапаргалиева1, https://orcid.org/0000-0002-0172-353X
Диас Б. Малик1, https://orcid.org/0009-0008-3542-1960
Гульжан Ш. Мырзахметова1, https://orcid.org/0000-0001-8325-1267
Юрий В. Пя1, https://orcid.org/0000-0001-7249-0510
Айдос К. Болатов2, https://orcid.org/0000-0002-5390-4623
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Баянова М.Ф., Аскербекова А.Т., Назарова Л.К., Абдикадирова А.Б., Сапаргалиева М.Е., Малик Д.Б., Мырзахметова Г.Ш., Пя Ю.В., Болатов А.К. Генетические биомаркеры острого отторжения трансплантата после трансплантации сердца // Наука и Здравоохранение. 2024. Т.26 (4). С. 177-189. doi 10.34689/SH.2024.26.4.021Похожие публикации:
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