小细胞外囊泡在实体器官移植中的应用 进展
Advances in the Application of Small Extracellular Vesicles in Solid Organ Transplantation
DOI: 10.12677/acm.2026.1651788, PDF,   
作者: 杨 晶：浙江大学医学院，浙江 杭州；吴国生*：浙江大学医学院附属第一医院结直肠外科，浙江 杭州
关键词: 细胞外囊泡；器官移植；免疫排斥；免疫耐受；生物标志物；Extracellular Vesicles； Organ Transplantation； Immune Rejection； Immune Tolerance； Biomarkers
摘要: 小细胞外囊泡(sEVs)作为细胞间通讯的关键载体，在实体器官移植的免疫调控中扮演着复杂而重要的角色。本文综述了sEVs在移植免疫中的作用机制、其作为无创生物标志物的应用潜力以及当前面临的临床转化挑战。sEVs可递送供体主要组织相容性复合体分子，参与同种异体免疫的“半直接识别”，从而启动针对移植物的排斥反应。另一方面，来源于调节性T细胞、间充质干细胞等特定细胞的sEVs又能参与诱导移植耐受。其最终效应取决于囊泡的细胞来源、内容物构成及所处的微环境。在临床诊断方面，体液(如血浆、尿液、支气管肺泡灌洗液)中的sEVs及其携带的蛋白质、RNA等分子，能够“镜像”反映移植物局部及全身的免疫状态。多项研究表明，sEVs及其内容物在肾、肝、心、肺等器官移植的排斥反应诊断、亚型鉴别及预后预测中具有重要潜力。未来，随着分离分析技术的进步和工程化改造sEVs技术的进步，sEVs有望成为推动实体器官移植精准诊疗的重要工具。
Abstract: Small extracellular vesicles (sEVs) serve as key mediators of intercellular communication and play complex and vital roles in the immune regulation of solid organ transplantation. This review summarizes the mechanistic roles of sEVs in transplant immunology, their potential as non-invasive biomarkers, and the current challenges in clinical translation. sEVs can deliver donor-derived major histocompatibility complex molecules and participate in the “semi-direct” pathway of allorecognition, thereby initiating immune rejection against the graft. Conversely, sEVs derived from specific cell types, such as regulatory T cells and mesenchymal stem cells, can contribute to the induction of transplant tolerance. Their ultimate biological effect depends on the cellular origin of the vesicles, their cargo composition, and the surrounding microenvironment. In clinical diagnostics, sEVs present in body fluids (e.g., plasma, urine, bronchoalveolar lavage fluid) and the proteins, RNAs, and other molecules they carry can “mirror” the local and systemic immune status of the transplanted organ. Numerous studies have demonstrated the significant potential of sEVs and their cargo for diagnosing rejection, differentiating its subtypes, and predicting prognosis in kidney, liver, heart, and lung transplantation. In the future, with advances in isolation and analysis technologies, as well as in engineering strategies for sEVs, they are expected to become important tools for advancing precision diagnosis and therapy in solid organ transplantation.
文章引用：杨晶, 吴国生. 小细胞外囊泡在实体器官移植中的应用 进展[J]. 临床医学进展, 2026, 16(5): 60-71. https://doi.org/10.12677/acm.2026.1651788

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