纳米医学重塑肝移植免疫耐受及其临床转化

Nanomedicine reshapes immune tolerance in liver transplantation and its clinical translation

  • 摘要: 肝移植作为终末期肝病的关键治疗手段,其长期疗效受限于排斥反应及免疫抑制药引发的肝肾毒性、感染风险及肿瘤复发等严重并发症。近年来,纳米技术凭借其靶向递送能力与时空可控释放特性,在精准调控免疫应答方面展现出巨大潜力。本文系统综述了纳米医学在肝移植免疫重编程中的多层次应用策略及其机制,涵盖先天免疫重编程(枯否细胞或巨噬细胞表型转换、炎症小体抑制与线粒体修复)、适应性免疫重塑(树突状细胞靶向调控、基因沉默载体与T细胞功能重编程),以及阐述了微环境协同调控策略,重点关注肝窦内皮细胞靶向的应用。针对临床转化瓶颈,文章提出可降解聚合物载体设计、智能响应系统构建及规模化生产路径优化等创新解决方案,为实现从“全局免疫抑制”到“精准免疫耐受”的范式转型提供理论支撑与实践方向。

     

    Abstract: As a key treatment method for end-stage liver diseases, long-term efficacy of liver transplantation is limited by rejection and serious complications such as liver and kidney toxicity, infection risks and tumor recurrence caused by immunosuppressive drugs. In recent years, nanotechnology, with its targeted delivery capabilities and spatio-temporal controlled release characteristics, has demonstrated great potential in precisely regulating immune responses. This article systematically reviews the multi-level application strategies and mechanisms of nanomedicine in the immunoreprogramming of liver transplantation, covering innate immunoreprogramming (phenotypic transformation of Kupffer cells or macrophages, inhibition of inflammasomes and mitochondrial repair), adaptive immune remodeling (targeted regulation of dendritic cells, gene silencing vectors and reprogramming of T cell functions), and elaborates on the strategies for coordinated regulation of the microenvironment. The article also focuses on the targeted application of liver sinusoidal endothelial cells. In response to clinical translation bottlenecks, innovative solutions such as the design of degradable polymer carriers, the construction of intelligent response systems and the optimization of large-scale production pathways are proposed, providing theoretical support and practical directions for achieving the paradigm shift from "global immunosuppression" to "precise immune tolerance".

     

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