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PubMedDate not supplied

[Immunosuppressive agents in pediatric renal transplantation].

Advances in immunosuppressive therapy over the past decade have led to dramatic improvements of patient and graft survival. The immunosuppression that is used is constantly evolving. The goal remains to find the best combination that will optimize long-term graft survival, while minimizing the adverse effects. It is likely that in the near future the results will even be improved further by the development of new medications with a better therapeutic index and the induction of transplant tolerance.

Calcineurin Inhibitors↗

PubMed1990

Immunosuppressive agents in current use.

The use of immunosuppressants has increased as clinical applications for such therapy have become more widespread. Immunosuppressive therapy is now particularly relevant in the field of organ transplantation, a practice that has only developed over the last 20 years. Drugs used as immunosuppressants are discussed in relation to disease category, where they are of value, mode of action, and potential side effects. Future prospects concerning the development and use of immunosuppressants are considered.

Humans↗

PubMed1993

New immunosuppressive agents.

In summary, many new modalities of immunosuppression after transplantation are being investigated (Fig. 1). These approaches include various new drugs or monoclonal antibodies that target different cell subsets, cellular activation pathways, cellular effector function or mediators (such as cytokines) of effector function, ligands that stabilize cellular interactions, or antimetabolites that preferentially affect lymphocytes (Tables 4 and 5). Because of the excellent early graft and patient survival results after liver transplantation under various current immunosuppressive protocols, future clinical trials using these various new modalities will require large numbers of patients to show statistically significant differences in graft or patient survival. Therefore, other criteria in addition to graft and patient survival must be analyzed to evaluate the importance of new immunosuppressive therapies. These criteria may include incidence of acute or chronic rejection, long-term graft function, incidence of infectious complications, length of hospitalization, drug toxicity, and patient tolerance and compliance with new therapies.

Alprostadil↗

PubMed2005

Experimental isolation and transplantation of hepatocytes with the use of antibody against interleukin-2 receptor (daclizumab) as immunosuppressive agent.

INTRODUCTION: Daclizumab (Dmab) is a genetically engineered humanized IgG1 monoclonal antibody that binds to the alpha chain of the interleukin-2 receptor (Tac, CD25, p55) expressed on activated human T lymphocytes. Dmab has been used in a clinical protocol of islet transplantation with satisfactory results. The aim of the present study was to evaluate the use of an antibody against the interleukin-2 receptor (Dmab) as an immunosuppressive agent in an experimental model of hepatocyte allotransplantation (allo-Tx) in rats with fulminant hepatic failure (FHF). MATERIALS AND METHODS: Six Wistar rats were used as donors and 48 Lewis rats as recipients: four groups of 12 animals each with induction of FHF and 24 hour later hepatocyte Tx--group A: no treatment; group B: cyclosporin (20 mg/kg days 0 to 5 and 10 mg/kg days 6 to 15); group C: Dmab (0.05 mg day of Tx and 0.05 mg day 7); and group D: Dmab and cyclosporine. Hepatocytes were transplanted intrasplenically. Animals were followed for 15 days. RESULTS: Statistical analysis showed better survival among groups C (83%, MST = 13) and D (92%, MST = 14.25) compared to groups A (max 72, MST = 1.5) or B (50%, MST = 9). Survival in group D was better but not significantly than group C. Biochemical evaluation and histology confirmed satisfactory function and engraftment, respectively. CONCLUSION: This experimental model showed the safe, effective use of Dmab.

Animals↗

PubMed1991

Therapeutic response of herpes simplex virus-induced corneal edema to trifluridine in combination with immunosuppressive agents.

Herpetic stromal disease often is treated with combinations of antiviral agents and corticosteroids. The addition of steroids to the antiviral treatment regimen frequently increases the efficacy of therapy in patients; however, many complications may arise as a result of corticosteroid therapy. Using a rabbit model, the effects of trifluridine (F3TdR) on corneal edema and stromal disease were examined when combined with each of three immunosuppressive agents. The therapeutic response was evaluated by classifying eyes as either responsive or unresponsive based on the maximum corneal thickness attained during therapy. The data indicate that about 56% of the eyes responded to therapy with 1% F3TdR alone even when therapy was initiated after signs of stromal inflammation had begun to appear and epithelial disease was resolving. Combination of F3TdR with 0.125% prednisolone acetate significantly increased the proportion of responsive eyes to about 78%. Therapy with F3TdR combined with topical 5% cyclosporine A was no better than F3TdR alone, and combination with 0.2% deoxycoformycin and 0.4% 2'-deoxyadenosine significantly decreased the proportion of responsive eyes. These data further document that the responses of stromal disease to therapy must be evaluated on an eye-by-eye basis because the distribution of the data may not be Gaussian in nature. Eyes with corneal edema and stromal disease induced by herpes simplex viral (HSV) infection may respond to therapy with antiviral agents alone, but others require steroid. Still others do not respond to combined therapy. Combining the responses of all eyes in a given treatment group to obtain a "population mean" may be misleading.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

PubMedDate not supplied

Estradiol-induced release of immunosuppressive agent from human malignant melanoma cells.

One human skin fibroblast (HSF) and three human malignant melanoma cell (HMMC) lines were examined for responsiveness to 17 alpha- and 17 beta- estradiol. Responsiveness was monitored by changes in 3H-uridine uptake (nucleic acid synthesis). 3H-leucine uptake (protein synthesis) and to complement-mediated serum cytotoxicity. 17 alpha-Estradiol had no effect on any of the examined cell lines. 17 beta-Estradiol had no effect on HSF, but increased HMMC resistance to complement-mediated serum cytotoxicity, nucleic acid and protein synthesis. An immunosuppressive agent was isolated from HMMC lysates and spent cell-free culture medium.

Cell Division↗

PubMed2005

Cardiovascular complications of immunosuppressive agents in renal transplant recipients.

Fatal and nonfatal cardiovascular events are the most important cause of graft loss in patients with a functioning graft following transplantation. The available data indicate that transplant patients have a high prevalence of hypertension, hyperlipidaemia and new onset diabetes mellitus after transplantation. The aetiology and pathogenesis of post-transplant hypertension, hyperlipidaemia and diabetes are multifactorial. In addition, disease of the native kidney and recurrence of renal disease can contribute to the development of cardiovascular disease in transplant recipients. Most transplant patients are at risk of clinically important drug-drug interactions involving immunosuppressive agents. Adverse reactions and drug-drug interactions should not be neglected when selecting an agent for treatment of cardiovascular risk factors in transplant recipients.

Cardiovascular Diseases↗

PubMed1975

Effects of cytotoxic and immunosuppressive agents on the immune system.

Most chemotherapeutic agents are myelosuppressive and immunosuppressive. Consequently their use greatly increases a patient's susceptibility to infection. Neutropenia creates greater risk than lymphopenia and is a particular problem in patients with acute leukemia who are treated with combination chemotherapy. Chemotherapy is less immunosuppressive if given in short intensive courses rather than continuously. Continuous therapy causes severe depression of antibody production and inhibition of delayed hypersensitivity reaction.

Anti-Bacterial Agents↗

PubMed2003

[New immunosuppressive agents for treating psoriasis].

Accumulative evidence suggests that psoriasis may be a genetically determined immunologenic inflammatory disorder based on an ongoing autoreactive Th-1 response. Various cytokines (e.g. IL-2, interferon-gamma etc.) are released and exert proliferative signals on to keratinocytes, which start proliferation that finally results in an incomplete differentiation. During this pathobiological process keratinocytes themselves express receptors that make them sensitive for growth inducing stimulation and also start the production of a set of cytokines that contribute to and maintain inflammation. Immunosuppressive agents, mostly by affecting T-cells may interfere with or even disrupt by rather unspecific mechanisms, this complex process of mutual stimulation of leucocytes and keratinocytes. In this manuscript we show mode of action, efficacy and side effects of Methotrexate, Ciclosporin A, Tacrolimus and Pimecrolimus, and discuss therapeutic options with mycophenolate mofetil and fumaric acid esters.

Autoantibodies↗

PubMed1996

UVB irradiation of human-derived peripheral blood lymphocytes induces apoptosis but not T-cell anergy: additive effects with various immunosuppressive agents.

UVB irradiation of bone marrow or pancreatic islets has been shown to prevent GVHD and to induce transplant tolerance in experimental animal models. To clarify the underlying mechanism(s) responsible for these UVB effects we have examined in vitro cell function following UVB irradiation using LDA, FACS analysis, and DNA gel electrophoresis to assess the role of UVB-induced anergy and/or cell death. To extend our studies to the clinical setting and to promote chimerism and tolerance to organ allografts, we have further studied the effects of UVB irradiation combined with the commonly used immunosuppressive agents (cyclosporine, azathioprine, and methylprednisolone) on human T cells in proliferative in vitro assays. When cytotoxic and proliferative responses to allogeneic cells or to PHA stimulation were evaluated in LDA, the use of increasing doses of UVB irradiation resulted in a dose-dependent decrease in proliferative and cytotoxic responses of T-cells as seen by decreases in precursor frequencies. The results of proliferative T-cell assays suggest an additive immunosuppressive effect of various immunosuppressive drugs when combined with UVB irradiation. Gel electrophoresis of DNA derived from resting and activated, UVB-irradiated PBLs showed apoptosis at all UVB doses used. FACS analysis of UVB-treated CD2+ cells resulted in a UVB dose-related decrease in cell numbers that correlated with viability studies. It appears that UVB irradiation of both activated and resting PBLs induces programmed cell death but not anergy of T-cells.

Apoptosis↗

PubMedDate not supplied

[Infections and immunosuppressive agents in rheumatology].

The authors review the problem of infection occurring in patients with chronic inflammatory rheumatism, e.g. rheumatoid arthritis, and lupus erythematosus, treated with cytolytic drugs for immunodepressive reasons. From their investigation, it seems that there is a high frequency of bacterial and mycotic and viral infections in these patients, but controlled investigations seem to show quite definitely that the frequency of these infections depends on the disease itself. The risk does not seem to be increased by cytolytic drugs. The only exception is herpes which appears in 10 to 20% of patients treated with immunosuppressive agents, as against 2% in a controll series. The other virus diseases did not have an abnormally high frequency. The conclusions are, of course, only of value for the types of treatment used in rheumatology.

Arthritis, Rheumatoid↗

PubMed1994

Effect of immunosuppressive agents FK 506 and cyclosporin and steroids on the expression of IL-6 and its receptor by stimulated lymphocytes and monocytes.

The interaction of interleukin-6 (IL-6) with its receptor (IL-6R) is not well understood. In the present study, we investigated the effect of different immunosuppressive agents on the expression of the couple IL-6/IL-6R on cultured lymphocytes and monocytes. IL-6 in culture supernatants from cultured monocytes were analyzed by ELISA. The expression of IL-6R was studied by flow cytometry. Dexamethazone, cyclosporin (CyA), and FK 506 at immunosuppressive concentrations induced a dose-dependent inhibition of IL-6 secretion from adherent monocytes (MO) stimulated with phytohemagglutinin (PHA). Dexamethazone was the most effective agent in inhibiting IL-6 secretion, while the inhibitory effect observed with 1 ng/ml FK 506 was comparable with that obtained with 100 ng/ml CyA. Unstimulated MO strongly expressed IL-6R (80% positive cells). Stimulation of MO with PHA resulted in a significant downregulation of IL-6R expression. Treatment of PHA-stimulated adherent MO with different concentrations of CyA and FK 506 induced a restoration of IL-6R expression. FK 506 was 100 time more effective in restoring IL-6R than CyA. This restoration of IL-6R was incomplete. FK 506, CyA, and steroids may exert their immunosuppressive effect by inhibiting IL-6 secretion and partially restoring MO IL-6R, which may be important in protecting the cell target against IL-6 autocrine stimulation.

Cells, Cultured↗

PubMed1982

Immunosuppressive agents prevent guanethidine-induced destruction of rat sympathetic neurons.

Chronic administration of guanethidine to rats causes destruction of peripheral sympathetic neurons. Neuronal destruction, characterized morphologically by small cell infiltration and the reduction in the number of neurons within sympathetic ganglia, and biochemically by a marked reduction in tyrosine hydroxylase activity, occurred reproducibly by day 7 of treatment following 5 daily injections of 50 mg/kg guanethidine sulfate. Several observations in the literature suggested that guanethidine-induced destruction may occur by an immunologically mediated mechanism. Experiments were therefore designed to test the effects of immunosuppressive agents on guanethidine sympathectomy. A single exposure to either gamma-irradiation or cyclophosphamide, administered 8 h prior to the initiation of guanethidine treatment, protected against guanethidine-induced destruction in a dose-related manner and was virtually complete with either 900 rads of irradiation or with 100 or 150 mg/kg of cyclophosphamide. Cyclophosphamide afforded complete protection only if administered immediately prior to guanethidine treatment suggesting that it was acting during the proliferative phase of an immune response rather than non-specifically. Pretreatment with either irradiation or cyclophosphamide had no effect on the sympathectomy produced by treatment with either 6-hydroxydopamine or antibodies to nerve growth factor, nor did it prevent the accumulation of guanethidine within the sympathetic ganglia. Concurrent treatment with either azathioprine or dexamethazone also provided partial protection against guanethidine sympathectomy. These results strongly suggest that the destruction of sympathetic neurons induced by guanethidine occurs by an immunologically mediated mechanism.

Animals↗

PubMed1991

Pyrrolo[3,2-d]pyrimidines, a new class of purine nucleoside phosphorylase (PNP) inhibitors as potential T-cell selective immunosuppressive agents.

Previously, we have described the synthesis and biological activity of 2,8-diamino-1,9-dihydro-9-(2-thienylmethyl)-6H-purin-6-one (PD 119229; Cl-950) as a potent and competitive PNP inhibitor. As a part of our continuing efforts to develop a PNP inhibitor for autoimmune diseases, we have synthesized a series of pyrrolo[3,2-d]pyrimidines as PNP inhibitors. In this series, 2,6-diamino-3,5-dihydro-7-(3- thienylmethyl)-4H-pyrrolo-[3,2-d]pyrimidin-4-one (Cl-972) was found to be a potent, competitive inhibitor of PNP with Ki of 0.83 microM. It was also found to be selectively cytotoxic to human MOLT-4 (T cell) (IC50 = 3.0 microM) but non-toxic to MGL-8 (B cell) lymphoblasts. Cl-972 is under development as a potential T-cell selective immunosuppressive agent. Synthesis and biological activities of the series are discussed.

Cell Line↗

PubMed1979

Immunosuppressive agents in the treatment of the nephrotic syndrome and glomerulonephritis in children.

There is good, controlled evidence which suggests that cyclophosphamide, and perhaps related drugs, have a definite role in the treatment of nephrotic children with the minimal change lesion. This role is one of secondary treatment, and the drugs should not be used as a first line of attack; they should be employed only when corticosteroid resistance or toxicity is a problem. In a few patients, azathioprine or 6-mercaptopurine may have a role in minimising corticosteroid toxicity, but the remission induced in relapsing children is no more durable than that after corticosteroids. Chlorambucil must be given in doses, and for periods long enough to run the risk of neoplasia, particularly leukaemia; there does not appear to be a place for its use in nephrotic children unless the duration of remission can be shown to be longer than that obtainable with cyclophosphamide. There is no evidence that any immunosuppressive agent has a place in the management of children with idiopathic glomerular disease showing structural alterations in the glomeruli. Children with systemic lupus erythematosus and nephritis may benefit from the addition of cytotoxic agents to their corticosteroid regime, although the indications for this are not clear, and controlled evidence is lacking.

Azathioprine↗

PubMed2003

APC0576: a novel small molecule, immunosuppressive agent effective in primate models.

BACKGROUND: APC0576, 5-(((S)-2,2-dimethylcyclopropanecarbonyl)amino)-2-(4-(((S)-2,2-dimethylcyclopropanecarbonyl)amino)phenoxy)pyridine is a novel synthetic compound with an inhibitory activity on NF-kappaB-dependent gene activation and chemokine synthesis in human endothelial cells. This article describes the effect of APC0576 on T-cell-dependent immune functions in vitro and in vivo in primate models, because NF-kappaB is known to be one of the potent mediators in T-cell activation. METHODS: The effects of APC0576 on interleukin-2 production and proliferative responses in human peripheral blood mononuclear cells were studied under various stimuli with in vitro culture assay. Next, female rhesus monkeys were immunized with tetanus toxoid (TTx), and APC0576 was orally administered for 4 weeks. Serum-specific antibody for TTx was monitored weekly using an enzyme-linked immunosorbent assay, and delayed-type hypersensitivity reaction was examined after 4 weeks of APC0576 treatment. To evaluate the immunosuppressive activity, APC0576 was orally administered for 32 days to rhesus monkeys that received transplants of allogeneic kidney. RESULTS: APC0576 effectively suppressed interleukin-2 production and proliferation in activated human peripheral blood mononuclear cells. Both delayed-type hypersensitivity reaction and specific antibody formation evoked by TTx was significantly and dose-dependently attenuated by 4 weeks treatment of APC0576 without any serious toxicologic signs. Allogeneic kidneys grafted in rhesus monkeys were not rejected and fully functioned during the 32 days of APC0576 treatment, although they were rapidly rejected after the withdrawal of the drug. CONCLUSIONS: A novel, orally available immunosuppressive agent, APC0576, effectively inhibited T-cell-based immune responses both in vitro and in vivo. APC0576 may have potential for a therapeutic agent in clinical organ transplantation and various cytokine-mediated diseases.

Animals↗

PubMed1994

Effects of FK506, an immunosuppressive agent, on genesis of water-immersion stress-induced gastric lesions in rats.

We examined the effects of FK506, an immunosuppressive agent, on the genesis of water immersion stress-induced gastric lesions in rats. Using high-performance liquid chromatography, four kinds of prostaglandins, ie, 6-keto-prostaglandin F1 alpha, prostaglandin F2 alpha, prostaglandin E2, and prostaglandin D2, were detected, and no leukotrienes were detected in gastric mucosa in rats without stress. After 6 hr of stress, gastric lesions developed with decreases in all prostaglandin contents, and the emergence of peptide leukotrienes was observed. Intramuscular administration of FK506 (0.1, 0.25, 0.5, 1.0, and 2.0 mg/kg) reduced lesion index dose-dependently. Administration of FK506 at doses over 0.25 mg/kg decreased all prostaglandin contents, but did not affect the increase in leukotriene contents. Pretreatment with famotidine or omeprazole reduced lesion index, and the protective effects were equivalent to those of 1.0 mg/kg of FK506, although FK506 did not affect gastric secretion during water-immersion stress. Water-immersion stress did not change the activities of xanthine oxidase in either stomach or serum. Polyoxyethylene-modified superoxide dismutase did not prevent gastric lesions. Water-immersion stress significantly increased myeloperoxidase activity in gastric mucosa, and FK506 reduced the increase in myeloperoxidase activity induced by stress. From our results, other factors besides gastric acid secretion and tissue eicosanoid contents, such as chemoattractant factor, might also be involved in the genesis of water-immersion stress-induced gastric lesions in rats.

Animals↗

PubMed1995

Immunosuppressive agents in the treatment of Crohn's disease and ulcerative colitis.

Low doses of 6-mercaptopurine (6MP) were used for the treatment of inflammatory bowel disease, and 20-30 mg/day was found to be effective for patients with ulcerative colitis who were corticosteroid-dependent or corticosteroid-resistant. Corticosteroid was tapered in 20 of 21 patients with ulcerative colitis. Of 15 patients who were refractory to conventional therapy, 11 responded to 6MP treatment. The same doses of 6MP were given to patients with Crohn's disease who were corticosteroid-dependent or who had associated fistula. Treatment with 6MP did not influence the changes in colonic or ileac lesions in Crohn's disease. However, the fistulas were closed or improved in 70% of 10 patients by 6MP treatment. The adverse effects of small doses of 6MP were minimal. These results confirm that immunosuppressive agents are effective for patients with inflammatory bowel disease. In a rat colitis model induced by immunization with trinitrobenzene (TNB), we used anti-CD4 monoclonal antibodies to prevent colonic inflammation; these antibodies were effective for this colitis model, suggesting that a novel therapy targeting CD4 intestinal lymphocytes may be feasible in the treatment of Crohn's disease.

Animals↗