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New immunosuppressive agents for pediatric transplantation.

Pediatric transplantation has always been challenging for transplant surgeons. Although the higher immunoreactivity and the faster metabolism showed by this unique population when compared with adults requires a heavy immunosuppressive regimen, the possibility of disrupting the delicate balance of correct psychophysical development calls for a regimen of more selective and less toxic immunosuppressive drugs. In the past decade several new drugs have been investigated and some of them appear to be very promising, although pleiotropic toxicities have not yet been eliminated. An appropriate pharmacokinetic approach and the evaluation of synergistic multi-drug combinations by rigorous mathematical models would lead to highly selective immunosuppressive regimens which may result in virtually no toxicity.

Child↗

The novel JAK-3 inhibitor CP-690550 is a potent immunosuppressive agent in various murine models.

JAK-3 has been shown to play a key role in cytokine signaling via gammac, e.g. IL-2, 4, 7, 9, 15, 21. The current study describes the immunosuppressive effects of CP-690550, a novel, small molecule inhibitor of JAK-3, in various murine models. In vitro, CP-690550 effectively inhibited a murine mixed lymphocyte reaction (MLR) (IC50= 91 nm). Mice chronically dosed with CP-690550 (1.5-15 mg/kg/day) demonstrated dose- and time-dependent alterations in lymphocyte subsets when examined by flow cytometry. The most dramatic change observed was a 96% reduction in splenic NK1.1 + TCRbeta- cell numbers following 21 days of treatment. Delayed-type hypersensitivity (DTH) responses in sensitized mice were reduced in a dose-dependent manner following treatment with the JAK-3 inhibitor (1.87-30 mg/kg, s.c.). Extended survival of neonatal Balb/c hearts implanted into the ear pinna of MHC mismatched C3H/HEN mice was observed with CP-690550 monotherapy (10-30 mg/kg/day), but improved upon combination with cyclosporin (10 mg/kg/day). These data support the participation of JAK-3 in various lymphocyte homeostatic functions in mature mice. Furthermore, the ability of CP-690550 to extend cardiac allograft survival in murine models suggests it may afford a new treatment for prevention of transplant rejection.

Animals↗

What role for FTY720, a novel immunosuppressive agent, in canine nonmyeloablative hematopoietic stem cell transplantation?

BACKGROUND: Stable mixed donor/host hematopoietic chimerism was almost uniformly achieved in dogs given 200 cGy total body irradiation (TBI) before, and a short course of immunosuppression after, transplantation of marrow from dog leukocyte antigen-identical littermates, but was transient when the TBI dose was decreased to 100 cGy. Here, we examined whether stable engraftment could be achieved in five dogs given FTY720 (days -5 and -4), followed by 100 cGy TBI, dog leukocyte antigen-identical marrow grafts, and mycophenolate mofetil/cyclosporine. RESULTS AND CONCLUSIONS: Although all five dogs showed initial engraftment, four dogs rejected their grafts within 11 weeks, whereas one dog was euthanized on day 17 due to enteritis. This was not different from the control dogs not given FTY720 (P=0.32). Thus, FTY720 failed to enhance allogeneic engraftment in this model, perhaps due to in vivo T-cell depletion of the graft resulting from sequestration of donor lymphocytes in host central lymphoid tissues.

Animals↗

Disruption of myofibrillar proteins in cardiac muscle of Calomys callosus chronically infected with Trypanosoma cruzi and treated with immunosuppressive agent.

Calomys callosus (Rodentia: Cricetidae) chronically infected with CL strain of Trypanosoma cruzi undergo recrudescence of the acute phase when treated with the immunosuppressor cyclophosphamide. The distribution of cytoskeletal proteins in cardiac tissue of immunosuppressed animals was mapped by immunofluorescence and electron microscopy to evaluate myofibrillar distribution during the intracellular life cycle of T. cruzi. Cardiac muscle sections showed enhancement of myocarditis and parasite proliferation after immunosuppression. Immunofluorescence using monoclonal antibodies against myosin, actin, desmin, titin, tropomyosin, and troponin T demonstrated disruption and loss of contractile proteins, such as myosin and actin. Desmin and titin were irregularly distributed in close proximity to parasite nests. Ultrastructural observations confirmed alterations of cardiac cells with Z-line fragmentation, indistinguishable I-bands and A-bands, and loss of myofibrillar elements. The disruption of the muscle cell architecture was greater as infection progressed, probably as a result of increased myocarditis and physical displacement due to the activity of flagellated parasites.

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