Ex vivo assessment of immunosuppression in undiluted whole blood from pigs dosed with tacrolimus (FK506)

Toll-Like Receptors: Ligands, Cell-Based Models, and Readouts for Receptor Action

This chapter details Toll-like receptors (TLRs) and the tools available to study their biology in vitro. Key parameters to consider before exploring TLR action such as receptor localization, signaling pathways, nature of ligands and cellular expression are introduced. Cellular models (i.e., host cells and readouts) based on the use of cell lines, primary cells, or whole blood are presented. The use of modified TLRs to circumvent some technical problems is also discussed.

Mycophenolic Acid Interaction With Cyclosporine and Tacrolimus In Vitro and In Vivo

The effect of mycophenolic acid (MPA) in combination with either cyclosporine (CsA) or tacrolimus (TRL) on whole-blood lymphocyte function was assessed in vitro as well as in vivo. For the in vitro studies, rat whole blood was incubated with different concentrations of MPA together with CsA or TRL. In vivo, rats (n = 6 per group) were orally treated with 2.5 or 5 mg/kg of mycophenolate mofetil (MMF), either alone or in combination with 5 mg/kg CsA or 4 mg/kg TRL. Blood was obtained before and at different times after dosing. For both in vitro and in vivo studies, mitogen-stimulated whole blood was analyzed by flow cytometry to determine inhibition of expression of lymphocyte proliferation (proliferating cell nuclear antigen, PCNA) and T-cell activation (eg, CD25). Plasma MPA concentrations were measured by HPLC, and whole-blood CsA and TRL concentrations were quantified using LC-MS/MS. In vitro, low concentrations of 250 and 500 nM MPA acted additively with CsA and overadditively with TRL to suppress lymphocyte function, whereas higher MPA concentrations (1000 nM) in these combinations did not further increase inhibition compared with monotherapy with CsA or TRL alone. In vivo, the MPA AUC0-24 showed a dose-dependent increase. CsA and TRL AUC0-24 were not influenced by the MMF dose. Combination therapy increased inhibition of lymphocyte function compared with MMF monotherapy with a pronounced effect on PCNA compared with CD25. Significant differences between 2.5 and 5 mg/kg MMF in the combination groups were observed at 2 or 6 hours after dosing because of the maximal inhibitory effect on PCNA and CD25 expression (P < 0.05, ANOVA). However, in combination with TRL no different effects on the inhibition of CD25 expression were found between the 2 MMF doses. These novel data indicate that measurement of pharmacodynamic parameters of lymphocyte function in whole blood may help to monitor drug combination therapy and provide a rationale for drug reduction to minimize toxicity without compromising efficacy.

Flow cytometric quantitation of calcium-dependent and -independent mitogen-stimulation of T cell functions in whole blood: inhibition by immunosuppressive drugs in vitro

We have optimized assays to measure mitogen-stimulated rat lymphocyte activation in whole blood and have used these assays to quantitate the potencies of immunosuppressive drugs with different mechanisms of action. To define the optimal conditions for measuring T cell functions in whole blood, the effects of different concentrations of mitogens that activate T cells through calcium-dependent and -independent pathways were measured over time. Proliferation was measured by tritium-labeled thymidine ([3H]-TdR) incorporation and by flow cytometric analysis of proliferating cell nuclear antigen (PCNA)/DNA content. Furthermore, we detected the increases in percent expression of cell-surface activation antigens (CD25, CD134, CD71, CD11a and CD54). Concanavalin A (Con A) stimulated maximum lymphocyte proliferation and expression of T cell surface activations by 72-96 h, which was 48 h later than stimulation by phorbol 12-myristate 13-acetate (PMA) plus anti-CD28 monoclonal antibody (mAb) or PMA plus ionomycin (IONO). Addition of sirolimus, tacrolimus, cyclosporine or the active metabolite of leflunomide, A77 1726, to mitogen-stimulated whole blood produced drug concentration-dependent inhibitions of lymphocyte proliferation and expression of cell surface activation antigen expression. From these data, we determined drug potencies (inhibitory concentration of 50%, IC(50)) and drug concentrations causing maximum inhibition of T cell functions (I(max)). We developed simple and reproducible assays to measure different lymphocyte functions in whole blood cultures. These assays were used to investigate the mechanisms of different immunosuppressive drugs. These methods can be exploited to measure T cell functions in blood collected from subjects treated with immunosuppressants in vivo.