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Baboudjian M, Gondran-Tellier B, Boissier R, Ancel P, Marjollet J, Lyonnet L, François P, Sabatier F, Lechevallier E, Dutour A, Paul P. An enhanced level of VCAM in transplant preservation fluid is an independent predictor of early kidney allograft dysfunction. Front Immunol 2022; 13:966951. [PMID: 36032101 PMCID: PMC9403542 DOI: 10.3389/fimmu.2022.966951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background We aimed to evaluate whether donor-related inflammatory markers found in kidney transplant preservation fluid can associate with early development of kidney allograft dysfunction. Methods Our prospective study enrolled 74 consecutive donated organs who underwent kidney transplantation in our center between September 2020 and June 2021. Kidneys from 27 standard criteria donors were allocated to static cold storage and kidneys from 47 extended criteria donors to hypothermic machine perfusion. ELISA assessment of inflammatory biomarkers (IL-6, IL6-R, ICAM, VCAM, TNFα, IFN-g, CXCL1 and Fractalkine) was analyzed in view of a primary endpoint defined as the occurrence of delayed graft function or slow graft function during the first week following transplantation. Results Soluble VCAM levels measured in transplant conservation fluid were significantly associated with recipient serum creatinine on day 7. Multivariate stepwise logistic regression analysis identified VCAM as an independent non-invasive predictor of early graft dysfunction, both at 1 week (OR: 3.57, p = .04, 95% CI: 1.06-12.03) and 3 Months (OR: 4.039, p = .034, 95% CI: 1.11-14.73) after transplant surgery. Conclusions This prospective pilot study suggests that pre-transplant evaluation of VCAM levels could constitute a valuable indicator of transplant health and identify the VCAM-CD49d pathway as a target to limit donor-related vascular injury of marginal transplants.
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Affiliation(s)
- Michael Baboudjian
- Department of Urology and Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux Marseille, Marseille, France
- Department of Urology, Assistance Publique-Hôpitaux de Marseille, Hopital Nord, Aix-Marseille University, Marseille, France
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Bastien Gondran-Tellier
- Department of Urology and Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux Marseille, Marseille, France
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Romain Boissier
- Department of Urology and Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux Marseille, Marseille, France
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Patricia Ancel
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Juline Marjollet
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Luc Lyonnet
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, Marseille, France
| | - Pauline François
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
| | - Florence Sabatier
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Cell Therapy Laboratory, Centre d'Investigation Clinique (CIC)-149, La Conception Hospital, Assistance Publique-Hôpitaux Marseille, Marseille, France
| | - Eric Lechevallier
- Department of Urology and Transplantation, La Conception Hospital, Assistance Publique-Hôpitaux Marseille, Marseille, France
| | - Anne Dutour
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Endocrinology, Metabolic Diseases and Nutrition Department, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Pascale Paul
- Institut national de la santé et de la recherche médicale (INSERM) 1263, Aix Marseille University, French national research institute for agriculture, food and the environment (INRAE), Centre de recherche en CardioVasculaire et Nutrition (C2VN), Marseille, France
- Department of Hematology, Hopital de la Conception, Assistance Publique-Hôpitaux Marseille, Marseille, France
- Institut national de la santé et de la recherche médicale (INSERM) unité mixte de recherche (UMR)_1090, Aix Marseille University, TAGC Theories and Approaches of Genomic Complexity, Parc Scientifique de Luminy Case 928, Marseille, France
- *Correspondence: Pascale Paul,
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A synergistic effect of Ambroxol and Beta-Glucosylceramide in alleviating immune-mediated hepatitis: A novel immunomodulatory non-immunosuppressive formulation for treatment of immune-mediated disorders. Biomed Pharmacother 2020; 132:110890. [DOI: 10.1016/j.biopha.2020.110890] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 12/12/2022] Open
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Kłoda K, Domański L, Pawlik A, Wiśniewska M, Safranow K, Ciechanowski K. The impact of ICAM1 and VCAM1 gene polymorphisms on chronic allograft nephropathy and transplanted kidney function. Transplant Proc 2014; 45:2244-7. [PMID: 23953534 DOI: 10.1016/j.transproceed.2013.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/15/2012] [Accepted: 03/06/2013] [Indexed: 10/26/2022]
Abstract
ICAM-1 and VCAM-1 adhesion molecules play important roles in the immune response and emergence of chronic allograft nephropathy (CAN). The several polymorphisms of ICAM1 and VCAM1 genes are associated with changes in molecular expression therefore affecting allograft function and immune responses after kidney transplantation. The aim of this study was to examine the impact of polymorphisms in ICAM1 and VCAM1 genes on biopsy-proven CAN and renal allograft function. The 270 Caucasian renal transplant recipients (166 men and 104 women) were genotyped for the rs5498 ICAM1 and rs1041163 and rs3170794 VCAM1 gene polymorphisms using real-time polymerase chain reaction. There was no correlation between polymorphisms and CAN. Creatinine concentrations in the first month after transplantation differed between the rs5498 ICAM1 genotypes (P = .095), being higher for GG carriers (AA + AG vs GG, P =.07) albeit not with statistical significance. Creatinine concentrations at 12, 24, and 36 months after transplantation differed significantly among rs5498 ICAM1 genotypes (P = .0046, P =.016, and P = .02) and were higher among GG carriers (AA + AG vs GG, P = .001, P = .004, and P = .006). Rs5498 ICAM1 GG genotype and receipient male gender were independent factors associated with higher creatinine concentrations. These results suggest that the rs5498 ICAM1 GG genotype may be associated with long-term allograft function.
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Affiliation(s)
- K Kłoda
- Clinical Department of Nephrology, Transplantology and Internal Medicine, Pomeranian Medical University in Szczecin, Szczecin, Poland
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Martin ST, Tichy EM, Gabardi S. Belatacept: A Novel Biologic for Maintenance Immunosuppression After Renal Transplantation. Pharmacotherapy 2011; 31:394-407. [DOI: 10.1592/phco.31.4.394] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
Pharmacokinetic drug monitoring has been used for many years to relate immunosuppressant dose to drug exposure in vivo. However, this conventional therapeutic drug monitoring of blood immunosuppressant levels may not necessarily predict the pharmacologic effects on immune cells. The direct determination of target enzyme activity (eg, calcineurin activity, inosine-5'-monophospahte dehydrogenase [IMPDH] activity, p70S6 kinase) may help to better assess the individual response to the immunosuppressant. However, its use is limited by the difficulties of the assay systems, which did not allow yet the prospective assessment of these enzymes in larger patient cohorts with the establishment of validated pharmacodynamic drug monitoring. The most progress regarding a robust and reproducible test system has been achieved with the determination of IMPDH activity as a specific pharmacodynamic parameter of mycophenolic acid activity. This recently validated and standardized assay allows the investigation of IMPDH activity in larger clinical studies. Although the determination of target enzyme activity, eg, by the determination of IMPDH activity, holds promise for a more individualized therapy in transplant medicine, more studies are needed to prospectively validate this approach.
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Chiarelli LR, Molinaro M, Libetta C, Tinelli C, Cosmai L, Valentini G, Dal Canton A, Regazzi M. Inosine monophosphate dehydrogenase variability in renal transplant patients on long-term mycophenolate mofetil therapy. Br J Clin Pharmacol 2010; 69:38-50. [PMID: 20078611 DOI: 10.1111/j.1365-2125.2009.03542.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT * Mycophenolic acid (MPA) is a potent, selective and reversible inhibitor of inosine 5'-monophosphate dehydrogenase (IMPDH), the rate-limiting enzyme for de novo guanosine triphosphate biosynthesis. * The large IMPDH interindividual variability could be responsible for the differences in therapeutic effects and side-effects observed with MPA. * Induction of IMPDH activity has been observed in whole blood during immunosuppressive therapy. WHAT THIS STUDY ADDS * Our data were acquired in long-term mycophenolate mofetil-treated renal transplant recipients on different combinations of immunosuppressive agents (ciclosporin, tacrolimus, sirolimus) and with different treatment duration (up to 8.8 years post transplant). * The increasing trend in IMPDH activity that we observed throughout our 12-month observation period was significantly higher in rejecting than in nonrejecting subjects. AIMS Long-term mycophenolate mofetil (MMF) therapy may induce inosine 5'-monophosphate dehydrogenase (IMPDH) activity in peripheral blood mononuclear cells (PBMCs), thus decreasing MMF immunosuppressive properties. Pharmacodynamic monitoring was used to investigate whether biological activity is altered after long-term therapy. METHODS IMPDH activity was measured in PBMC samples from 54 stable kidney transplant patients, already on MMF (for at least 3 months), before (t(0)) and 2 h after (t(2)) MMF morning dose administration; levels were monitored for up to 15 months, together with total mycophenolic acid (MPA) and free MPA concentrations. RESULTS During the 15 months' monitoring, t(0) IMPDH activity in transplant recipients increased from 5.9 +/- 3.7 nmol h(-1) mg(-1)[95% confidence interval (CI) 4.9, 6.9] to 9.0 +/- 3.9 nmol h(-1) mg(-1) (95% CI 7.2, 10.8), with an intra- and interpatient variability of 28% and 42%. Five patients experienced acute rejection during the follow-up: t(0) IMPDH activity was increased during rejection vs. nonrejection, and the trend was significantly higher in rejecting than in nonrejecting subjects for the whole monitoring period. CONCLUSIONS Even though a correlation has been found between IMPDH activity and rejection, its efficacy as a predictive tool in long-term transplant outcomes may be affected by high interpatient variability; on the other hand, continuous monitoring of the IMPDH trend could make an effective prognostic parameter of rejection. Other trials also including pre-transplant data on both IMPDH expression and activity are warranted to better assess their role as biomarkers for MPA effect in clinical practice.
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Affiliation(s)
- Laurent R Chiarelli
- Department of Biochemistry, University of Pavia, Pharmacokinetics Unit, Pavia, Italy
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Marquet P. Counterpoint: Is Pharmacokinetic or Pharmacodynamic Monitoring of Calcineurin Inhibition Therapy Necessary? Clin Chem 2010; 56:736-9. [DOI: 10.1373/clinchem.2009.138693] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Pierre Marquet
- INSERM U850, Limoges, France
- University of Limoges, laboratory of clinical pharmacology, Limoges, France
- CHU Limoges, Department of Pharmacology-Toxicology, Limoges, France
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van Rossum HH, Romijn FP, Smit NP, de Fijter JW, van Pelt J. Everolimus and sirolimus antagonize tacrolimus based calcineurin inhibition via competition for FK-binding protein 12. Biochem Pharmacol 2009; 77:1206-12. [DOI: 10.1016/j.bcp.2008.12.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Revised: 12/15/2008] [Accepted: 12/16/2008] [Indexed: 12/16/2022]
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Böhler T, Canivet C, Nguyen PNL, Galvani S, Thomsen M, Durand D, Salvayre R, Negre-Salvayre A, Rostaing L, Kamar N. Cytokines correlate with age in healthy volunteers, dialysis patients and kidney-transplant patients. Cytokine 2009; 45:169-73. [DOI: 10.1016/j.cyto.2008.11.014] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 10/05/2008] [Accepted: 11/29/2008] [Indexed: 11/27/2022]
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CD40: an upstream master switch for endothelial cell activation uncovered by RNAi-coupled transcriptional profiling. Blood 2008; 112:3624-37. [DOI: 10.1182/blood-2008-03-143305] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The CD40-CD154 dyad seems to play a prominent role fostering the immune-inflammatory response triggered by endothelial cell (EC)–T-cell communication. To delineate comprehensively the involvement of CD40 (TNFRSF5) in EC activation, we combined RNAi-mediated CD40 knockdown with comparative genome-wide transcriptional profiling of ECs interacting with (CD154+) T cells. We report the initiation of a profound stress response in ECs upon CD40-CD154 engagement through early up-regulation of, among others, the major proinflammatory NF-κB and MAPK/SAPK pathways and their associated transcription factors. Moreover, we have identified novel genes regulated through the CD40-CD154 interaction, and pathways previously unrecognized to be induced by CD40 signaling in ECs. Thus, we document a significant down-regulation of endothelial APLN by CD40-CD154 interaction, TNFα/IFNγ exposure, and in immune-inflammatory pathologies, which could lead to hemodynamic dysfunction. Conversely, CD40-mediated up-regulation of the viral immune surveillance system, notably TLR3, IFIH1, RIG-I, and RNASEL, establishes a reverse link from adaptive to innate immunity in ECs. Moreover, systematic enrichment analysis substantiates endothelial CD40 involvement in the transcriptional regulation of gene networks associated with adhesion and motility, immunity, cell fate control, hemostasis, and metabolism. Our study also highlights the anti-inflammatory potential of RNAi-mediated CD40 inhibition, and the relevance of CD40 signaling for therapeutic intervention.
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Hiestand PC, Rausch M, Meier DP, Foster CA. Ascomycete derivative to MS therapeutic: S1P receptor modulator FTY720. PROGRESS IN DRUG RESEARCH. FORTSCHRITTE DER ARZNEIMITTELFORSCHUNG. PROGRES DES RECHERCHES PHARMACEUTIQUES 2008; 66:361, 363-81. [PMID: 18416311 DOI: 10.1007/978-3-7643-8595-8_8] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Fingolimod (FTY720) represents the first in a new class of immune-modulators whose target is sphingosine-1-phosphate (S1P) receptors. It was first identified by researchers at Kyoto University and Yoshitomi Pharmaceutical as a chemical derivative of the ascomycete metabolite ISP-1 (myriocin). Unlike its natural product parent, FTY720 does not interfere with sphingolipid biosynthesis. Instead, its best characterized mechanism of action upon in vivo phosphorylation, leading to the active principle FTY720-P, is the rapid and reversible inhibition of lymphocyte egress from peripheral lymph nodes. As a consequence of S1P1 receptor internalization, tissue-damaging T-cells can not recirculate and infiltrate sites of inflammation such as the central nervous system (CNS). Furthermore, FTY720-P modulation of S1P receptor signaling also enhances endothelial barrier function. Due to its mode of action, FTY720 effectively prevents transplant rejection and is active in various autoimmune disease models. The most striking efficacy is in the multiple sclerosis (MS) model of experimental autoimmune encephalomyelitis, which has now been confirmed in the clinic. FTY720 demonstrated promising results in Phase II trials and recently entered Phase III in patients with relapsing MS. Emerging evidence suggests that its efficacy in the CNS extends beyond immunomodulation to encompass other aspects of MS pathophysiology, including an influence on the blood-brain-barrier and glial repair mechanisms that could ultimately contribute to restoration of nerve function. FTY720 may represent a potent new therapeutic modality in MS, combined with the benefit of oral administration.
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Brunet M, Campistol JM, Diekmann F, Guillen D, Millán O. T-cell function monitoring in stable renal transplant patients treated with sirolimus monotherapy. Mol Diagn Ther 2007; 11:247-56. [PMID: 17705579 DOI: 10.1007/bf03256246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sirolimus is an agent with lymphocyte-specific features similar to those of calcineurin inhibitors but with a different mechanism of action and safety profile. To optimize the use of sirolimus-based immunosuppression, further investigation of appropriate pharmacokinetic (sirolimus exposure) and pharmacodynamic (sirolimus T-cell immunomodulator effect) monitoring is required to determine personalized target concentrations. AIM The main objective of the study was to evaluate the feasibility and reproducibility of combined pharmacokinetic and pharmacodynamic monitoring and to apply biomarkers of immunosuppression in stable kidney transplant recipients receiving sirolimus monotherapy. METHODS Fourteen renal transplant patients treated with sirolimus monotherapy (median 2 years) were included in this study. Pharmacokinetic and pharmacodynamic parameters were evaluated in each patient three times: at inclusion in the study (day 1), then again at 3 and 6 months. RESULTS The median sirolimus concentration was 11.5 ng/mL. CD4+ T-cell adenosine triphosphate (ATP) concentrations (150 ng/mL) and interleukin (IL)-10 production (50.9 ng/mL) were significantly lower in treated patients than in healthy controls (n = 95) [301 ng/mL; 278 ng/mL, respectively]. Median inhibition of T-cell proliferation was 60% (31-96%) in treated patients. Interferon-gamma and transforming growth factor-beta production was found to be similar to those in the healthy controls. Our results suggest an association between low ATP and IL-10 concentrations and the presence of infection. CONCLUSIONS The sequential measurement of these biomarkers in stable renal transplant recipients treated with monotherapy could be useful to evaluate the biological effect of sirolimus in each patient and to establish personalized therapy taking into account the individual response to the drug.
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Affiliation(s)
- Mercè Brunet
- Laboratorio de Farmacología, Centre de Diagnòstic Biomèdic, IDIBAPS, Hospital Clínic, Barcelona University, Barcelona, Spain.
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FTY720 Versus Mycophenolate Mofetil in De Novo Renal Transplantation: Six-Month Results of a Double-Blind Study. Transplantation 2007; 84:885-92. [DOI: 10.1097/01.tp.0000281385.26500.3b] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Böhler T, Nolting J, Kamar N, Gurragchaa P, Reisener K, Glander P, Neumayer HH, Budde K, Klupp J. Validation of Immunological Biomarkers for the Pharmacodynamic Monitoring of Immunosuppressive Drugs in Humans. Ther Drug Monit 2007; 29:77-86. [PMID: 17304154 DOI: 10.1097/ftd.0b013e318030a40b] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pharmacodynamic monitoring (PD) can evaluate the efficacy of immunosuppressive drug therapies. In this study, the expressions of PD biomarkers [lymphocyte proliferation, CD25 and CD71 expression, interleukin-2 (IL-2), and tumor necrosis factor-alpha (TNF-alpha) synthesis] were determined in whole-blood assays and were validated for their application in PD of immune modulators in future clinical trials. Initially, the assay conditions were re-evaluated. The measurement of T-lymphocyte proliferation and activation marker expression in whole-blood cultures resulted in optimized stimulation for 72 hours with 7.5 microg/mL concavalin A. Intracellular cytokine expression of CD3+ T-cells received optimized stimulation for 4 hours with 15 ng/mL phorbol 12-myristate 13-acetate and 0.75 microg/mL ionomycin. Statistical assay parameters (intra-assay, intra-individual, and interindividual variabilities) were determined. It was found that blood storage for up to 24 hours is possible without any change in biomarker expression. Dosage effects of immunosuppressive drugs (tacrolimus, cyclosporin A, sirolimus, mycophenolic acid, and methylprednisolone) were evaluated in vitro and the assay was applied successfully to dialysis, renal transplant, and liver transplant patients. We conclude that these biomarkers used in whole-blood assays are suitable for PD of immune modulators in clinical trials.
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