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Ousti A, Slama L, Rhazi R, Lamzouri O, Taheri H, Saadi H, Mimouni A. Successful maternal and fetal outcomes in a kidney transplant patient under everolimus throughout pregnancy complicated by pyelonephritis and preeclampsia. AJOG GLOBAL REPORTS 2022; 2:100093. [PMID: 36591604 PMCID: PMC9794561 DOI: 10.1016/j.xagr.2022.100093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Pregnancy in kidney transplant patients has many risks such as worsening renal function and/or proteinuria, allograft rejection, preeclampsia, spontaneous abortion, premature fetal delivery, and low fetal birthweight. We report a case of a 35-year-old patient with a history of kidney transplant, who received everolimus throughout pregnancy and experienced a successful cesarean delivery with positive maternal and fetal outcomes. Information regarding everolimus use in pregnancy is limited. However, data from animal studies suggest that everolimus may cause fetal harm when administered during pregnancy. In our case, everolimus did not affect the pregnancy of this patient; cesarean delivery was performed without complications. Owing to the increased risks and monitoring required during pregnancy in patients with a previous kidney transplant and limited information regarding the use of antirejection agents during pregnancy, care throughout pregnancy should involve a multidisciplinary team, including transplant, maternal fetal medicine, and nephrology.
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Klingenberg R, Stähli BE, Heg D, Denegri A, Manka R, Kapos I, von Eckardstein A, Carballo D, Hamm CW, Vietheer J, Rolf A, Landmesser U, Mach F, Moccetti T, Jung C, Kelm M, Münzel T, Pedrazzini G, Räber L, Windecker S, Matter CM, Ruschitzka F, Lüscher TF. Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS) - A phase II, randomized, double-blind, multi-center, placebo-controlled trial. Am Heart J 2022; 247:33-41. [PMID: 35092722 DOI: 10.1016/j.ahj.2022.01.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Activation of inflammatory pathways during acute myocardial infarction contributes to infarct size and left ventricular (LV) remodeling. The present prospective randomized clinical trial was designed to test the efficacy and safety of broad-spectrum anti-inflammatory therapy with a mammalian target of rapamycin (mTOR) inhibitor to reduce infarct size. DESIGN Controlled-Level EVERolimus in Acute Coronary Syndrome (CLEVER-ACS, clinicaltrials.gov NCT01529554) is a phase II randomized, double-blind, multi-center, placebo-controlled trial on the effects of a 5-day course of oral everolimus on infarct size, LV remodeling, and inflammation in patients with acute ST-elevation myocardial infarction (STEMI). Within 5 days of successful primary percutaneous coronary intervention (pPCI), patients are randomly assigned to everolimus (first 3 days: 7.5 mg every day; days 4 and 5: 5.0 mg every day) or placebo, respectively. The primary efficacy outcome is the change from baseline (defined as 12 hours to 5 days after pPCI) to 30-day follow-up in myocardial infarct size as measured by cardiac magnetic resonance imaging (CMRI). Secondary endpoints comprise corresponding changes in cardiac and inflammatory biomarkers as well as microvascular obstruction and LV volumes assessed by CMRI. Clinical events, laboratory parameters, and blood cell counts are reported as safety endpoints at 30 days. CONCLUSION The CLEVER-ACS trial tests the hypothesis whether mTOR inhibition using everolimus at the time of an acute STEMI affects LV infarct size following successful pPCI.
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Affiliation(s)
- Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Dik Heg
- Clinical Trial Unit, Social and Preventive Medicine, University of Bern, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ioannis Kapos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | | | - David Carballo
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Julia Vietheer
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Andreas Rolf
- Department of Cardiology, Kerckhoff Heart and Thorax Center, and Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Department of Cardiology, Charité - University Medicine, , Berlin, Germany
| | - François Mach
- Department of Cardiology, Hopitaux Universitaires de Geneve, Geneva, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Christian Jung
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Division of Cardiology, Pulmonary Diseases and Vascular Medicine, University Hospital of Duesseldorf, Duesseldorf, Germany
| | - Thomas Münzel
- Department of Cardiology, University Hospital Mainz, Mainz, Germany
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland; Center for Molecular Cardiology, University of Zurich, Schlieren, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland; Imperial College, National Heart and Lung Institute and Royal Brompton and Harefield Hospitals, Heart Division London, U.K..
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Cholongitas Ε, Koukoufiki A, Pipili C, Antoniadis N, Fouzas I, Haidich AB, Goulis I. Is everolimus linked to metabolic syndrome in liver transplant recipients? Indian J Gastroenterol 2019; 38:348-355. [PMID: 31515763 DOI: 10.1007/s12664-019-00971-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/03/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND As the mortality rates after liver transplantation (LT) have been reduced, the attention has shifted to additional conditions which still compromise the quality of life and the survival of these patients, such as the post-LT metabolic syndrome (MS). In order to determine the prevalence and the factors associated with the post-LT MS, we carried out the present study. METHODS One hundred and six LT recipients, after completing at least 1 year follow up after LT, were included in the study. Data on clinical, laboratory parameters and immunosuppressive therapy before and after LT were recorded. MS was defined as per current diagnostic criteria. RESULTS MS was prevalent in 47.2% (50 of 106 patients) and was not associated with the LT indications and the time period after LT. Univariate analysis showed that history of diabetes mellitus before (odds ratio [OR] 3.2, 95% confidence interval [CI] 1.046-9.918, p = 0.042) and after LT (OR 6.03, 95% CI 2.18-16.67, p = 0.001), the age at the time of baseline visit (OR 1.077, 95% CI 1.033-1.124, p = 0.001) and the everolimus-based immunosuppression (OR 1.23, 95% CI 1.003-1.33, p = 0.019) were significantly associated with MS. Notably, everolimus administration was the only factor independently associated with the presence of post-LT MS (OR 1.026, 95% CI 1.004-1.047, p = 0.019). More specifically, everolimus was linked to the presence of arterial hypertension (OR 1.02, 95% CI 1.0-1.03, p = 0.05) and hyperlipidemia (OR 2.87, 95% CI 1.28-6.56, p = 0.011). CONCLUSIONS Our study demonstrated for the first time that everolimus was independently associated with post-LT MS. Nevertheless, more robust studies are required to confirm these findings.
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Affiliation(s)
- Εvangelos Cholongitas
- 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece. .,First Department of Internal Medicine, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital, Agiou Thoma 17, 115 27, Athens, Greece.
| | - Argyro Koukoufiki
- 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Chrysoula Pipili
- Renal Clinical Fellow, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nikolaos Antoniadis
- Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Fouzas
- Department of Transplant Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene and Epidemiology, Medical School of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Goulis
- 4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Thessaloniki, Greece
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Barten MJ, Hirt SW, Garbade J, Bara C, Doesch AO, Knosalla C, Grinninger C, Stypmann J, Sieder C, Lehmkuhl HB, Porstner M, Schulz U. Comparing everolimus-based immunosuppression with reduction or withdrawal of calcineurin inhibitor reduction from six months after heart transplantation: the randomized MANDELA study. Am J Transplant 2019; 19:S1600-6135(22)09293-0. [PMID: 30884079 DOI: 10.1111/ajt.15361] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the 12-month, open-label MANDELA study, patients were randomized at month 6 after heart transplantation to (i) convert to calcineurin inhibitor (CNI)-free immunosuppression with everolimus (EVR), mycophenolic acid and steroids (CNI-free, n=71), or to (ii) continue reduced-exposure CNI, with EVR and steroids (EVR/redCNI, n=74). Tacrolimus was administered in 48.8% of EVR/redCNI patients and 52.6% of CNI-free patients at radomization. Both strategies improved and stabilized renal function based on the primary endpoint (estimated GFR at month 18 post-transplant post-randomization) with superiority of the CNI-free group versus EVR/redCNI : mean 64.1mL/min/1.73m2 versus 52.9mL/min/1.73m2 ; difference +11.3mL/min/1.73m2 (p<0.001). By month 18, estimated GFR had increased by ≥10mL/min/1.732 in 31.8% and 55.2% of EVR/redCNI and CNI-free patients, respectively, and by ≥25 mL/min/1.73m2 in 4.5% and 20.9%. Rates of biopsy-proven acute rejection (BPAR) were 6.8% and 21.1%; all cases were without hemodynamic compromise. BPAR was less frequent with EVR/redCNI versus the CNI-free regimen (p=0.015); 6/15 episodes in CNI-free patients occurred with EVR concentration <5ng/mL. Rates of adverse events and associated discontinuations were comparable EVR/redCNI from month 6 achieved stable renal function with infrequent BPAR. One-year renal function can be improved by early conversion to EVR-based CNI-free therapy but requires close EVR monitoring. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Markus J Barten
- Department of Cardiovascular Surgery, University Heart Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - Stephan W Hirt
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Jens Garbade
- University Department of Cardiac Surgery, Leipzig Heart Center, Strümpellstraße 39 Leipzig, Germany
| | - Christoph Bara
- Division of Cardiovascular, Thoracic and Transplantation Surgery, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Andreas O Doesch
- Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Institute Berlin, DZHK (German Centre for Cardiovascular Research), partner site Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Carola Grinninger
- Department of Cardiac Surgery, Munich Transplantation Center, Klinikum Großhadern LMU, Marchioninistraße 15, 81377, Munich, Germany
| | - Jörg Stypmann
- Department of Cardiovascular Medicine, Division of Cardiology, University Hospital Münster, Albert-Schweitzer-Straße 33, 48149, Münster, Germany
| | | | - Han B Lehmkuhl
- University Department of Cardiac Surgery, Leipzig Heart Center, Strümpellstraße 39 Leipzig, Germany
| | | | - Uwe Schulz
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr University Bochum, Georgstrasse 11, 32545, Bad Oeynhausen, Germany
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Katsumata H, Miyairi S, Ikemiyagi M, Hirai T, Fukuda H, Kanzawa T, Ishii R, Saiga K, Ishii Y, Omoto K, Okumi M, Yokoo T, Tanabe K. Evaluation of the impact of conventional immunosuppressant on the establishment of murine transplantation tolerance - an experimental study. Transpl Int 2019; 32:443-453. [PMID: 30561097 DOI: 10.1111/tri.13390] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022]
Abstract
Regulatory T cells (Tregs) play a significant role in immune tolerance. Since Treg function deeply depends on Interleukin-2 signaling, calcineurin inhibitors could affect their suppressive potentials, whereas mammalian target of rapamycin (mTOR) inhibitors may have less impact, as mTOR signaling is not fundamental to Treg proliferation. We previously reported a novel mixed hematopoietic chimerism induction regimen that promotes Treg proliferation by stimulating invariant natural killer T cells under CD40 blockade. Here, we use a mouse model to show the impact of tacrolimus (TAC) or everolimus (EVL) on the establishment of chimerism and Treg proliferation in the regimen. In the immunosuppressive drug-dosing phase, peripheral blood chimerism was comparably enhanced by both TAC and EVL. After dosing was discontinued, TAC-treated mice showed gradual graft rejection, whereas EVL-treated mice sustained long-term robust chimerism. Tregs of TAC-treated mice showed lower expression of both Ki67 and cytotoxic T lymphocyte antigen-4 (CTLA-4), and lower suppressive activity in vitro than those of EVL-treated mice, indicating that TAC negatively impacted the regimen by interfering with Treg proliferation and activation. Our results suggest that the usage of calcineurin inhibitors should be avoided if utilizing the regimen to induce Tregs in vivo for the establishment of mixed hematopoietic chimerism.
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Affiliation(s)
- Haruki Katsumata
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan.,Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Satoshi Miyairi
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan.,Department of Cardiovascular Surgery, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Masako Ikemiyagi
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Toshihito Hirai
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Hironori Fukuda
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Taichi Kanzawa
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Rumi Ishii
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Kan Saiga
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan.,Department of Urology, Jyoban Hosipital of Tokiwa Foundation, Fukushima, Japan
| | - Yasuyuki Ishii
- Vaccine Innovation Laboratory, RIKEN Cluster for Science, Technology and Innovation Hub (RCSTI), RIKEN, Suehirocho, Tsurumi-ku, Yokohama, Kanagawa, Japan.,REGiMMUNE Corporation, Nihonbashi-Hakozakicho, Chuou-ku, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Masayoshi Okumi
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, Kawadacho, Shinjuku-ku, Tokyo, Japan
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6
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Cholongitas Ε, Goulis I, Theocharidou E, Antoniadis N, Fouzas I, Imvrios G, Giouleme O, Angelaki A, Vasiliadis T, Papanikolaou V, Akriviadis E. Everolimus with or without mycophenolate mofetil in a liver transplantation setting: a single-center experience. Ann Gastroenterol 2018; 31:613-620. [PMID: 30174399 PMCID: PMC6102469 DOI: 10.20524/aog.2018.0278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 04/11/2018] [Indexed: 12/16/2022] Open
Abstract
Background This study evaluated the efficacy, safety, and impact on renal function of everolimus in patients after liver transplantation (LT) with or without mycophenolate mofetil (MMF). Methods We evaluated LT recipients with calcineurin inhibitor (CNI)-related renal dysfunction after everolimus initiation. Laboratory data, including evaluation of renal function based on glomerular filtration rate (GFR) at baseline (i.e., everolimus initiation) and at the end of follow up, were analyzed. Results Fifty consecutive patients started taking everolimus at 30 months post-LT (range: 1-240), 6 as monotherapy and 44 in combination with MMF. After 30.5 months (range: 6-112), all patients were alive, without any biochemical evidence of a rejection episode or recurrence of hepatocellular carcinoma. The mean GFR, based on the Modification of Diet in Renal Disease equation, was 53±13 mL/min at baseline and 59±12 mL/min at the end of follow up (P=0.031). Eleven (22%) of the patients had GFR <60 mL/min at baseline but returned to GFR >60 mL/min by the end of follow up. In multivariate analysis, the time between the development of renal dysfunction and everolimus initiation was the only factor independently associated with GFR improvement (odds ratio [OR] 0.85, 95% confidence interval [95%CI] 0.76-0.96; P=0.007). Everolimus was stopped in 11 patients (22%) at the end of follow up because of adverse events. Conclusion A CNI-free everolimus-based regimen was effective in LT recipients with renal dysfunction and was associated with an improvement in GFR.
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Affiliation(s)
- Εvangelos Cholongitas
- 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki (Evangelos Cholongitas, Ioannis Goulis, Aliki Angelaki, Evangelos Akriviadis), Greece.,1 Department of Internal Medicine, Medical School of National & Kapodistrian University, Athens (Evangelos Cholongitas), Greece
| | - Ioannis Goulis
- 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki (Evangelos Cholongitas, Ioannis Goulis, Aliki Angelaki, Evangelos Akriviadis), Greece
| | - Eleni Theocharidou
- 2 Propedeutic Department of Internal Medicine, Medical School of Aristotle University, Hippokration Hospital, Thessaloniki (Eleni Theocharidou, Olga Giouleme), Greece
| | - Nikolaos Antoniadis
- Department of Transplant Surgery, Aristotle University of Thessaloniki (Nikolaos Antoniadis, Ioannis Fouzas, George Imvrios, Vasilios Papanikolaou), Greece
| | - Ioannis Fouzas
- Department of Transplant Surgery, Aristotle University of Thessaloniki (Nikolaos Antoniadis, Ioannis Fouzas, George Imvrios, Vasilios Papanikolaou), Greece
| | - George Imvrios
- Department of Transplant Surgery, Aristotle University of Thessaloniki (Nikolaos Antoniadis, Ioannis Fouzas, George Imvrios, Vasilios Papanikolaou), Greece
| | - Olga Giouleme
- 2 Propedeutic Department of Internal Medicine, Medical School of Aristotle University, Hippokration Hospital, Thessaloniki (Eleni Theocharidou, Olga Giouleme), Greece
| | - Aliki Angelaki
- 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki (Evangelos Cholongitas, Ioannis Goulis, Aliki Angelaki, Evangelos Akriviadis), Greece
| | - Themistoklis Vasiliadis
- 3 Department of Internal Medicine, Papageorgiou General Hospital, Aristotle University of Thessaloniki (Themistoklis Vasiliadis), Greece
| | - Vasilios Papanikolaou
- Department of Transplant Surgery, Aristotle University of Thessaloniki (Nikolaos Antoniadis, Ioannis Fouzas, George Imvrios, Vasilios Papanikolaou), Greece
| | - Evangelos Akriviadis
- 4 Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki (Evangelos Cholongitas, Ioannis Goulis, Aliki Angelaki, Evangelos Akriviadis), Greece
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7
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Manzia TM, Angelico R, Toti L, Grimaldi C, Sforza D, Vella I, Tariciotti L, Lenci I, Breshanaj G, Baiocchi L, Tisone G. Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients. Transplant Proc 2018; 50:175-183. [PMID: 29407305 DOI: 10.1016/j.transproceed.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 11/13/2017] [Accepted: 12/12/2017] [Indexed: 02/05/2023]
Abstract
AIM We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT). METHODS Seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. RESULTS Baseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P = .908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P = .013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P = .04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. CONCLUSION Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment.
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Affiliation(s)
- T M Manzia
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy.
| | - R Angelico
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy; Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesu` Children's Research Hospital IRCCS, Rome, Italy
| | - L Toti
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - C Grimaldi
- Division of Abdominal Transplantation and Hepatobiliopancreatic Surgery, Bambino Gesu` Children's Research Hospital IRCCS, Rome, Italy
| | - D Sforza
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - I Vella
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - L Tariciotti
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - I Lenci
- Department of Hepatology and Gastroenterology, Liver Unit, Tor Vergata University of Rome, Italy
| | - G Breshanaj
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
| | - L Baiocchi
- Department of Hepatology and Gastroenterology, Liver Unit, Tor Vergata University of Rome, Italy
| | - G Tisone
- Department of Experimental Medicine and Surgery, Liver Unit, Tor Vergata University of Rome, Italy
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8
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Kaufmann SHE, Dorhoi A, Hotchkiss RS, Bartenschlager R. Host-directed therapies for bacterial and viral infections. Nat Rev Drug Discov 2017; 17:35-56. [PMID: 28935918 PMCID: PMC7097079 DOI: 10.1038/nrd.2017.162] [Citation(s) in RCA: 405] [Impact Index Per Article: 57.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Host-directed therapy (HDT) is a novel approach in the field of anti-infectives for overcoming antimicrobial resistance. HDT aims to interfere with host cell factors that are required by a pathogen for replication or persistence, to enhance protective immune responses against a pathogen, to reduce exacerbated inflammation and to balance immune reactivity at sites of pathology. HDTs encompassing the 'shock and kill' strategy or the delivery of recombinant interferons are possible approaches to treat HIV infections. HDTs that suppress the cytokine storm that is induced by some acute viral infections represent a promising concept. In tuberculosis, HDT aims to enhance the antimicrobial activities of phagocytes through phagosomal maturation, autophagy and antimicrobial peptides. HDTs also curtail inflammation through interference with soluble (such as eicosanoids or cytokines) or cellular (co-stimulatory molecules) factors and modulate granulomas to allow the access of antimicrobials or to restrict tissue damage. Numerous parallels between the immunological abnormalities that occur in sepsis and cancer indicate that the HDTs that are effective in oncology may also hold promise in sepsis. Advances in immune phenotyping, genetic screening and biosignatures will help to guide drug therapy to optimize the host response. Combinations of canonical pathogen-directed drugs and novel HDTs will become indispensable in treating emerging infections and diseases caused by drug-resistant pathogens.
Host-directed therapy (HDT) aims to interfere with host cell factors that are required by a pathogen for replication or persistence. In this Review, Kaufmannet al. describe recent progress in the development of HDTs for the treatment of viral and bacterial infections and the challenges in bringing these approaches to the clinic. Despite the recent increase in the development of antivirals and antibiotics, antimicrobial resistance and the lack of broad-spectrum virus-targeting drugs are still important issues and additional alternative approaches to treat infectious diseases are urgently needed. Host-directed therapy (HDT) is an emerging approach in the field of anti-infectives. The strategy behind HDT is to interfere with host cell factors that are required by a pathogen for replication or persistence, to enhance protective immune responses against a pathogen, to reduce exacerbated inflammation and to balance immune reactivity at sites of pathology. Although HDTs encompassing interferons are well established for the treatment of chronic viral hepatitis, novel strategies aimed at the functional cure of persistent viral infections and the development of broad-spectrum antivirals against emerging viruses seem to be crucial. In chronic bacterial infections, such as tuberculosis, HDT strategies aim to enhance the antimicrobial activities of phagocytes and to curtail inflammation through interference with soluble factors (such as eicosanoids and cytokines) or cellular factors (such as co-stimulatory molecules). This Review describes current progress in the development of HDTs for viral and bacterial infections, including sepsis, and the challenges in bringing these new approaches to the clinic.
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Affiliation(s)
- Stefan H E Kaufmann
- Department of Immunology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117 Berlin, Germany
| | - Anca Dorhoi
- Department of Immunology, Max Planck Institute for Infection Biology, Charitéplatz 1, 10117 Berlin, Germany.,Institute of Immunology, Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Südufer 10, 17493 Greifswald - Insel Riems, Germany
| | - Richard S Hotchkiss
- Departments of Anesthesiology, Medicine, and Surgery, Washington University School of Medicine, St Louis, 660 S. Euclid, St Louis, Missouri 63110, USA
| | - Ralf Bartenschlager
- Department of Infectious Diseases, Molecular Virology, Heidelberg University, Im Neuenheimer Feld 345, 69120 Heidelberg, Germany.,German Center for Infection Research (DZIF), Heidelberg Partner Site, Im Neuenheimer Feld 345, 69120 Heidelberg, Germany.,Division of Virus-Associated Carcinogenesis, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg, Germany
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9
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Rubín Suárez A, Bilbao Aguirre I, Fernández-Castroagudin J, Pons Miñano JA, Salcedo Plaza M, Varo Pérez E, Prieto Castillo M. Recommendations of everolimus use in liver transplant. GASTROENTEROLOGIA Y HEPATOLOGIA 2017; 40:629-640. [PMID: 28743539 DOI: 10.1016/j.gastrohep.2017.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 05/23/2017] [Accepted: 05/23/2017] [Indexed: 01/26/2023]
Abstract
Mammalian target of rapamycin (mTOR) inhibitors, everolimus (EVL) and sirolimus are immunosuppressive agents with a minor nephrotoxic effect, limited to the development of proteinuria in some cases. The combination of EVL and low-dose tacrolimus has proven to be as safe and effective as standard therapy with tacrolimus for the prevention of acute cellular rejection. Early initiation of EVL-based immunosuppressive regimens with reduced exposure to calcineurin inhibitors has been shown to significantly improve renal function of LT recipients during induction and maintenance phases, with comparable efficacy and safety profiles. In patients with established kidney failure, initiating EVL may enable clinicians to reduce calcineurin inhibitors exposure, thereby contributing to the improved renal function of these patients. Although there is not sufficient evidence to recommend their use to prevent the recurrence of hepatocellular carcinoma and the progression of de novo tumours, they are used in this context in routine clinical practice.
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Affiliation(s)
- Angel Rubín Suárez
- Unidad de Hepatología, Servicio de Medicina Digestiva, Área de Enfermedades Digestivas, Hospital Universitari i Politècnic La Fe, CIBERehd, Valencia, España.
| | - Itxarone Bilbao Aguirre
- Servicio de Cirugía HBP y Trasplantes Digestivos, Hospital Universitario Vall d'Hebrón. Grupos de investigación VHIR y CIBERehd, Barcelona, España
| | - Javier Fernández-Castroagudin
- Servicio de Medicina Digestiva, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - José Antonio Pons Miñano
- Unidad de Hepatología y Trasplante Hepático, IMIB. Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, España
| | - Magdalena Salcedo Plaza
- Unidad de Trasplante Hepático, Servicio de Aparato Digestivo, Hospital General Universitario Gregorio Marañón IISGM. CIBERehd, Madrid, España
| | - Evaristo Varo Pérez
- Unidad de Trasplante Abdominal, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, España
| | - Martín Prieto Castillo
- Unidad de Hepatología, Servicio de Medicina Digestiva, Área de Enfermedades Digestivas, Hospital Universitari i Politècnic La Fe, CIBERehd, Valencia, España
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10
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Torigoe M, Iwata S, Nakayamada S, Sakata K, Zhang M, Hajime M, Miyazaki Y, Narisawa M, Ishii K, Shibata H, Tanaka Y. Metabolic Reprogramming Commits Differentiation of Human CD27 +IgD + B Cells to Plasmablasts or CD27 -IgD - Cells. THE JOURNAL OF IMMUNOLOGY 2017. [PMID: 28626065 DOI: 10.4049/jimmunol.1601908] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
B cells play a crucial role in the pathogenesis of autoimmune diseases, such as systemic lupus erythematosus (SLE). However, the relevance of the metabolic pathway in the differentiation of human B cell subsets remains unknown. In this article, we show that the combination of CpG/TLR9 and IFN-α markedly induced the differentiation of CD27+IgD+ unswitched memory B cells into CD27hiCD38hi plasmablasts. The response was accompanied by mammalian target of rapamycin complex 1 (mTORC1) activation and increased lactate production, indicating a shift to glycolysis. However, CpG alone induced the differentiation of unswitched memory B cells into CD27-IgD- memory B cells with high cytokine production, but such differentiation was suppressed by IFN-α. AMP-activated protein kinase activation enhanced the differentiation to CD27-IgD- B cells, but it attenuated mTORC1 activation and differentiation into plasmablasts. High mTORC1 activation was noted in CD19+ B cells of patients with SLE and correlated with plasmablast differentiation and disease activity. Taken together, differential metabolic reprogramming commits the differentiation of human unswitched memory B cells into plasmablasts (the combination of CpG and IFN-α amplifies mTORC1-glycolysis pathways) or CD27-IgD- memory B cells (CpG alone amplifies the AMP-activated protein kinase pathway). The former metabolic pathway may play a pivotal role in SLE.
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Affiliation(s)
- Masataka Torigoe
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan.,Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan; and
| | - Shigeru Iwata
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan
| | - Shingo Nakayamada
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan
| | - Kei Sakata
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan.,Mitsubishi Tanabe Pharma, Yokohama, Kanagawa 227-0033, Japan
| | - Mingzeng Zhang
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan
| | - Maiko Hajime
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan
| | - Yusuke Miyazaki
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan
| | - Manabu Narisawa
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan
| | - Koji Ishii
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan; and
| | - Hirotaka Shibata
- Department of Endocrinology, Metabolism, Rheumatology and Nephrology, Faculty of Medicine, Oita University, Yufu, Oita 879-5593, Japan; and
| | - Yoshiya Tanaka
- First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Fukuoka 807-8555, Japan;
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11
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Everolimus-Induced Systemic Serositis After Simultaneous Liver and Kidney Transplantation: A Case Report. Transplant Proc 2017; 49:181-184. [PMID: 28104132 DOI: 10.1016/j.transproceed.2016.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 11/16/2016] [Indexed: 11/20/2022]
Abstract
Although everolimus, a mammalian target of rapamycin inhibitor, has been used as a potent immunosuppressive agent in organ transplantation, data regarding its adverse effect profile compared with that of sirolimus in clinical circumstances are limited. A 50-year-old man who underwent simultaneous liver and kidney transplantation 14 months previously was admitted with large pleural effusion, pericardial effusion, and ascites. Laboratory findings and cultures for possible infectious causes were all negative. Pericardial window surgery with drainage of the pericardial fluid was performed on day 3. Pleural and pericardial biopsy revealed non-specific inflammation without evidence of malignant cells. Everolimus was discontinued and replaced by mycophenolate mofetil on day 4. Significant clinical improvement was observed after discontinuation of everolimus, and follow-up echocardiography and chest radiography showed no recurrence of the pericardial or pleural effusion after discharge.
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12
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Jiang ZC, Li H, Zhu B. Everolimus for neurological and psychiatric diseases: Friend or foe? J Psychiatr Res 2016; 81:46-7. [PMID: 27376505 DOI: 10.1016/j.jpsychires.2016.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 06/12/2016] [Accepted: 06/17/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Zhe-Cheng Jiang
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Huan Li
- Department of Orthopedics, The Third Affiliated Hospital of Soochow University, Changzhou, China.
| | - Bin Zhu
- Department of Critical Care Medicine, The Third Affiliated Hospital of Soochow University, No. 185 Juqian Street, Changzhou 213003, China.
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13
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Cervera C, Cofan F, Hernandez C, Soy D, Marcos MA, Sanclemente G, Bodro M, Moreno A, Diekmann F, Campistol JM, Oppenheimer F. Effect of mammalian target of rapamycin inhibitors on cytomegalovirus infection in kidney transplant recipients receiving polyclonal antilymphocyte globulins: a propensity score-matching analysis. Transpl Int 2016; 29:1216-1225. [DOI: 10.1111/tri.12848] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 05/13/2016] [Accepted: 08/17/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Carlos Cervera
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
- Division of Infectious Diseases; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Frederic Cofan
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Cristina Hernandez
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Dolors Soy
- Division of Pharmacy; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Maria Angeles Marcos
- Division of Microbiology; Centre Diagnòstic Biomèdic (CDB); Centre for International Health Research (CRESIB); IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Gemma Sanclemente
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Marta Bodro
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Asunción Moreno
- Division of Infectious Diseases; Department of Medicine; University of Alberta; Edmonton AB Canada
| | - Fritz Diekmann
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Josep Maria Campistol
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
| | - Frederic Oppenheimer
- Renal Transplantation Unit; Division of Nephrology; IDIBAPS; Hospital Clinic of Barcelona; University of Barcelona; Barcelona Spain
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14
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Dumortier J, Dharancy S, Calmus Y, Duvoux C, Durand F, Salamé E, Saliba F. Use of everolimus in liver transplantation: The French experience. Transplant Rev (Orlando) 2016; 30:161-70. [DOI: 10.1016/j.trre.2015.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 12/14/2015] [Indexed: 12/18/2022]
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15
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Reinwald M, Boch T, Hofmann WK, Buchheidt D. Risk of Infectious Complications in Hemato-Oncological Patients Treated with Kinase Inhibitors. Biomark Insights 2016; 10:55-68. [PMID: 27127405 PMCID: PMC4841329 DOI: 10.4137/bmi.s22430] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/13/2015] [Accepted: 09/15/2015] [Indexed: 12/30/2022] Open
Abstract
Infectious complications are a major cause of morbidity and mortality in patients with hemato-oncological diseases. Although disease-related immunosuppression represents one factor, aggressive treatment regimens, such as chemotherapy, stem cell transplantation, or antibody treatment, account for a large proportion of infectious side effects. With the advent of targeted therapies affecting specific kinases in malignant diseases, the outcome of patients has further improved. Nonetheless, dependent on the specific pathway targeted or off-target activity of the kinase inhibitor, therapy-associated infectious complications may occur. We review the most common and approved kinase inhibitors targeting a variety of hemato-oncological malignancies for their immunosuppressive potential and evaluate their risk of infectious side effects based on preclinical evidence and clinical data in order to raise awareness of the potential risks involved.
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Affiliation(s)
- Mark Reinwald
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - Tobias Boch
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - Wolf-Karsten Hofmann
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Mannheim University Hospital, University of Heidelberg, Mannheim, Germany
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16
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Malignancy After Heart Transplantation Under Everolimus Versus Mycophenolate Mofetil Immunosuppression. Transplant Proc 2016; 48:969-73. [DOI: 10.1016/j.transproceed.2015.12.071] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/07/2015] [Indexed: 01/20/2023]
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17
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Pasin VP, Pereira AR, Carvalho KAD, Paiva JMGD, Enokihara MMSES, Porro AM. New drugs, new challenges for dermatologists: mucocutaneous ulcers secondary to everolimus. An Bras Dermatol 2016; 90:165-7. [PMID: 26312705 PMCID: PMC4540539 DOI: 10.1590/abd1806-4841.20153672] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Accepted: 05/21/2014] [Indexed: 01/17/2023] Open
Abstract
Everolimus, a mammalian target of rapamycin inhibitor, is an emerging drug, which is
being increasingly applied in oncology and solid organ transplantation. Oral ulcers
are a frequent side effect associated with this immunosupressor. We report the case
of a renal transplant recipient who developed disfiguring oral and perianal ulcers
secondary to everolimus's toxicity. This is probably the first report of perianal
involvement. Dermatologists need to be aware of the potential mucocutaneous adverse
effects related to these new drugs that are becoming evermore common in our clinical
practice.
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18
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Witzke O, Sommerer C, Arns W. Everolimus immunosuppression in kidney transplantation: What is the optimal strategy? Transplant Rev (Orlando) 2016; 30:3-12. [DOI: 10.1016/j.trre.2015.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 12/19/2022]
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19
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Cicora F, Massari P, Acosta F, Petrone H, Cambariere R, Imperiali N, López F, Arriola M, Roberti J. Variances in the Use of Everolimus in Kidney Transplantation: A 2-Year Registry of Everyday Practice. Transplant Proc 2015; 47:2841-5. [PMID: 26707299 DOI: 10.1016/j.transproceed.2015.10.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Everolimus (EVL)-based immunosuppressive strategies may permit the reduction of calcineurin inhibitors (CNI) and their side effects, while offering a safe and efficient treatment. Our aim was to describe our experience with EVL in everyday practice and provide information for its optimal utilization. METHODS Prospective, multicenter study of 181 kidney transplant recipients treated with EVL as part of their immunosuppressive regimen, with a follow-up of 24 months. We studied demographic data, transplant characteristics, clinical information, drugs used, serum creatinine, estimated glomerular filtration rate (eGFR), rejection episodes, and adverse events. RESULTS In total, 181 renal transplant recipients were included. Of these, 30 (16.6%) received EVL de novo and 151 (83.4%) were converted; median time from transplantation to conversion was 10 (range, 1-312) months. Main reasons for conversion were prevention of interstitial fibrosis and tubular atrophy (23.9%), intolerance to immunosuppressants (11.1%), neoplasia (13.9%), nephrotoxicity (8.9%), and cytomegalovirus infections (8.3%). The eGFR values at baseline, months 12, and 24 were 46.4 ± 27.4 mL/min, 54.8 ± 22.9 mL/min, and 55.9 ± 26.5 ml/min, respectively. Two of 181 (1.1%) patients died, 5 of 181 (2.8%) lost their grafts, 12 of 181 (6.6%) had an episode of acute rejection, 13 of 181 (7.2%) had ≥1 serious event and infection, and 85 of 181 (49.9%) had ≥1 nonserious adverse event or infection. Multivariate analysis showed that increased eGFR at month 24 was associated with lower donor age, shorter time from transplant to EVL introduction, and a baseline eGFR ≥40 mL/min. CONCLUSION Through different strategies among centers, the inclusion of EVL improved renal function during the first 12 months.
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Affiliation(s)
- F Cicora
- Renal Transplant, Hospital Alta Complejidad Pte JD Perón, Formosa, Argentina; Foundation for Research and Assistance of Renal Disease (FINAER), Buenos Aires, Argentina
| | - P Massari
- Renal Transplant, Hospital Privado Córdoba, Argentina
| | - F Acosta
- Renal Transplant, Hospital Provincial del Centenario de Rosario, Argentina
| | - H Petrone
- Crai Sur Cucaiba, La Plata, Argentina
| | - R Cambariere
- Instituto de Nefrología (Nephrology), Buenos Aires, Argentina
| | - N Imperiali
- Renal Transplant, Hospital Italiano, Buenos Aires, Argentina
| | - F López
- Renal Transplant, Hospital JC Perrando, Resistencia, Argentina
| | - M Arriola
- Clínica de Nefrología, Urología y Enfermedades Cardiovasculares, Santa Fe, Argentina
| | - J Roberti
- Foundation for Research and Assistance of Renal Disease (FINAER), Buenos Aires, Argentina.
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20
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Deuse T, Bara C, Barten MJ, Hirt SW, Doesch AO, Knosalla C, Grinninger C, Stypmann J, Garbade J, Wimmer P, May C, Porstner M, Schulz U. The MANDELA study: A multicenter, randomized, open-label, parallel group trial to refine the use of everolimus after heart transplantation. Contemp Clin Trials 2015; 45:356-363. [DOI: 10.1016/j.cct.2015.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 09/02/2015] [Accepted: 09/04/2015] [Indexed: 12/18/2022]
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21
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Thibault G, Paintaud G, Legendre C, Merville P, Coulon M, Chasseuil E, Ternant D, Rostaing L, Durrbach A, Di Giambattista F, Büchler M, Lebranchu Y. CD25 blockade in kidney transplant patients randomized to standard-dose or high-dose basiliximab with cyclosporine, or high-dose basiliximab in a calcineurin inhibitor-free regimen. Transpl Int 2015; 29:184-95. [DOI: 10.1111/tri.12688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 07/30/2015] [Accepted: 09/09/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gilles Thibault
- Laboratoire d'Immunologie; Bretonneau Hospital; CHRU de Tours; CNRS; GICC UMR 7292; Université François-Rabelais de Tours; Tours France
| | - Gilles Paintaud
- Laboratoire de Pharmacologie-Toxicologie; Bretonneau Hospital; CHRU de Tours; CNRS; GICC UMR 7292; Université François-Rabelais de Tours; Tours France
| | - Christophe Legendre
- Service de Nephrologie-Transplantation; Hôpital Necker; Assistance Publique-Hôpitaux de Paris; Université Paris Descartes; INSERM U 845; Paris France
| | - Pierre Merville
- Department of Nephrology, Transplantation and Dialysis; CHU Bordeaux; Pellegrin Hospital; UMR-CNRS 5164; Bordeaux University; Bordeaux France
| | - Maxime Coulon
- Laboratoire d'Immunologie; Bretonneau Hospital; CHRU de Tours; CNRS; GICC UMR 7292; Université François-Rabelais de Tours; Tours France
| | - Elodie Chasseuil
- Laboratoire de Pharmacologie-Toxicologie; Bretonneau Hospital; CHRU de Tours; CNRS; GICC UMR 7292; Université François-Rabelais de Tours; Tours France
| | - David Ternant
- Laboratoire de Pharmacologie-Toxicologie; Bretonneau Hospital; CHRU de Tours; CNRS; GICC UMR 7292; Université François-Rabelais de Tours; Tours France
| | - Lionel Rostaing
- Department of Nephrology, Dialysis and Organ Transplantation; Rangueil Hospital; Toulouse France
| | - Antoine Durrbach
- Department of Nephrology; INSERM UMR 1197; Kremlin Bicetre Hospital; Le Kremlin-Bicêtre France
| | | | - Matthias Büchler
- Department of Nephrology and Clinical Immunology; Bretonneau Hospital; CHRU de Tours; EA4245, Université François-Rabelais de Tours; Tours France
| | - Yvon Lebranchu
- Department of Nephrology and Clinical Immunology; Bretonneau Hospital; CHRU de Tours; EA4245, Université François-Rabelais de Tours; Tours France
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22
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Bolton EM, Bradley JA. Avoiding immunological rejection in regenerative medicine. Regen Med 2015; 10:287-304. [DOI: 10.2217/rme.15.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
One of the major goals of regenerative medicine is repair or replacement of diseased and damaged tissues by transfer of differentiated stem cells or stem cell-derived tissues. The possibility that these tissues will be destroyed by immunological rejection remains a challenge that can only be overcome through a better understanding of the nature and expression of potentially immunogenic molecules associated with cell replacement therapy and the mechanisms and pathways resulting in their immunologic rejection. This review draws on clinical experience of organ and tissue transplantation, and on transplantation immunology research to consider practical approaches for avoiding and overcoming the possibility of rejection of stem cell-derived tissues.
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Affiliation(s)
- Eleanor M Bolton
- Department of Surgery, University of Cambridge, Box 202, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - John Andrew Bradley
- Department of Surgery, University of Cambridge, Box 202, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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23
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24
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Carmellini M, Garcia V, Wang Z, Vergara M, Russ G. Efficacy of everolimus with reduced-exposure cyclosporine in de novo kidney transplant patients at increased risk for efficacy events: analysis of a randomized trial. J Nephrol 2015; 28:633-9. [PMID: 25708913 DOI: 10.1007/s40620-015-0180-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 02/05/2015] [Indexed: 01/05/2023]
Abstract
The efficacy of de novo everolimus with reduced-exposure calcineurin inhibitor (CNI) was examined in kidney transplant subpopulations from the A2309 study that were identified to be at increased risk for efficacy events. A2309 was a 24-month, multicenter, open-label trial in which 833 de novo kidney transplant recipients were randomized to everolimus targeting 3-8 or 6-12 ng/ml with reduced-exposure cyclosporine (CsA), or mycophenolic acid (MPA) with standard-exposure CsA, all with basiliximab induction. The composite efficacy endpoint was treated biopsy-proven acute rejection (BPAR), graft loss, death, or loss to follow-up. Cox proportional hazard modeling showed male gender, younger recipient age, black race, delayed graft function, human leukocyte antigen (HLA) mismatch ≥3 and increasing donor age to be significantly predictive for the composite efficacy endpoint at months 12 or 24 post-transplant. CsA exposure was 53-75 % lower, and 46-75 % lower, in patients receiving everolimus 3-8 ng/ml or receiving everolimus 6-12 ng/ml, respectively, versus MPA-treated patients. The incidence of the composite endpoint was similar in all three treatment groups within each subpopulation analyzed. The incidence of treated BPAR was similar with everolimus 3-8 ng/ml or MPA in all subpopulations, but less frequent with everolimus 6-12 ng/ml versus MPA in patients with HLA mismatch ≥3 (p = 0.049). This post hoc analysis of a large, randomized trial suggests that a de novo regimen of everolimus with reduced-exposure CsA maintains immunosuppressive efficacy even in kidney transplant patients at increased risk for efficacy events despite substantial reductions in CsA exposure.
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Affiliation(s)
- Mario Carmellini
- Department of Surgery and Bioengineering, University of Siena, Siena, Italy. .,Centro Trapianti di Rene, Az. Osped Universitaria Senese Ospedale S Maria alle Scotte, U.O.C. Chirugira dei Trpianti-Dip. Chirugria Gen. e Spec, Viale Bracci 1, 53100, Siena, Italy.
| | - Valter Garcia
- Hospital Don Vicente Scherer, Santa Casa de Misericordia do Porto Alegre, Porto Alegre, Brazil
| | | | | | - Graeme Russ
- Renal Unit, The Queen Elizabeth Hospital, Woodville, Australia
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25
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Kim E, Yoon SY, Shin YJ. Oxidative Stress in Cornea. OXIDATIVE STRESS IN APPLIED BASIC RESEARCH AND CLINICAL PRACTICE 2015. [DOI: 10.1007/978-1-4939-1935-2_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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26
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Everolimus-based immunosuppressive regimens in lung transplant recipients: Impact on CMV infection. Antiviral Res 2015; 113:19-26. [DOI: 10.1016/j.antiviral.2014.10.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 11/21/2022]
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Pharmacodynamic Monitoring of Mammalian Target of Rapamycin Inhibition by Phosphoflow Cytometric Determination of p70S6 Kinase Activity. Transplantation 2015; 99:210-9. [DOI: 10.1097/tp.0000000000000273] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Salvadori M, Bertoni E. What's new in clinical solid organ transplantation by 2013. World J Transplant 2014; 4:243-66. [PMID: 25540734 PMCID: PMC4274595 DOI: 10.5500/wjt.v4.i4.243] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/11/2014] [Accepted: 07/27/2014] [Indexed: 02/05/2023] Open
Abstract
Innovative and exciting advances in the clinical science in solid organ transplantation continuously realize as the results of studies, clinical trials, international conferences, consensus conferences, new technologies and discoveries. This review will address to the full spectrum of news in transplantation, that verified by 2013. The key areas covered are the transplantation activity, with particular regards to the donors, the news for solid organs such as kidney, pancreas, liver, heart and lung, the news in immunosuppressive therapies, the news in the field of tolerance and some of the main complications following transplantation as infections and cancers. The period of time covered by the study starts from the international meetings held in 2012, whose results were published in 2013, up to the 2013 meetings, conferences and consensus published in the first months of 2014. In particular for every organ, the trends in numbers and survival have been reviewed as well as the most relevant problems such as organ preservation, ischemia reperfusion injuries, and rejections with particular regards to the antibody mediated rejection that involves all solid organs. The new drugs and strategies applied in organ transplantation have been divided into new way of using old drugs or strategies and drugs new not yet on the market, but on phase Ito III of clinical studies and trials.
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Cicora F, Massari P, Acosta F, Petrone H, Cambariere R, González I, Imperiali N, López F, Otero A, Roberti J. Use of Everolimus in Renal Transplant Recipients: Data From a National Registry. Transplant Proc 2014; 46:2991-5. [DOI: 10.1016/j.transproceed.2014.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hsieh YW, Huang CY, Yang SY, Peng YH, Yu CP, Chao PDL, Hou YC. Oral intake of curcumin markedly activated CYP 3A4: in vivo and ex-vivo studies. Sci Rep 2014; 4:6587. [PMID: 25300360 PMCID: PMC5377466 DOI: 10.1038/srep06587] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 09/17/2014] [Indexed: 12/01/2022] Open
Abstract
Curcumin, a specific secondary metabolite of Curcuma species, has potentials for a variety of beneficial health effects. It is nowadays used as a dietary supplement. Everolimus (EVL) is an immunosuppressant indicated for allograft rejection and cancer therapy, but with narrow therapeutic window. EVL is a substrate of P-glycoprotein (P-gp) and cytochrome P450 3A4 (CYP3A4). This study investigated the effect of coadministration of curcumin on the pharmacokinetics of EVL in rats and the underlying mechanisms. EVL (0.5 mg/kg) was orally administered without and with 50 and 100 mg/kg of curcumin, respectively, in rats. Blood samples were collected at specific time points and EVL concentrations in blood were determined by QMS® immunoassay. The underlying mechanisms were evaluated using cell model and recombinant CYP 3A4 isozyme. The results indicated that 50 and 100 mg/kg of curcumin significantly decreased the AUC0-540 of EVL by 70.6% and 71.5%, respectively, and both dosages reduced the Cmax of EVL by 76.7%. Mechanism studies revealed that CYP3A4 was markedly activated by curcumin metabolites, which apparently overrode the inhibition effects of curcumin on P-gp. In conclusion, oral intake of curcumin significantly decreased the bioavailability of EVL, a probe substrate of P-gp/CYP 3A4, mainly through marked activation on CYP 3A4.
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Affiliation(s)
- Yow-Wen Hsieh
- 1] School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C. [2] Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan 404, R.O.C
| | - Ching-Ya Huang
- 1] School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C. [2] Department of Pharmacy, China Medical University Hospital, Taichung, Taiwan 404, R.O.C
| | - Shih-Ying Yang
- School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C
| | - Yu-Hsuan Peng
- School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C
| | - Chung-Ping Yu
- School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C
| | - Pei-Dawn Lee Chao
- School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C
| | - Yu-Chi Hou
- 1] School of Pharmacy, China Medical University, Taichung, Taiwan 404, R.O.C. [2] Department of Medical Research, China Medical University Hospital, Taichung, Taiwan 404, R.O.C
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5 year Comparison of Very Low-dose Cyclosporine and High-dose Everolimus vs Standard Cyclosporine and Enteric-coated Mycophenolate in Renal Transplantation Patients. Transplant Proc 2014; 46:2228-30. [DOI: 10.1016/j.transproceed.2014.07.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Holdaas H, Potena L, Saliba F. mTOR inhibitors and dyslipidemia in transplant recipients: a cause for concern? Transplant Rev (Orlando) 2014; 29:93-102. [PMID: 25227328 DOI: 10.1016/j.trre.2014.08.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 07/19/2014] [Accepted: 08/22/2014] [Indexed: 02/06/2023]
Abstract
Post-transplant dyslipidemia is exacerbated by mammalian target of rapamycin (mTOR) inhibitors. Early clinical trials of mTOR inhibitors used fixed dosing with no concomitant reduction in calcineurin inhibitor (CNI) exposure, leading to concerns when consistent and marked dyslipidemia was observed. With use of modern concentration-controlled mTOR inhibitor regimens within CNI-free or reduced-exposure CNI regimens, however, the dyslipidemic effect persists but is less pronounced. Typically, total cholesterol levels are at the upper end of normal, or indicate borderline risk, in kidney and liver transplant recipients, and are lower in heart transplant patients under near-universal statin therapy. Of note, it is possible that mTOR inhibitors may offer a cardioprotective effect. Experimental evidence for delayed progression of atherosclerosis is consistent with evidence from heart transplantation that coronary artery intimal thickening and the incidence of cardiac allograft vasculopathy are reduced with everolimus versus cyclosporine therapy. Preliminary data also indicate that mTOR inhibitors may improve arterial stiffness, a predictor of cardiovascular events, and may reduce ventricular remodeling and decrease left ventricular mass through an anti-fibrotic effect. Post-transplant dyslipidemia under mTOR inhibitor therapy should be monitored and managed closely, but unless unresponsive to therapy should not be regarded as a barrier to its use.
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Affiliation(s)
- Hallvard Holdaas
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Luciano Potena
- Heart Failure and Heart Transplant Program, Academic Hospital S. Orsola-Malpighi, Alma-Mater University of Bologna, Bologna, Italy
| | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France
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Perbos E, Juinier E, Guidicelli G, Dromer C, Merville P, Billes MA, Taupin JL, Neau-Cransac M. Evolution of donor-specific antibodies (DSA) and incidence ofde novoDSA in solid organ transplant recipients after switch to everolimus alone or associated with low dose of calcineurin inhibitors. Clin Transplant 2014; 28:1054-60. [DOI: 10.1111/ctr.12418] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 01/26/2023]
Affiliation(s)
- Emma Perbos
- Department of Nephrology, Dialysis and Transplantation; Bordeaux University Hospital; Bordeaux France
| | - Estelle Juinier
- Laboratory of Immunology and Immunogenetics; Bordeaux University Hospital; Bordeaux France
| | - Gwendaline Guidicelli
- Laboratory of Immunology and Immunogenetics; Bordeaux University Hospital; Bordeaux France
| | - Claire Dromer
- Department of Thoracic Surgery; Bordeaux University Hospital; Bordeaux France
| | - Pierre Merville
- Department of Nephrology, Dialysis and Transplantation; Bordeaux University Hospital; Bordeaux France
- CNRS UMR 5164 CIRID; University of Bordeaux; Bordeaux France
| | - Marc-Alain Billes
- Department of Cardiac Surgery; Bordeaux University Hospital; Bordeaux France
| | - Jean-Luc Taupin
- Laboratory of Immunology and Immunogenetics; Bordeaux University Hospital; Bordeaux France
- CNRS UMR 5164 CIRID; University of Bordeaux; Bordeaux France
| | - Martine Neau-Cransac
- Liver Transplantation Unit; Department of Hepato-gastroenterology, Nutrition and Diabetology; Bordeaux University Hospital; Bordeaux France
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Cornu C, Dufays C, Gaillard S, Gueyffier F, Redonnet M, Sebbag L, Roussoulières A, Gleissner CA, Groetzner J, Lehmkuhl HB, Potena L, Gullestad L, Cantarovich M, Boissonnat P. Impact of the reduction of calcineurin inhibitors on renal function in heart transplant patients: a systematic review and meta-analysis. Br J Clin Pharmacol 2014; 78:24-32. [PMID: 24251918 PMCID: PMC4168377 DOI: 10.1111/bcp.12289] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/31/2013] [Indexed: 01/13/2023] Open
Abstract
AIMS Calcineurin inhibitors (CNIs) taken after heart transplantation lead to excellent short-term outcomes, but long-term use may cause chronic nephrotoxicity. Our aim was to identify, appraise, select and analyse all high-quality research evidence relevant to the question of the clinical impact of CNI-sparing strategies in heart transplant patients. METHODS We carried out a systematic review and meta-analysis of randomized controlled trials on CNI reduction in heart transplant recipients. Primary outcomes were kidney function and acute rejection after 1 year. Secondary outcomes included graft loss, all-cause mortality and adverse events. RESULTS Eight open-label studies were included, with 723 patients (four tested de novo CNI reduction and four maintenance CNI reduction). Calcineurin inhibitor reduction did not improve creatinine clearance at 12 months 5.46 [-1.17, 12.03] P = 0.32 I(2) = 65.4%. Acute rejection at 12 months (55/360 vs. 52/332), mortality (18/301 vs. 15/270) and adverse event rates (55/294 vs. 52/281) did not differ between the low-CNI and standard-CNI groups. There was significant benefit on creatinine clearance in patients with impaired renal function at 6 months [+12.23 (+5.26, +18.82) ml min(-1) , P = 0.0003] and at 12 months 4.63 [-4.55, 13.82] P = 0.32 I(2) = 75%. CONCLUSIONS This meta-analysis did not demonstrate a favourable effect of CNI reduction on kidney function, but there was no increase in acute rejection. To provide a better analysis of the influence of CNI reduction patterns and associated treatments, a meta-analysis of individual patient data should be performed.
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Affiliation(s)
- Catherine Cornu
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - Christophe Dufays
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - Ségolène Gaillard
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - François Gueyffier
- INSERM, CIC201Lyon, France
- CHU Lyon, Service de Pharmacologie CliniqueLyon, France
- Université de Lyon, UMR 5558Lyon, France
- Hospices Civils de Lyon, Hôpital Louis PradelBron Cedex, France
| | - Michel Redonnet
- Département de Chirurgie Cardiaque, Hôpital Charles Nicolle, Université de RouenRouen, France
| | - Laurent Sebbag
- Hospices Civils de Lyon, Hôpital Louis Pradel, Pôle médico-chirurgical de Transplantation cardiaque adulteBron Cedex, France
| | - Ana Roussoulières
- Hospices Civils de Lyon, Hôpital Louis Pradel, Pôle médico-chirurgical de Transplantation cardiaque adulteBron Cedex, France
| | - Christian A Gleissner
- Department of Cardiology, Angiology and Pneumonology, University of HeidelbergHeidelberg, Germany
| | - Jan Groetzner
- Department of Cardiac Surgery, Ludwig-Maximilians-University GrosshadernMunich, Germany
| | | | - Luciano Potena
- Dipartimento Cardiovascolare, Policlinico S. Orsola-MalpighiBologna, Italy
| | - Lars Gullestad
- Department of Cardiology, Oslo University HospitalRikshospitalet, Oslo, Norway
- Faculty of Medicine, University of OsloOslo, Norway
| | - Marcelo Cantarovich
- Department of Medicine, Multi-Organ Transplant Program, Royal Victoria Hospital, McGill University Health CenterMontreal, Quebec, Canada
| | - Pascale Boissonnat
- Hospices Civils de Lyon, Hôpital Louis Pradel, Pôle médico-chirurgical de Transplantation cardiaque adulteBron Cedex, France
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Vecchiati A, Tellatin S, Angelini A, Iliceto S, Tona F. Coronary microvasculopathy in heart transplantation: Consequences and therapeutic implications. World J Transplant 2014; 4:93-101. [PMID: 25032098 PMCID: PMC4094955 DOI: 10.5500/wjt.v4.i2.93] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/11/2014] [Accepted: 03/12/2014] [Indexed: 02/05/2023] Open
Abstract
Despite the progress made in the prevention and treatment of rejection of the transplanted heart, cardiac allograft vasculopathy (CAV) remains the main cause of death in late survival transplanted patients. CAV consists of a progressive diffuse intimal hyperplasia and the proliferation of vascular smooth muscle cells, ending in wall thickening of epicardial vessels, intramyocardial arteries (50-20 μm), arterioles (20-10 μm), and capillaries (< 10 μm). The etiology of CAV remains unclear; both immunologic and non-immunologic mechanisms contribute to endothelial damage with a sustained inflammatory response. The immunological factors involved are Human Leukocyte Antigen compatibility between donor and recipient, alloreactive T cells and the humoral immune system. The non-immunological factors are older donor age, ischemia-reperfusion time, hyperlipidemia and CMV infections. Diagnostic techniques that are able to assess microvascular function are lacking. Intravascular ultrasound and fractional flow reserve, when performed during coronary angiography, are able to detect epicardial coronary artery disease but are not sensitive enough to assess microvascular changes. Some authors have proposed an index of microcirculatory resistance during maximal hyperemia, which is calculated by dividing pressure by flow (distal pressure multiplied by the hyperemic mean transit time). Non-invasive methods to assess coronary physiology are stress echocardiography, coronary flow reserve by transthoracic Doppler echocardiography, single photon emission computed tomography, and perfusion cardiac magnetic resonance. In this review, we intend to analyze the mechanisms, consequences and therapeutic implications of microvascular dysfunction, including an extended citation of relevant literature data.
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Sageshima J, Ciancio G, Chen L, Dohi T, El-Hinnawi A, Paloyo S, Misawa R, Ekwenna O, Yatawatta A, Burke GW. Everolimus with low-dose tacrolimus in simultaneous pancreas and kidney transplantation. Clin Transplant 2014; 28:797-801. [PMID: 24779669 DOI: 10.1111/ctr.12381] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2014] [Indexed: 02/06/2023]
Abstract
The efficacy and safety of everolimus (EVR) in simultaneous pancreas and kidney transplantation (SPKT) is unclear. We retrospectively evaluated 25 consecutive SPKT recipients at our center from November 2011 to March 2013. All patients received dual induction (Thymoglobulin/basiliximab) and low-dose tacrolimus plus corticosteroids. Nine patients who received EVR were compared with 14 patients who received enteric-coated mycophenolate sodium (EC-MPS); two patients who received sirolimus were excluded from the analysis. With a median follow-up of 14 months, the pancreas graft survival rate was 100% in both groups, and the kidney graft survival rate was 100% and 93% in EVR and EC-MPS patients, respectively. One EC-MPS patient lost her kidney graft from proteinuric kidney disease. Another EC-MPS patient received treatment for clinically diagnosed pancreas and kidney graft rejection. No rejection was observed in EVR patients. Serum creatinine and HbA1c levels were similar between the groups. There was no significant difference of surgical or medical complications. In conclusion, EVR seems to provide comparable short-term outcome to EC-MPS when combined with low-dose tacrolimus/steroids and dual induction therapy. A larger study with a longer follow-up is required to further assess this combination.
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Affiliation(s)
- Junichiro Sageshima
- Division of Kidney and Pancreas Transplantation, Dewitt Daughtry Department of Surgery, University of Miami Miller School of Medicine, Miami, FL, USA; Miami Transplant Institute at the Jackson Memorial Hospital and University of Miami, Miami, FL, USA
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Analytical Performance of QMS Everolimus Assay on Ortho Vitros 5,1 FS Fusion Analyzer. Ther Drug Monit 2014; 36:264-8. [DOI: 10.1097/ftd.0b013e3182a3b3f6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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38
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Catalano G, De Simone P, Mazzoni A, Ghinolfi D, Coletti L, Filipponi F. Everolimus-based immunosuppression in a case of ABO-incompatible liver transplantation with calcineurin inhibitor-related posterior occipital syndrome. Transpl Int 2014; 27:e84-6. [PMID: 24606320 DOI: 10.1111/tri.12304] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Gabriele Catalano
- Liver Transplantation Unit, Department of Oncology, Transplantation and New Technologies, Azienda Ospedaliero-Universitaria, Pisa, Italy.
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Margoles H, Gomez-Lobo V, Veis J, Sherman M, Moore J. Successful Maternal and Fetal Outcome in a Kidney Transplant Patient with Everolimus Exposure Throughout Pregnancy: A Case Report. Transplant Proc 2014; 46:281-3. [DOI: 10.1016/j.transproceed.2013.09.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Accepted: 09/12/2013] [Indexed: 11/17/2022]
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40
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Cholongitas Ε, Goulis I, Theocharidou E, Antoniadis N, Fouzas I, Giakoustidis D, Imvrios G, Giouleme O, Papanikolaou V, Akriviadis E, Vasiliadis T. Everolimus-based immunosuppression in liver transplant recipients: a single-centre experience. Hepatol Int 2013. [DOI: 10.1007/s12072-013-9492-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Reiff A, Kadayifcilar S, Özen S. Rheumatic Inflammatory Eye Diseases of Childhood. Rheum Dis Clin North Am 2013; 39:801-32. [DOI: 10.1016/j.rdc.2013.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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42
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Peddi VR, Wiseman A, Chavin K, Slakey D. Review of combination therapy with mTOR inhibitors and tacrolimus minimization after transplantation. Transplant Rev (Orlando) 2013; 27:97-107. [DOI: 10.1016/j.trre.2013.06.001] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 06/24/2013] [Indexed: 12/24/2022]
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Funakoshi T, Latif A, Galsky MD. Risk of hematologic toxicities in patients with solid tumors treated with everolimus: A systematic review and meta-analysis. Crit Rev Oncol Hematol 2013; 88:30-41. [DOI: 10.1016/j.critrevonc.2013.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/06/2013] [Accepted: 06/07/2013] [Indexed: 01/14/2023] Open
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Abstract
Biological functions of antibiotics are not limited to killing. The most likely function of antibiotics in natural microbial ecosystems is signaling. Does this signaling function of antibiotics also extend to the eukaryotic – in particular mammalian – cells? In this review, the host modulating properties of three classes of antibiotics (macrolides, tetracyclines, and β-lactams) will be briefly discussed. Antibiotics can be effective in treatment of a broad spectrum of diseases and pathological conditions other than those of infectious etiology and, in this capacity, may find widespread applications beyond the intended antimicrobial use. This use, however, should not compromise the primary function antibiotics are used for. The biological background for this inter-kingdom signaling is also discussed.
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Affiliation(s)
- Rustam I Aminov
- Faculty of Medical Sciences, University of the West Indies Kingston, Jamaica
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45
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Swords DC, Al-Geizawi SM, Farney AC, Rogers J, Burkart JM, Assimos DG, Stratta RJ. Treatment options for renal cell carcinoma in renal allografts: a case series from a single institution. Clin Transplant 2013; 27:E199-205. [PMID: 23419131 DOI: 10.1111/ctr.12088] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2012] [Indexed: 12/29/2022]
Abstract
Renal cell carcinoma (RCC) is more common in renal transplant and dialysis patients than the general population. However, RCC in transplanted kidneys is rare, and treatment has previously consisted of nephrectomy with a return to dialysis. There has been recent interest in nephron-sparing procedures as a treatment option for RCC in allograft kidneys in an effort to retain allograft function. Four patients with RCC in allograft kidneys were treated with nephrectomy, partial nephrectomy, or radiofrequency ablation. All of the patients are without evidence of recurrence of RCC after treatment. We found nephron-sparing procedures to be reasonable initial options in managing incidental RCCs diagnosed in functioning allografts to maintain an improved quality of life and avoid immediate dialysis compared with radical nephrectomy of a functioning allograft. However, in non-functioning renal allografts, radical nephrectomy may allow for a higher chance of cure without the loss of transplant function. Consequently, radical nephrectomy should be utilized whenever the allograft is non-functioning and the patient's surgical risk is not prohibitive.
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Affiliation(s)
- Darden C Swords
- Wake Forest School of Medicine, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA
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