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Pascual J, Crespo M, Portoles J, Jimenez C, Ortega-Carrion A, Diez T, Portero I. The IMBG Test for Evaluating the Pharmacodynamic Response to Immunosuppressive Therapy in Kidney Transplant Patients: Current Evidence and Future Applications. Int J Mol Sci 2023; 24:ijms24065201. [PMID: 36982276 PMCID: PMC10049381 DOI: 10.3390/ijms24065201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/12/2023] Open
Abstract
Immunosuppressive drugs are widely used to prevent rejection after kidney transplantation. However, the pharmacological response to a given immunosuppressant can vary markedly between individuals, with some showing poor treatment responses and/or experiencing serious side effects. There is an unmet need for diagnostic tools that allow clinicians to individually tailor immunosuppressive therapy to a patient’s immunological profile. The Immunobiogram (IMBG) is a novel blood-based in vitro diagnostic test that provides a pharmacodynamic readout of the immune response of individual patients to a range of immunosuppressants commonly used in kidney transplant recipients. Here, we discuss the current approaches used to measure the pharmacodynamic responses of individual patients to specific immunosuppressive drugs in vitro, which can then be correlated with patient’s clinical outcomes. We also describe the procedure of the IMBG assay, and summarize the results obtained using the IMBG in different kidney transplant populations. Finally, we outline future directions and other novel applications of the IMBG, both in kidney transplant patients and other autoimmune diseases.
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Affiliation(s)
- Julio Pascual
- Nephrology Department, Hospital 12 de Octubre, 28041 Madrid, Spain
- Nephrology Department, Hospital del Mar, Institut Mar for Medical Research, 08003 Barcelona, Spain
- Correspondence:
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Institut Mar for Medical Research, 08003 Barcelona, Spain
| | - Jose Portoles
- Nephrology Department, Hospital Puerta de Hierro Mahadahonda, Institute IDHIPHIM for Medical Research, 28222 Madrid, Spain
| | - Carlos Jimenez
- Nephrology Department, Hospital La Paz, 28046 Madrid, Spain
| | | | - Teresa Diez
- Biohope Scientific Solutions for Human Health, 28760 Madrid, Spain
| | - Isabel Portero
- Biohope Scientific Solutions for Human Health, 28760 Madrid, Spain
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Kusano J, Tanaka S, Matsuda H, Hara Y, Fujii Y, Suzuki S, Sekiyama M, Ando E, Sugiyama K, Hirano T. Vitamin K1 and Vitamin K2 immunopharmacological effects on the peripheral lymphocytes of healthy subjects and dialysis patients, as estimated by the lymphocyte immunosuppressant sensitivity test. J Clin Pharm Ther 2018; 43:895-902. [DOI: 10.1111/jcpt.12747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Junichi Kusano
- Division of Pharmacy; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Sachiko Tanaka
- Department of Clinical Pharmacology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
| | - Hiroto Matsuda
- Division of Nephrology; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Yoshikazu Hara
- Division of Nephrology; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Yoshiaki Fujii
- Division of Nephrology; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Shinya Suzuki
- Division of Pharmacy; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Masao Sekiyama
- Division of Pharmacy; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Eiki Ando
- Division of Pharmacy; Kanagawa-ken Keiyukai Keiyu Hospital; Kanagawa Japan
| | - Kentaro Sugiyama
- Department of Clinical Pharmacology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
| | - Toshihiko Hirano
- Department of Clinical Pharmacology; School of Pharmacy; Tokyo University of Pharmacy and Life Sciences; Tokyo Japan
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Sugiyama K, Sasahara H, Tsukaguchi M, Isogai K, Toyama A, Satoh H, Saitoh K, Nakagawa Y, Takahashi K, Tanaka S, Onda K, Hirano T. Peripheral Lymphocyte Response to Mycophenolic Acid In Vitro and Incidence of Cytomegalovirus Infection in Renal Transplantation. CELL MEDICINE 2013; 6:47-55. [PMID: 26858880 DOI: 10.3727/215517913x674216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The lymphocyte immunosuppressant sensitivity test (LIST) with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay procedure has been used to predict the pharmacological efficacy of immunosuppressive agents to prevent acute rejection episodes for renal transplant recipients. In this study, mycophenolic acid (MPA) pharmacological efficacies were evaluated by LIST at both prior to and just after renal transplantation. We compared the efficacies to the clinical outcome of these recipients. MPA's pharmacological efficacy was evaluated by LIST not only before the operation but also at 2, 4, and 6 weeks after transplantation in 16 renal transplant recipients. These recipients were divided into high- and low-sensitivity groups according to peripheral blood mononuclear cell (PBMC) sensitivity to MPA in vitro. The MPA sensitivities were compared to cytomegalovirus (CMV) infection and acute rejection episodes in these recipients under MPA immunosuppressive therapy. The rate of CMV infection episodes in the low-MPA pharmacological efficacy group categorized at 2 weeks after renal transplantation was 5/6 (83.3%), which was significantly higher than the rate of 1/10 (10.0%) (p < 0.01) in the high-MPA sensitivity group. However, the MPA pharmacological efficacy evaluated both before and after transplantation had no relationship with the incidence of rejection episodes. These findings suggest that the MPA pharmacological efficacy evaluated by LIST at 2 weeks after operation is a useful biomarker for predicting the following occurrence of CMV infection episodes in renal transplant recipients.
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Affiliation(s)
- Kentaro Sugiyama
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Hachioji , Japan
| | - Hiroyasu Sasahara
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Mahoto Tsukaguchi
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Kazuya Isogai
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Akira Toyama
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Hiroshi Satoh
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Kazuhide Saitoh
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Yuki Nakagawa
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Kota Takahashi
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Sachiko Tanaka
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Hachioji , Japan
| | - Kenji Onda
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Hachioji , Japan
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Hachioji , Japan
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Sugiyama K, Isogai K, Toyama A, Satoh H, Saito K, Nakagawa Y, Tasaki M, Takahashi K, Hirano T. Clinical Significance of the Pharmacological Efficacy of Tacrolimus Estimated by the Lymphocyte Immunosuppressant Sensitivity Test (LIST) Before and After Renal Transplantation. CELL MEDICINE 2012; 3:81-88. [PMID: 28058184 DOI: 10.3727/215517912x639360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The lymphocyte immunosuppressant sensitivity test (LIST) with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay procedure can predict the pharmacological efficacy of immunosuppressive agents. A previous study reported the pharmacological efficacy of tacrolimus evaluated by LIST just before renal transplantation significantly correlated with the incidence of acute rejection episodes. However, the pharmacological efficacy of tacrolimus has not been estimated after renal transplantation. Therefore, the present study evaluated the pharmacological efficacy of tacrolimus by LIST using the MTT assay procedure before and 1, 3, and 12 months after transplantation in 17 renal transplant recipients that received tacrolimus-based immunosuppressive therapy. The tacrolimus pharmacological efficacies before and after the procedure were also compared with incidence of acute rejection and cytomegalovirus (CMV) infection episodes. The individual values of tacrolimus 50% inhibition of lymphocyte proliferation (IC50) varied widely before transplantation, and the mean value of the IC50 was 126.4 ± 337.7 ng/ml. The patients were divided into two groups according to the tacrolimus IC50 values evaluated before transplantation. The rate of acute rejection episodes in the tacrolimus high-sensitivity group was significantly lower than that in the tacrolimus low-sensitivity group (p = 0.005). The tacrolimus IC50 deviation between patients expanded further at one and three months after surgery. However, the sensitivity deviation almost converged at 1 year after surgery. Moreover, the pharmacological efficacy of tacrolimus evaluated at 1, 3, and 12 months after transplantation did not significantly correlate with the incidence of acute rejection episodes. The pharmacological efficacies of tacrolimus evaluated at both before and after surgery were not significantly correlated with the episodes of CMV infection. These findings suggest that the pharmacological efficacy of tacrolimus evaluated with LIST before surgery is a useful biomarker for predicting the occurrence of acute allograft rejection in renal transplantation.
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Affiliation(s)
- Kentaro Sugiyama
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
| | - Kazuya Isogai
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Akira Toyama
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Hiroshi Satoh
- † Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Kazuhide Saito
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Yuki Nakagawa
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Masayuki Tasaki
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Kota Takahashi
- ‡ Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University , Niigata , Japan
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
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Sugiyama K, Isogai K, Horisawa S, Toyama A, Satoh H, Saito K, Nakagawa Y, Tasaki M, Takahashi K, Hirano T. Comparative Study of the Cellular Pharmacodynamics of Tacrolimus in Renal Transplant Recipients Treated with and without Basiliximab. Cell Transplant 2012; 21:565-70. [DOI: 10.3727/096368911x605493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Basiliximab is a recently developed immunosuppressive agent for the prevention of acute allograft rejection in renal transplant recipients. The combination use of basiliximab and a calcineurin inhibitor was suggested to be more effective in comparison to immunosuppressive therapy using calcineurin inhibitor without basiliximab. Cyclosporine has been generally administered with basiliximab for renal transplant recipients. However, in cases of tacrolimus-based immunosuppressive regimen, the clinical efficacy and safety of combined use of tacrolimus and basiliximab remains to be elucidated. This study evaluated the tacrolimus pharmacological efficacy using a lymphocyte immunosuppressant sensitivity test (LIST) with MTT assay procedures in 16 cases of renal transplant recipients treated by tacrolimus without basiliximab and in 13 cases treated by tacrolimus in combination with basiliximab. The rate of acute rejection episodes in the recipients treated with tacrolimus plus basiliximab was 1/13 (7.7%), whereas the rate in the recipients treated with tacrolimus without basiliximab was 6/16 (37.5%). The recipients were divided into two groups according to their peripheral blood mononuclear cell (PBMC) sensitivity to tacrolimus [i.e., including a tacrolimus high sensitivity group (IC50 <1.0 ng/ml) and a low sensitivity group (IC50 >1.0 ng/ml). In the recipients treated with tacrolimus without basiliximab, the rate of acute rejection episodes in the tacrolimus high sensitivity group was 1/10 (10.0%), which was significantly lower than the rate in the low sensitivity group of 5/6 (83.3%; p = 0.008). The incidence of cytomegalovirus infection was not significantly different between the tacrolimus high and the low sensitivity groups of the recipients treated with tacrolimus with and without basiliximab. Therefore, in the case of selected tacrolimus-based immunosuppressive therapy for renal transplant recipients, the tacrolimus pharmacological efficacy should be evaluated using LIST at a time just before the transplant procedure in order to accurately predict allograft rejection. The data also suggested that low tacrolimus sensitivity recipients should be treated with tacrolimus-based immunosuppressive therapy in combination with basiliximab.
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Affiliation(s)
- Kentaro Sugiyama
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Science, Tokyo, Japan
| | - Kazuya Isogai
- Division of Pharmacy, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoshi Horisawa
- Division of Pharmacy, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Akira Toyama
- Division of Pharmacy, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Hiroshi Satoh
- Division of Pharmacy, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazuhide Saito
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Yuki Nakagawa
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Masayuki Tasaki
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Kota Takahashi
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Science, Tokyo, Japan
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Sugiyama K, Isogai K, Horisawa S, Toyama A, Satoh H, Saito K, Nakagawa Y, Tasaki M, Takahashi K, Hirano T. The pharmacological efficacy of mycophenolic acid before and after renal transplantation as estimated by the lymphocyte immunosuppressant sensitivity test (LIST). Immunopharmacol Immunotoxicol 2010; 32:430-6. [DOI: 10.3109/08923970903490478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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