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Li P, Cheng D, Wen J, Ni X, Xie K, Li X, Chen J. Conversion from mycophenolate mofetil to mizoribine in the early stages of BK polyomavirus infection could improve kidney allograft prognosis: a single-center study from China. BMC Nephrol 2021; 22:328. [PMID: 34600511 PMCID: PMC8487576 DOI: 10.1186/s12882-021-02527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background Some studies have suggested mizoribine (MZR) could inhibit the replication of BK polyomavirus (BKPyV). The purpose of this study was to explore whether conversion from mycophenolate mofetil (MMF) to MZR in the early stages of BKPyV infection can improve kidney allograft prognosis. Methods Twenty-one kidney transplant recipients with BKPyV viruria/viremia and ten with BK polyomavirus-associated allograft nephropathy (BKPyVAN) received MZR conversion therapy were retrospectively identified. The clearance rate of urine and blood BKPyV DNA, change of serum creatinine (SCr), uric acid (UA), hemoglobin (HB), white blood cell (WBC), lymphocyte ratio, platelet (PLT), routine urinalysis, panel reactive antibody (PRA), and gastrointestinal disorders during follow-up of the 2 groups were evaluated and compared. Results After MZR conversion therapy, the clearance rate of urine and blood viral load in BKPyV viruria/viremia group were 85.7 and 100 %, while that in BKPyVAN were 40 and 87.5 %, respectively. Stable SCr were observed in all cases of BKPyV viruria/viremia group, while that of BKPyVAN was only 40 % (P < 0.001) and one even progressed to end-stage renal disease. The results of routine urinalysis in the two groups showed no significant changes before and after MZR conversion therapy. However, in BKPyV viruria/viremia group, four cases developed acute rejection and one had positive PRA-II but no donor specific antibody, requiring conversion back to MMF. Hyperuricemia was the common adverse effect of MZR. Conclusions Conversion from MMF to MZR could help clear BKPyV infection. As compared to BKPyVAN, patients who underwent initiation of MZR conversion therapy in the early stages of BKPyV infection maintained stable allograft function. Prospective studies with larger sample size are needed to ascertain this preliminary finding.
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Affiliation(s)
- Ping Li
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China
| | - Dongrui Cheng
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China
| | - Jiqiu Wen
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China
| | - Xuefeng Ni
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China
| | - Kenan Xie
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China
| | - Xue Li
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China
| | - Jinsong Chen
- Jinling Hospital, National Clinical Research Center of Kidney Diseases, Medical School of Nanjing University, 305 East Zhong Shan Road, 210002, Nanjing, China.
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Long-term Survival Analysis of Kidney Transplant Recipients Receiving Mizoribine as a Maintenance Immunosuppressant: A Single-Center Study. Transplant Proc 2019; 51:2637-2642. [PMID: 31349984 DOI: 10.1016/j.transproceed.2019.03.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/04/2019] [Accepted: 03/13/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mizoribine (MZR) has been developed as an immunosuppressant and is widely used in Asia. However, most studies on MZR have been performed in Japan, and there remains a lack of reports on long-term use in other countries. The purpose of this study is to evaluate the efficacy and safety of MZR's use in Korean kidney transplant recipients by observing their clinical courses and analyzing their long-term patent and graft survival rates. METHODS We studied 129 subjects who had received MZR as a maintenance immunosuppressant since January 2000. Our analysis was based on the patients' medical records from January 2000 to December 2017. RESULTS The overall survival rates of the kidney transplant recipients were 100% at 1 year, 99.1% at 5 years, 96.8% at 10 years, and 92.5% at 15 years. The graft survival rates were 100% at 1 year, 98.3% at 5 years, 93.2% at 10 years, and 82.2% at 15 years. There were differences in the recipient survival and graft survival rates according to the kidney donor and the use of renal replace therapy before transplant. There were no differences in the survival rates according to the MZR dose, the type of underlying disease, or other clinical factors. CONCLUSIONS The use of low doses of MZR as a maintenance immunosuppressant could be an effective means of ensuring relatively good long-term patient and graft survival rates in cases of kidney transplant.
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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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Pallet N, Fernández-Ramos AA, Loriot MA. Impact of Immunosuppressive Drugs on the Metabolism of T Cells. INTERNATIONAL REVIEW OF CELL AND MOLECULAR BIOLOGY 2018; 341:169-200. [DOI: 10.1016/bs.ircmb.2018.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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The effect of immunosuppressive molecules on T-cell metabolic reprogramming. Biochimie 2016; 127:23-36. [DOI: 10.1016/j.biochi.2016.04.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/22/2016] [Indexed: 12/22/2022]
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Chen S, Sugiyama K, Inamura M, Tanaka S, Onda K, Yin H, Hirano T. Effects of insulin on pharmacodynamics of immunosuppressive drugs against mitogen-activated human peripheral blood mononuclear cells. Immunopharmacol Immunotoxicol 2016; 38:372-8. [PMID: 27443993 DOI: 10.1080/08923973.2016.1214143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CONTEXT Diabetes mellitus is one of the most common causes of chronic renal failure. Immunosuppressive efficacies of glucocorticoids, calcineurin inhibitors, and mycophenolic acid are possibly affected by insulin after renal transplantation in these patients. OBJECTIVES We investigated the effects of insulin on responses of mitogen-activated human peripheral blood mononuclear cells (PBMCs) to several immunosuppressive drugs. MATERIALS AND METHODS Antiproliferative efficacies of prednisolone, hydrocortisone, cyclosporine, tacrolimus, and mycophenolic acid against concanavalin A-stimulated PBMCs were evaluated in the presence of physiological (5 μunits/mL) and super physiological (50 μunits/mL) concentrations of insulin. Insulin-receptor expressions on PBMCs were evaluated by flow cytometry. RESULTS Insulin itself had no effects on the mitogen-induced proliferation of PBMCs. The IC50 values of cyclosporine against the mitogen-activated PBMCs in the presence of 5 or 50 μunits/mL insulin were significantly higher than those of cyclosporine without insulin (p < 0.05). The IC50 values of mycophenolic acid significantly increased by 50 μunits/mL insulin (p < 0.01). Insulin receptors were detected on the mitogen-activated CD4(+)/CD14(+ )cells in PBMCs. DISCUSSION AND CONCLUSIONS These results indicate that insulin at even physiological concentration attenuates suppressive efficacies of several immunosuppressive drugs against mitogen-activated proliferation of human PBMCs, possibly via insulin receptors. Insulin used in dialysis patients accompanying diabetes mellitus is suggested to attenuate efficacies of immunosuppressive drugs after renal transplantation.
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Affiliation(s)
- Shuiling Chen
- a Department of Clinical Pharmacology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan ;,b Cardiovascular Department , Xiyuan Hospital, China Academy of Chinese Medical Sciences , Beijing , P.R. China
| | - Kentaro Sugiyama
- a Department of Clinical Pharmacology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
| | - Mariko Inamura
- a Department of Clinical Pharmacology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
| | - Sachiko Tanaka
- a Department of Clinical Pharmacology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
| | - Kenji Onda
- a Department of Clinical Pharmacology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
| | - Huijun Yin
- b Cardiovascular Department , Xiyuan Hospital, China Academy of Chinese Medical Sciences , Beijing , P.R. China
| | - Toshihiko Hirano
- a Department of Clinical Pharmacology, School of Pharmacy , Tokyo University of Pharmacy and Life Sciences , Tokyo , Japan
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EXP CLIN TRANSPLANTExp Clin Transplant 2014; 12. [DOI: 10.6002/ect.2013.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register]
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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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Monitoring of the immunomodulatory effect of CP-690,550 by analysis of the JAK/STAT pathway in kidney transplant patients. Transplantation 2010; 88:1002-9. [PMID: 19855246 DOI: 10.1097/tp.0b013e3181b9ced7] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND.: The small molecule drug CP-690,550 inhibits Janus kinase 3 at nanomolar concentrations and has recently been shown to prevent allograft rejection in rodents and nonhuman primates. METHODS.: As part of a phase 1 clinical trial, we investigated the effect of CP-690,550 after 29 days of 30 mg twice daily treatment at the cellular level in eight kidney transplant patients by studying ex vivo phosphorylation of STAT5 (P-STAT5), the key substrate of JAK3. RESULTS.: As determined by quantitative fluorescent western blotting, interleukin-2-induced P-STAT5 in YT cells was reduced by a median of 73% (P<0.01) in the presence of serum collected on day 29 compared with pretreatment baseline. When evaluated by phosphospecific flow cytometry, CP-690,550 also reduced interleukin-2-induced P-STAT5 in CD3 (median 20%; P<0.05), CD3CD4 (median 37%; P<0.05), and CD3CD8 (median 34%; P<0.01) populations in patient-derived peripheral blood mononuclear cells. At the functional level, the inhibitory effect of CP-690,550 was confirmed by determining the expression of several STAT5 targets genes. CONCLUSION.: Analysis of P-STAT5 may, therefore, be used to determine the immunomodulatory effect of CP-690,550 at the cellular level in transplant patients.
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Cheng KW, Wong CC, Wang M, He QY, Chen F. Identification and characterization of molecular targets of natural products by mass spectrometry. MASS SPECTROMETRY REVIEWS 2010; 29:126-155. [PMID: 19319922 DOI: 10.1002/mas.20235] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Natural products, and their derivatives and mimics, have contributed to the development of important therapeutics to combat diseases such as infections and cancers over the past decades. The value of natural products to modern drug discovery is still considerable. However, its development is hampered by a lack of a mechanistic understanding of their molecular action, as opposed to the emerging molecule-targeted therapeutics that are tailored to a specific protein target(s). Recent advances in the mass spectrometry-based proteomic approaches have the potential to offer unprecedented insights into the molecular action of natural products. Chemical proteomics is established as an invaluable tool for the identification of protein targets of natural products. Small-molecule affinity selection combined with mass spectrometry is a successful strategy to "fish" cellular targets from the entire proteome. Mass spectrometry-based profiling of protein expression is also routinely employed to elucidate molecular pathways involved in the therapeutic and possible toxicological responses upon treatment with natural products. In addition, mass spectrometry is increasingly utilized to probe structural aspects of natural products-protein interactions. Limited proteolysis, photoaffinity labeling, and hydrogen/deuterium exchange in conjunction with mass spectrometry are sensitive and high-throughput strategies that provide low-resolution structural information of non-covalent natural product-protein complexes. In this review, we provide an overview on the applications of mass spectrometry-based techniques in the identification and characterization of natural product-protein interactions, and we describe how these applications might revolutionize natural product-based drug discovery.
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Affiliation(s)
- Ka-Wing Cheng
- School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China
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Sugiyama K, Isogai K, Toyama A, Satoh H, Saito K, Nakagawa Y, Tasaki M, Takahashi K, Saito N, Hirano T. Cyclosporine pharmacological efficacy estimated by lymphocyte immunosuppressant sensitivity test before and after renal transplantation. J Clin Pharm Ther 2009; 34:539-45. [DOI: 10.1111/j.1365-2710.2009.01036.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Pretransplant Pharmacodynamic Analysis of Immunosuppressive Agents Using CFSE-Based T-Cell Proliferation Assay. Clin Pharmacol Ther 2009; 86:285-9. [DOI: 10.1038/clpt.2009.61] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sugiyama K, Isogai K, Toyama A, Satoh H, Saito K, Nakagawa Y, Tasaki M, Takahashi K, Saito N, Hirano T. Pharmacodynamic Parameters of Immunosuppressive Drugs Are Not Correlated with Age, Duration of Dialysis, Percentage of Lymphocytes or Lymphocyte Stimulation Index in Renal Transplant Recipients. Biol Pharm Bull 2008; 31:2146-9. [DOI: 10.1248/bpb.31.2146] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Kentaro Sugiyama
- Division of Pharmacy, Niigata University Medical and Dental Hospital
| | - Kazuya Isogai
- Division of Pharmacy, Niigata University Medical and Dental Hospital
| | - Akira Toyama
- Division of Pharmacy, Niigata University Medical and Dental Hospital
| | - Hiroshi Satoh
- Division of Pharmacy, Niigata University Medical and Dental Hospital
| | - Kazuhide Saito
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University
| | - Yuki Nakagawa
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University
| | - Masayuki Tasaki
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University
| | - Kota Takahashi
- Division of Urology, Graduate School of Medical and Dental Sciences, Niigata University
| | - Noriko Saito
- Division of Clinical Nephrology, Rheumatology, Respiratory Medicine, and Infection Control and Prevention, Graduate School of Medical and Dental Sciences, Niigata University
| | - Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Science
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Hirano T. Cellular pharmacodynamics of immunosuppressive drugs for individualized medicine. Int Immunopharmacol 2007; 7:3-22. [PMID: 17161812 DOI: 10.1016/j.intimp.2006.09.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Revised: 09/04/2006] [Accepted: 09/17/2006] [Indexed: 12/13/2022]
Abstract
The therapeutic effects of immunosuppressive drugs are known to deviate largely between patients, but efficient strategies for the differentiation of patients who show clinical resistance to immunosuppressive therapies have not been established. Accordingly, a considerable number of patients receive treatment with immunosuppressive drugs despite the onset of serious side effects and poor responses. Cellular pharmacodynamics of immunosuppressive drugs in vitro using peripheral lymphocytes derived from each patient, an attractive way to distinguish resistant patients, is respected and has been applied to the carrying out of individualized immunosuppressive therapy. In this article, I summarize experimental procedures for assaying immune cell responses to immunosuppressive drugs in vitro, and highlight the relationship between cellular sensitivity to immunosuppressive drugs and the therapeutic efficacy of drugs in organ transplantation and several immunological disorders. I will also overview the molecular mechanisms and genetic bases for cellular and clinical resistance to immunosuppressive drugs. Lastly, the future clinical prospects for the application of in vitro drug sensitivity tests for "patient-tailored" immunosuppressive therapies are discussed.
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Affiliation(s)
- Toshihiko Hirano
- Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Science, 1432-1 Horinouchi, Hachioji, Tokyo 192-0392, Japan.
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Shimmura H, Tanabe K, Habiro K, Abe R, Toma H. Combination effect of mycophenolate mofetil with mizoribine on cell proliferation assays and in a mouse heart transplantation model. Transplantation 2006; 82:175-9. [PMID: 16858279 DOI: 10.1097/01.tp.0000226227.79142.31] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mycophenolate mofetil (MMF) is a highly potent immunosuppressant that suppresses the proliferation of T and B cells by the uncompetitive inhibition of inosine monophosphate dehydrogenase (IMPDH). Consequently, under MMF immunosuppression, good graft survival has been achieved in clinical organ transplantation, although MMF shows adverse gastrointestinal effects. Mizoribine (MZ) also inhibits IMPDH in a competitive manner and is used clinically for organ transplantation in Japan as an immunosuppressant with fewer adverse gastrointestinal effects. Therefore, in this study we investigated the synergistic effects on in vitro and in vivo assays of mice of a combination of MMF with MZ immunosuppression. METHODS Mixed lymphocyte reaction (MLR) assay and a mouse heart transplantation model were used to evaluate the immunosuppressive effect of MMF with MZ. The median-effect principle and a combination index (CI) were employed to determine synergism, an additive effect, or antagonism. RESULTS Combination of MMF with MZ resulted in mild synergistic effects in the inhibition of MLR (CI = 0.854-1.143). In the mouse heart transplantation model, C57BL/6 recipients who received a BALB/c heart under the combination of MMF and MZ at 40 + 40 or 80 + 80 mg/kg/day showed a strong synergistic prolongation of graft survival with 19.7 +/- 18.9 (P = 0.0012, CI = 0.438) and 78.4 +/- 36.9 days (P = 0.0002, CI = 0.317), respectively, compared with recipients treated with MMF or MZ monotherapy. CONCLUSIONS.: The combination of MMF and MZ showed mild synergistic effects in the inhibition of MLR and strong synergistic effects in a mouse heart transplantation model.
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Affiliation(s)
- Hiroaki Shimmura
- Department of Urology, Kidney Center, Tokyo Women's Medical University, Shinjuku, Japan
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Sugiyama K, Arakawa K, Satoh H, Saito K, Takahashi K, Saito N, Hirano T. Correlation Between Pharmacological Efficacy of Cyclosporine A and Tacrolimus, Evaluated by Lymphocyte Immunosuppressant‐Sensitivity Test (LIST) with MTT Assay Procedure in Renal Transplant Recipients. J Immunoassay Immunochem 2006; 27:195-205. [PMID: 16711256 DOI: 10.1080/15321810600595443] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The dose of calcineurin inhibitors in renal transplantation has been adjusted, based on the therapeutic drug monitoring data. However, the data do not always correlate with clinical drug efficacy. In vitro response of peripheral-blood mononuclear cells to immunosuppressive drugs is reported to correlate with the recipient-response to therapeutic efficacy of the drug. We report, here, usefulness of a lymphocyte immunosuppressant sensitivity test for the estimation of individual drug sensitivity in renal transplant recipients. The LIST we have developed includes MTT assay procedures without the use of radioisotope-labeled compounds, which is convenient for general hospital use. Utilizing this procedure, we compared the pharmacological efficacy between cyclosporine A and tacrolimus in 41 renal transplant recipients.
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Affiliation(s)
- Kentaro Sugiyama
- Division of Pharmacy, Niigata University Medical and Dental Hospital, Niigata City, Niigata, Japan.
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