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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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Sasahara H, Sugiyama K, Tsukaguchi M, Isogai K, Toyama A, Satoh H, Saitoh K, Nakagawa Y, Takahashi K, Tanaka S, Onda K, Hirano T. Comparison of the Pharmacological Efficacies of Immunosuppressive Drugs Evaluated by the ATP Production and Mitochondrial Activity in Human Lymphocytes. CELL MEDICINE 2013; 6:39-45. [PMID: 26858879 DOI: 10.3727/215517913x674207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The lymphocyte immunosuppressant sensitivity test (LIST) using patient peripheral lymphocytes can predict the therapeutic efficacy of immunosuppressive drugs used in renal transplantation. We have evaluated the pharmacological efficacy of drugs by using the LIST with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, which measures the cellular mitochondrial activity. The LIST with the MTT assay requires a relatively large amount of blood. As such, we developed a new assay for examining drug sensitivity with a CellTiter-Glo assay, which measures the amount of cellular ATP to help increase the assay's sensitivity and reduce the amount of blood needed. Renal transplant recipients generally receive either cyclosporine or tacrolimus, in addition to mycophenolate mofetil and methylprednisolone, as an immunosuppressive therapy to prevent acute rejection. We evaluated the pharmacological efficacy of these immunosuppressive agents with both the MTT and CellTiter-Glo assays using the peripheral blood mononuclear cells of 21 healthy volunteers. Furthermore, we also examined the relationship between these immunosuppressive agents' pharmacological efficacy and the results of the MTT and CellTiter-Glo assays. The IC50 values for cyclosporine, tacrolimus, mycophenolic acid, and methylprednisolone were significantly correlated between the MTT and CellTiter-Glo assays. The amount of blood cells required for LIST with the CellTiter-Glo assay was able to be reduced to 25% of the amount required for the previously established LIST with the MTT assay procedure. We concluded from these observations that the LIST with the CellTiter-Glo assay should be used instead of the MTT assay for carrying out individualized immunosuppressive therapy in renal transplantation patients.
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Affiliation(s)
- Hiroyasu Sasahara
- Division of Pharmacy, Niigata University Medical and Dental Hospital , Niigata , Japan
| | - Kentaro Sugiyama
- † Department of Clinical Pharmacology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences , Hachioji , 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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