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immunosuppression minimization

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https://www.readbyqxmd.com/read/29787522/belatacept-in-solid-organ-transplant-review-of-current-literature-across-transplant-types
#1
Caroline P Perez, Neha Patel, Caitlin R Mardis, Holly B Meadows, David J Taber, Nicole A Pilch
Calcineurin inhibitors (CNIs) have been the backbone immunosuppressant for solid organ transplant recipients for decades. Long-term use of CNIs unfortunately is associated with multiple toxicities, with the biggest concern being CNI-induced nephrotoxicity. Belatacept is a novel agent approved for maintenance immunosuppression in renal transplant recipients. In the kidney transplant literature, it has shown promise as being an alternative agent by preserving renal function and having a minimal adverse effect profile...
May 22, 2018: Transplantation
https://www.readbyqxmd.com/read/29787417/human-leukocyte-antigen-mismatch-and-precision-medicine-in-transplantation
#2
Chris Wiebe, Peter Nickerson
PURPOSE OF REVIEW: Pretransplant and posttransplant alloimmune risk assessment needs to evolve towards a precision medicine model already used in other areas of medicine. Although this has not been possible with traditional risk factors available at the time of transplant, new methods of human leukocyte antigen (HLA) molecular mismatch have generated hope that alloimmune risk assessment may be precise enough for personalized treatment strategies. RECENT FINDINGS: This review describes the various HLA molecular mismatch methods and some of the recent publications for each method...
May 18, 2018: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/29783907/association-between-potential-drug-interactions-and-clinical-outcomes-in-hematopoietic-stem-cell-transplantations
#3
Ingrid Apm Valverde, Mario Js da Silva, Maely Pf Retto
The association of anti-infective, antineoplastic and immunosuppressant drugs makes patients undergoing hematopoietic stem cell transplantation susceptible to the effects resulting from drug interactions. In this study, we analyzed the potential drug interactions in the association between anti-infective, antineoplastic and immunomodulators agents and their clinical effects presented by patients from a bone marrow transplant service of a Brazilian hospital specialized in cancer treatment. The retrospective cohort involved patients in the conditioning phase undergoing transplantation in the year 2013...
January 1, 2018: Journal of Oncology Pharmacy Practice
https://www.readbyqxmd.com/read/29779413/tailoring-tacrolimus-therapy-in-kidney-transplantation
#4
Thomas Jouve, Johan Noble, Lionel Rostaing, Paolo Malvezzi
BACKGROUND: The prevalence of end-stage renal disease is increasing worldwide. The best treatment is kidney transplantation, although life-long immunosuppressive therapy is then mandatory. Currently, the cornerstone immunosuppressive therapy relies on tacrolimus, a calcineurin inhibitor that is nephrotoxic but whose exposition can be minimized in a delicate balance. Area covered: We addressed whether, in the setting of kidney transplantation, tacrolimus-based therapy can be tailored to medical needs: to achieve this, we searched for suitable articles in PubMed...
May 19, 2018: Expert Review of Clinical Pharmacology
https://www.readbyqxmd.com/read/29775447/-mycophenolate-mofetil-mmf-as-the-first-choice-immunosuppressive-drug-in-treatment-of-steroid-dependent-nephrotic-syndrome-in-children
#5
Iwona Ogarek, Elżbieta Szczęsny-Choruz, Ewa Wierzchowska-Słowiaczek, Joanna Kwinta-Rybicka, Zofia Stec, Anna Moczulska, Katarzyna Wilkosz, Dorota Drożdż
Most children diagnosed with nephrotic syndrome show favourable response to corticosteroid therapy, nonetheless 30% of patients have frequent relapses or a steroid-dependent course of disease. Cyclophosphamide, cyclosporin A or MMF are being used in treatment of steroid-dependent nephrotic syndrome in search of a drug with highest long-term effectiveness and least amount of side effects. AIM: The aim of study was to assess of the efficacy of MMF as the first choice immunosuppressive drug in children with nephrotic syndrome after determining a steroid-dependency...
April 23, 2018: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
https://www.readbyqxmd.com/read/29771768/high-density-infiltration-of-v-domain-immunoglobulin-suppressor-of-t-cell-activation-up-regulated-immune-cells-in-human-pancreatic-cancer
#6
Jinʼe Liu, Xiaoxue Xie, Chunxiao Xuan, Tingting Li, Lanlan Wang, Lianghong Teng, Jun Liu
V-domain immunoglobulin suppressor of T-cell activation (VISTA) is constitutively expressed in hematopoietic lineage and is highly up-regulated in tumor infiltrated myeloid cells and regulatory T cells in animal models. However, its expression in human pancreatic tumor microenvironment remains unknown. In this research, we aimed at the expression of VISTA in human pancreatic cancer samples. METHODS: We performed immunohistochemistry to determine VISTA expression in human pancreatic cancer samples...
May 15, 2018: Pancreas
https://www.readbyqxmd.com/read/29770308/allo-and-auto-percutaneous-intra-portal-pancreatic-islet-transplantation-pipit-for-diabetes-cure-and-prevention-the-role-of-imaging-and-interventional-radiology
#7
REVIEW
Massimo Venturini, Claudio Sallemi, Paolo Marra, Anna Palmisano, Giulia Agostini, Carolina Lanza, Gianpaolo Balzano, Massimo Falconi, Antonio Secchi, Paolo Fiorina, Lorenzo Piemonti, Paola Maffi, Antonio Esposito, Francesco De Cobelli, Alessandro Del Maschio
Although the life expectancy of patients with type 1 diabetes mellitus (T1DM) has improved since the introduction of insulin therapy, the acute life-threatening and long-term complications from diabetes mellitus are significant causes of both mortality and morbidity. Percutaneous intra-portal pancreatic islet transplantation (PIPIT) is a minimally invasive, repeatable procedure which allows a β-cell replacement therapy through a liver islet engraftment, leading to insulin release and glycaemic control restoration in patients with diabetes...
April 2018: Gland Surgery
https://www.readbyqxmd.com/read/29762460/a-new-life-motherhood-after-heart-transplantation-a-single-center-experience-and-review-of-literature
#8
Francesca Macera, Lucia Occhi, Gabriella Masciocco, Marisa Varrenti, Maria Frigerio
BACKGROUND: Pregnancy after heart transplantation (HTx) may expose the recipient to hemodynamic and immunologic risks, and the newborn to toxic effects of immunosuppressive therapy. Adequate preconception counseling is crucial to identify optimal timing and to modify immunosuppressive therapy in order to minimize risks for both the mother and the fetus. METHOD: We describe our experience with 12 pregnancies occurred in 11 women who had undergone HTx at our center...
May 14, 2018: Transplantation
https://www.readbyqxmd.com/read/29760523/combination-of-fucoidan-based-magnetic-nanoparticles-and-immunomodulators-enhances-tumour-localized-immunotherapy
#9
Chih-Sheng Chiang, Yu-Jung Lin, Rachel Lee, Yen-Ho Lai, Hung-Wei Cheng, Chia-Hung Hsieh, Woei-Cherng Shyu, San-Yuan Chen
Checkpoint immunotherapy that inhibits tumour immune evasion has demonstrated significant clinical success. However, the therapeutic response is limited to certain patient populations, and immunotoxicity as well as autoimmunity have compromised the therapeutic benefits. Here, we report on an inherently therapeutic fucoidan-dextran-based magnetic nanomedicine (IO@FuDex3 ) conjugated with a checkpoint inhibitor (anti-PD-L1) and T-cell activators (anti-CD3 and anti-CD28). IO@FuDex3 can repair the immunosuppressive tumour microenvironment by reinvigorating tumour-infiltrating lymphocytes, while targeting the nanomedicine via magnetic navigation to the tumour to minimize off-target effects...
May 14, 2018: Nature Nanotechnology
https://www.readbyqxmd.com/read/29756410/the-feasibility-and-efficacy-of-preparing-porcine-descemet-s-membrane-endothelial-keratoplasty-dmek-grafts-by-two-techniques-an-ex-vivo-investigation-for-future-xeno-dmek
#10
Yang Liu, Jing Zhang, Yingnan Zhang, Mingyang Yin, Sen Miao, Qingfeng Liang, Zhiqiang Pan
BACKGROUND: Descemet's membrane endothelial keratoplasty (DMEK) might be a promising technique for future xeno-corneal transplantation due to its ultrathin graft, extremely low rejection occurrence, suture-free graft fixation, and minimal immunosuppressive regime usage. The aim of this study is to explore the feasibility and efficacy of preparing porcine DMEK grafts by 2 techniques and investigate the graft ultrastructure. METHODS: Two mainstream techniques, mechanical stripping technique and liquid bubble technique, were modified to prepare the porcine DMEK grafts...
May 13, 2018: Xenotransplantation
https://www.readbyqxmd.com/read/29749651/effects-of-immunosuppressive-agents-on-the-hemostatic-system-in-normal-dogs
#11
John M Thomason, Todd M Archer, Robert W Wills, Andrew J Mackin
BACKGROUND: In dogs, the effects of immunosuppressive medications on hemostasis are not well known. HYPOTHESIS/OBJECTIVES: The objective was to determine the effects of immunosuppressive medications on primary and secondary hemostasis. Our hypothesis was that cyclosporine and prednisone would increase markers of hypercoagulability and thromboxane synthesis, while azathioprine, mycophenolate mofetil, and leflunomide would have minimal effects on hemostasis. ANIMALS: Eight healthy dogs...
May 10, 2018: Journal of Veterinary Internal Medicine
https://www.readbyqxmd.com/read/29740522/a-case-report-of-nephrotic-syndrome-while-undergoing-quinine-therapy
#12
Brittany Albrecht, Shelley Giebel, Michelle McCarron, Bhanu Prasad
We summarize the case of an 81-year-old Caucasian female who presented to her family physician with signs and symptoms of nephrotic syndrome following a brief exposure to quinine. Prior to that visit, she was clinically well with no chronic medical ailments and met with her family physician for annual physical assessments. She had taken 11 tablets of quinine for nocturnal leg cramps over the course of 28 days before starting to notice mild peripheral edema, which subsequently progressed, leading to a family physician review...
March 7, 2018: Curēus
https://www.readbyqxmd.com/read/29739268/a-rare-cause-of-proximal-muscle-weakness-immune-necrotising-myopathy
#13
Deniz Can Guven, Abdulsamet Erden, Levent Kilic, Sevim Erdem Ozdamar, Omer Karadag
Background Immune-mediated necrotising myopathies are characterised clinically by the subacute onset of proximal limb weakness, accompanied by elevated creatinine kinase levels. They are distinguished from other myopathies by the absence of prominent infiltration of the muscle with inflammatory cells in the biopsies. Case presentation A 44-year-old man presented with upper extremity weakness and dysphagia. Laboratory tests included a creatinine kinase level of 4362 U/L (normal: 52-336 U/L). Rheumatological markers were all negative...
January 1, 2018: Scottish Medical Journal
https://www.readbyqxmd.com/read/29734146/rituximab-as-a-therapeutic-option-for-steroid-sensitive-minimal-change-nephrotic-syndrome-in-adults
#14
Yuko Iwabuchi, Takahito Moriyama, Mitsuyo Itabashi, Takashi Takei, Kosaku Nitta
Minimal change nephrotic syndrome (MCNS) usually responds to steroids but frequently relapses, requiring additional treatment with immunosuppressive agents. Rituximab is a chimeric murine/human monoclonal immunoglobulin G1 antibody that targets CD20, a B-cell differentiation marker. B-cell recovery begins at approximately 6 months following the completion of treatment. Rituximab has a beneficial effect, with the sustained remission or reduction of proteinuria in patients with steroid-dependent MCNS. Relapses are thought to be associated with an increase in CD19 cells...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29715551/severe-infections-in-critically-ill-solid-organ-transplant-patients
#15
REVIEW
Andre C Kalil, Uriel Sandkovsky, Diana F Florescu
BACKGROUND: Severe infections are among the most common causes of death in immunocompromised patients admitted to the intensive care unit. The epidemiology, diagnosis, and treatment of these infections has evolved in the last decade. AIMS: We aim to provide a comprehensive review of these severe infections in this population. SOURCES: Review of the literature pertaining to severe infections in critically ill solid organ transplant (SOT) patients...
April 28, 2018: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/29699851/blockade-of-adhesion-molecule-lymphocyte-function-associated-antigen-1-improves-long-term-heart-allograft-survival-in-mixed-chimeras
#16
Nina Pilat, Philipp Sabler, Christoph Klaus, Benedikt Mahr, Lukas Unger, Karin Hock, Mario Wiletel, Christoph Schwarz, Ivan Kristo, Heinz Regele, Thomas Wekerle
BACKGROUND: The mixed chimerism approach for intentional induction of donor-specific tolerance was shown to be successful in various models from mice to humans. For transplant patients, the approach would obviate the need for long-term immunosuppression and associated side effects; moreover, it would preclude the risk of late graft loss due to chronic rejection. Widespread clinical application is hindered by toxicities related to recipient pre-conditioning. Herein we aimed to investigate a clinically relevant protocol for tolerance induction to cardiac allografts, sparing CD40 blockade or T-cell depletion...
March 30, 2018: Journal of Heart and Lung Transplantation
https://www.readbyqxmd.com/read/29680230/percutaneous-ablative-cryoimmunotherapy-for-micrometastaic-abscopal-effect-no-complications
#17
Erik Soule, Mark Bandyk, Jerry Matteo
Recent studies have shown efficacy of nivolumab, a monoclonal antibody specific for an immunoregulatory protein termed programmed death 1 (PD-1), against metastatic renal cell carcinoma. PD-1 is a transmembrane protein expressed on T cells that suppresses activation upon binding to its ligands, which may be secreted paraneoplastically by various cancers. Inhibition of PD-1 signaling via nivolumab may sensitize tumor-specific T lymphocytes in the immunosuppressive tumor microenvironment. Systemic elimination of micrometastases requires robust activation and proliferation of tumor antigen stimulated T cells...
April 19, 2018: Cryobiology
https://www.readbyqxmd.com/read/29679356/regional-variations-in-immunosuppressive-therapy-in-patients-with-primary-nephrotic-syndrome-the-japan-nephrotic-syndrome-cohort-study
#18
Ryohei Yamamoto, Enyu Imai, Shoichi Maruyama, Hitoshi Yokoyama, Hitoshi Sugiyama, Kosaku Nitta, Tatsuo Tsukamoto, Shunya Uchida, Asami Takeda, Toshinobu Sato, Takashi Wada, Hiroki Hayashi, Yasuhiro Akai, Megumu Fukunaga, Kazuhiko Tsuruya, Kosuke Masutani, Tsuneo Konta, Tatsuya Shoji, Takeyuki Hiramatsu, Shunsuke Goto, Hirofumi Tamai, Saori Nishio, Arimasa Shirasaki, Kojiro Nagai, Kunihiro Yamagata, Hajime Hasegawa, Hidemo Yasuda, Shizunori Ichida, Tomohiko Naruse, Kei Fukami, Tomoya Nishino, Hiroshi Sobajima, Satoshi Tanaka, Toshiyuki Akahori, Takafumi Ito, Terada Yoshio, Ritsuko Katafuchi, Shouichi Fujimoto, Hirokazu Okada, Eiji Ishimura, Junichiro James Kazama, Keiju Hiromura, Tetsushi Mimura, Satashi Suzuki, Yosuke Saka, Tadashi Sofue, Yusuke Suzuki, Yugo Shibagaki, Kiyoki Kitagawa, Kunio Morozumi, Yoshiro Fujita, Makoto Mizutani, Takashi Shigematsu, Naoki Kashihara, Hiroshi Sato, Seiichi Matsuo, Ichiei Narita, Yoshitaka Isaka
BACKGROUND: The lack of high-quality clinical evidences hindered broad consensus on optimal therapies for primary nephrotic syndromes. The aim of the present study was to compare prevalence of immunosuppressive drug use in patients with primary nephrotic syndrome across 6 regions in Japan. METHODS: Between 2009 and 2010, 380 patients with primary nephrotic syndrome in 56 hospitals were enrolled in a prospective cohort study [Japan Nephrotic Syndrome Cohort Study (JNSCS)], including 141, 151, and 38 adult patients with minimal change disease (MCD), membranous nephropathy (MN), and focal segmental glomerulosclerosis (FSGS), respectively...
April 20, 2018: Clinical and Experimental Nephrology
https://www.readbyqxmd.com/read/29677072/state-of-the-art-role-of-the-dendritic-cell-in-induction-of-allograft-tolerance
#19
Sarah J Rosen, Paul E Harris, Mark A Hardy
Despite decades of research, the induction and maintenance of long-term allograft tolerance without immunosuppression remains an elusive goal in the field of solid organ and cell transplantation. Immunosuppressive medications frequently prevent or minimize acute cellular rejection but have failed to halt anti-donor antibody production and chronic organ rejection. Past efforts aimed at promoting lasting allograft tolerance have focused primarily on peripheral T cell depletion, augmentation of regulatory T cells, or induction via simultaneous hematopoietic stem cell transplantation and facilitation of donor chimerism...
April 19, 2018: Transplantation
https://www.readbyqxmd.com/read/29667346/in-situ-vaccination-harvesting-low-hanging-fruit-on-the-cancer-immunotherapy-tree
#20
REVIEW
Mee Rie Sheen, Steven Fiering
After 100 years of debate, it is clear that cancer is recognized by the immune system and this has generated immense interest in cancer immunotherapy. The systemic nature of the immune system gives immunotherapy the ability to treat metastatic disease, which currently requires chemotherapy that frequently fails. Like chemotherapy, most immunotherapy is systemically applied in an effort to generate systemic antitumor immune response. However, local administration of immunostimulatory reagents into a recognized tumor by in situ vaccination (ISV) can also generate systemic antitumor immunity to fight metastatic disease...
April 18, 2018: Wiley Interdisciplinary Reviews. Nanomedicine and Nanobiotechnology
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