New immunosuppressive drugs in heart transplantation

Abstract

commentary review reports primary research ALG = antilymphocyte globulin; ATG = antithymocyte globulin; AZA = azathioprine; CMV = cytomegalovirus; CSA = cyclosporine; HMG-CoA = 3-hydroxy-3-methylglutaryl coenzyme A; HT = heart transplant; ICAM-1 = intracellular adhesion molecule-1; IFN = interferon; IL = interleukin; ISHLT = International Society of Heart and Lung Transplantation; IV = intravenous; IVUS = intravascular ultrasound; LFA = lymphocyte function-associated antigen; MHC = major histocompatibility complex; MMF = mycophenolate mofetil; NL = Neoral; PCP = pneumocystis carinii pneumonia; SM = Sandimmune; TGF = transforming growth factor; TNF = tumor necrosis factor. Available online http://cvm.controlled-trials.com/content/2/1/045 IntroductionData from the International Society of Heart and Lung Transplantation (ISHLT) show that since 1995 the number of heart transplants (HTs) performed worldwide has gradually declined and was approximately 3000 in the year 2000 [1]. This small number of procedures is the main reason why only few randomized single-center, and even fewer multicenter, clinical trials have been performed so far in HT recipients. Other factors have hampered the performance of controlled studies in HT recipients. These include the following: the lack of a uniform system for measuring rejection severity until the publication of the ISHLT rejection grading system in 1991; the approximately 80% 1-year survival, which creates the requirement for patient populations larger than the total number of HTs performed worldwide to detect differences between the effects on outcome of two therapeutic interventions; the lack of reliable 'surrogate' endpoints, such as the incidence and severity of cardiac allograft vasculopathy, owing to the insensitivity of contrast coronary angiography for the detection of cardiac Review New immunosuppressive drugs in heart transplantation AbstractOnly a few randomized clinical trials have been performed so far in heart transplant recipients, mainly because of the relatively small number of heart transplants performed worldwide each year. The main focus of the few controlled trials that have been completed has been the prevention and treatment of heart allograft rejection. In the area of pharmacologic immunosuppression, both biological agents and drugs have been the subject of investigation. Among the biological agents, chimeric monoclonal antibodies directed against the interleukin (IL)-2 receptor, which have been found to be safe and effective in renal transplant recipients, are now undergoing the test of controlled trials in heart transplant recipients. Immunosuppressive drugs that have been studied in controlled trials include calcineurin inhibitors (such as the microemulsion formulation of cyclosporine and tacrolimus) and inhibitors of purine synthesis, such as mycophenolate mofetil. Non-pharmacologic prophylactic immunosuppression with photopheresis has also been tested in a prospective, multicenter, randomized trial. New immunosuppressive regimens, such as mycophenol...

Micro RNA-98 suppresses interleukin-10 in peripheral B cells in patient post-cardio transplantation

“…Upon the heart transplantation, immune suppressors are regularly administered to inhibit the possibility of allograft heart rejection. Because of the non-specific nature, administration with immune suppressors has some or severe side effects to the recipients [ 3 ]. Therefore, to efficiently establish immune tolerance to allograft hearts is of significance.…”