Red blood cell exchange as an approach for treating a case of severe tacrolimus overexposure

Spallanzani, Valentina; Bindi, L; Bianco, Irene; Precisi, A; Simone, Paolo De; Mazzoni, Alessandro; Biancofiore, Gianni

doi:10.1016/j.transci.2017.01.004

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…Since more than 90% of tacrolimus in circulation is confined to RBCs, RBC count is expected to affect blood tacrolimus concentration. 30 Previous studies also reported that tacrolimus was highly bound to plasma proteins, mainly to serum albumin. 31 Therefore, hemoglobin and albumin influence the free fraction but not the unbound concentration of tacrolimus in blood.…”

Section: Discussionmentioning

confidence: 98%

Genetic Polymorphisms Affecting Tacrolimus Metabolism and the Relationship to Post-Transplant Outcomes in Kidney Transplant Recipients

Cheng¹,

Li²,

Wang³

et al. 2021

PGPM

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Section: Discussionmentioning

confidence: 98%

Genetic Polymorphisms Affecting Tacrolimus Metabolism and the Relationship to Post-Transplant Outcomes in Kidney Transplant Recipients

Cheng¹,

Li²,

Wang³

et al. 2021

PGPM

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“…Sakamoto et al showed that the continuous administration of tacrolimus is more advantageous than intermittent administration to reduce neurotoxicity in rats [133]. In addition, tacrolimus-induced neurotoxicity and nephrotoxicity can be ameliorated, while maintaining its immunosuppressive effects, by treating rats in the dark phase [134]. According to a case report, red-blood cell exchange improved the clinical status of a 60-year-old woman with severe neurological impairment due to tacrolimus overexposure.…”

Section: Managementmentioning

confidence: 99%

Recent Topics on The Mechanisms of Immunosuppressive Therapy-Related Neurotoxicities

Zhang

Egashira

Masuda

2019

IJMS

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Although transplantation procedures have been developed for patients with end-stage hepatic insufficiency or other diseases, allograft rejection still threatens patient health and lifespan. Over the last few decades, the emergence of immunosuppressive agents such as calcineurin inhibitors (CNIs) and mammalian target of rapamycin (mTOR) inhibitors have strikingly increased graft survival. Unfortunately, immunosuppressive agent-related neurotoxicity commonly occurs in clinical practice, with the majority of neurotoxicity cases caused by CNIs. The possible mechanisms through which CNIs cause neurotoxicity include increasing the permeability or injury of the blood–brain barrier, alterations of mitochondrial function, and alterations in the electrophysiological state. Other immunosuppressants can also induce neuropsychiatric complications. For example, mTOR inhibitors induce seizures, mycophenolate mofetil induces depression and headaches, methotrexate affects the central nervous system, the mouse monoclonal immunoglobulin G2 antibody (used against the cluster of differentiation 3) also induces headaches, and patients using corticosteroids usually experience cognitive alteration. Therapeutic drug monitoring, individual therapy based on pharmacogenetics, and early recognition of symptoms help reduce neurotoxic events considerably. Once neurotoxicity occurs, a reduction in the drug dosage, switching to other immunosuppressants, combination therapy with drugs used to treat the neuropsychiatric manifestation, or blood purification therapy have proven to be effective against neurotoxicity. In this review, we summarize recent topics on the mechanisms of immunosuppressive drug-related neurotoxicity. In addition, information about the neuroprotective effects of several immunosuppressants is also discussed.

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“…According to a case report, red-blood cell exchange improved the clinical status of a 60-year-old woman with severe neurological impairment due to tacrolimus overexposure. Hence, red-blood cell exchange may be an effective therapy to reduce tacrolimus neurotoxicity [134]. This blood purification therapy has also been shown to be effective in ifosfamide-induced severe concurrent neurotoxicity and nephrotoxicity [135].…”

Section: Managementmentioning

confidence: 99%

Recent Topics on the Mechanisms of Immunosuppressive Therapy-Related Neurotoxicities

Zhang¹,

Egashira²,

Masuda³

2019

Preprint

View full text Add to dashboard Cite

Although transplantation procedures have been developed for patients with end-stagec hepatic insufficiency or other diseases, allograft rejection still threatens patient health and lifespan. Over the last few decades, the emergence of immunosuppressive agents, such as calcineurin inhibitors (CNIs) and mammalian target of rapamycin (mTOR) inhibitors, have strikingly increased graft survival. Unfortunately, immunosuppressive agent-related neurotoxicity is commonly occurred in clinical situations, with the majority of neurotoxicity cases caused by CNIs. The possible mechanisms whereby CNIs cause neurotoxicity include: increasing the permeability or injury of the blood-brain barrier, alterations of mitochondrial function, and alterations in electrophysiological state. Other immunosuppressants can also induce neuropsychiatric complications. For example, mTOR inhibitors induce seizures; mycophenolate mofetil induces depression and headache; methotrexate affects the central nervous system; mouse monoclonal immunoglobulin G2 antibody against cluster of differentiation 3 also induces headache; and patients using corticosteroids usually experience cognitive alteration. Therapeutic drug monitoring, individual therapy based on pharmacogenetics, and early recognition of symptoms have greatly reduced neurotoxic events. Once neurotoxicity occurs, a reduction in the drug dosage, switching to other immunosuppressants, using drugs to treat the neuropsychiatric manifestation, or blood purification therapy have proven to be effective against neurotoxicity. In this review, we summarize the recent topics on the mechanisms of neurotoxicity of immunosuppressive drugs. In addition, some information about neuroprotective effects of several immunosuppressants are also discussed.

show abstract

Red blood cell exchange as an approach for treating a case of severe tacrolimus overexposure

Cited by 8 publications

References 7 publications

Genetic Polymorphisms Affecting Tacrolimus Metabolism and the Relationship to Post-Transplant Outcomes in Kidney Transplant Recipients

Genetic Polymorphisms Affecting Tacrolimus Metabolism and the Relationship to Post-Transplant Outcomes in Kidney Transplant Recipients

Recent Topics on The Mechanisms of Immunosuppressive Therapy-Related Neurotoxicities

Recent Topics on the Mechanisms of Immunosuppressive Therapy-Related Neurotoxicities

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