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International Review of Neurobiology 2018Even though knowledge and systematic application of placebo responses in the immune system are sparse, this topic is of particular importance since it may aim at... (Review)
Review
Even though knowledge and systematic application of placebo responses in the immune system are sparse, this topic is of particular importance since it may aim at drug-dose reduction while maintaining therapeutic efficacy of treatment in clinical settings. Placebo responses in the immune system are inducible by associated learning paradigms, such as behaviorally conditioned immunosuppression. One established learning paradigm in both rats and humans is conditioned taste avoidance (CTA), where a novel taste as conditioned stimulus (CS) is paired with the administration of the immunosuppressive drug cyclosporine A (CsA) as unconditioned stimulus. By representing the CS alone at a later time point, the conditioned response is reflected by avoidance behavior toward the taste (CTA). Simultaneously, diminished cytokine production and proliferative capacity of T cells are observed, closely mimicking the pharmacological effects of CsA. This chapter provides an overview on placebo responses in the immune system and delineates actual approaches, translational aspects, and limitations of learning paradigms in clinical settings.
Topics: Animals; Brain; Conditioning, Classical; Humans; Immunosuppression Therapy; Placebo Effect
PubMed: 29681334
DOI: 10.1016/bs.irn.2018.01.001 -
Die Anaesthesiologie Nov 2023Organ transplant patients who must undergo nontransplant surgical interventions can be challenging for the anesthesiologists in charge. On the one hand, it is important... (Review)
Review
Organ transplant patients who must undergo nontransplant surgical interventions can be challenging for the anesthesiologists in charge. On the one hand, it is important to carefully monitor the graft function in the perioperative period with respect to the occurrence of a possible rejection reaction. On the other hand, the ongoing immunosuppression may have to be adapted to the perioperative requirements in terms of the active substance and the route of administration, the resulting increased risk of infection and possible side effects (e.g., myelosuppression, nephrotoxicity and impairment of wound healing) must be included in the perioperative treatment concept. Furthermore, possible persistent comorbidities of the underlying disease and physiological peculiarities as a result of the organ transplantation must be taken into account. Support can be obtained from the expertise of the respective transplantation center.
Topics: Humans; Organ Transplantation; Anesthesia; Immunosuppression Therapy
PubMed: 37874343
DOI: 10.1007/s00101-023-01332-x -
Current Opinion in Nephrology and... Jan 2019Mesenchymal stromal cells (MSC) have emerged as one of the most promising candidates for immunomodulatory cell therapy in kidney transplantation. Here we describe novel... (Review)
Review
PURPOSE OF REVIEW
Mesenchymal stromal cells (MSC) have emerged as one of the most promising candidates for immunomodulatory cell therapy in kidney transplantation. Here we describe novel insights into the MSC mechanism of action and provide an overview of initial safety and feasibility studies with MSC in kidney transplantation.
RECENT FINDINGS
Clinical studies of MSC-based cell therapy in kidney transplant recipients demonstrated the safety and feasibility of cell therapy and provide the first encouraging evidence of the efficacy of MSC in enabling the minimization of immunosuppressive drugs. In our initial experience with MSC-based therapy in kidney transplant recipients we carried out extensive clinical and immunological monitoring of MSC-treated patients and found possible biomarkers of MSC immunomodulation in some of them. Based on these biomarkers we identified a patient in whom complete discontinuation of immunosuppression has been achieved safely and successfully.
SUMMARY
Many issues should be addressed before MSC-based therapy becomes a standard treatment protocol for kidney transplantation. A better understanding of the MSC mechanism of action and the identification of biomarkers of response to therapy will inform the rational design of the most effective clinical protocol and the selection of patients amenable to safe immunosuppressive drug withdrawal.
Topics: Biomarkers; Humans; Immunosuppression Therapy; Kidney Transplantation; Mesenchymal Stem Cell Transplantation
PubMed: 30300159
DOI: 10.1097/MNH.0000000000000461 -
Annals of the American Thoracic Society Aug 2018
Topics: Humans; Immune Tolerance; Immunocompromised Host; Immunosuppression Therapy; Sepsis
PubMed: 30067099
DOI: 10.1513/AnnalsATS.201805-344ED -
Clinical Journal of the American... Aug 2018Most glomerular diseases are immunologically mediated disorders of the kidney and are common causes of ESKD. In addition to supportive therapy, a wide range of... (Review)
Review
Most glomerular diseases are immunologically mediated disorders of the kidney and are common causes of ESKD. In addition to supportive therapy, a wide range of immunosuppressive agents are used in the management of patients with these conditions. Immunosuppression requires a careful balance of risk and benefits, and many of these agents have a narrow therapeutic window and require close monitoring. This review describes the side effects of immunosuppressive agents used in recent randomized, controlled trials of glomerular disease, and highlights some of the key adverse events that determine the choice and prescription of these medications.
Topics: Humans; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Diseases; Kidney Glomerulus; Randomized Controlled Trials as Topic
PubMed: 30042223
DOI: 10.2215/CJN.01920218 -
Clinics in Laboratory Medicine Mar 2019It is increasingly recognized that calcineurin inhibitors (CNI) such as cyclosporine and tacrolimus are not ideal immunosuppressive agents. Side effects, including... (Review)
Review
It is increasingly recognized that calcineurin inhibitors (CNI) such as cyclosporine and tacrolimus are not ideal immunosuppressive agents. Side effects, including increased rates of infection, hypertension, and malignancy, can be severe. Thus, in the past decade, there has been much focus on the development of novel therapeutic agents and strategies designed to replace or minimize CNI exposure in transplant patients. This article reviews potential novel targets in T cells, alloantibody-producing B cells, plasma cells, and complement in transplantation.
Topics: Graft Rejection; Immunologic Factors; Immunosuppression Therapy; Models, Immunological; T-Lymphocytes; Transplantation; Transplantation Conditioning
PubMed: 30709504
DOI: 10.1016/j.cll.2018.10.008 -
Seminars in Nephrology May 2018Renal transplantation is the preferred treatment for patients with end-stage kidney disease. However, despite successful kidney transplantation, cardiovascular disease... (Review)
Review
Renal transplantation is the preferred treatment for patients with end-stage kidney disease. However, despite successful kidney transplantation, cardiovascular disease (CVD) remains one of the major causes of patient death and hence graft loss. The antecedents of this increased risk reside within the development of end-stage kidney disease and dialysis. Risk factors for the development of CVD include diabetes, hypertension, and dyslipidemia. Other transplant-specific factors include the presence of a patent arteriovenous fistula and immunosuppressive therapy. Efforts to modify these factors should be strongly encouraged to improve long-term outcomes of transplant patients and reduce death from CVD in this at-risk patient population.
Topics: Cardiovascular Diseases; Diabetes Mellitus; Humans; Hypertension; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Transplantation; Preoperative Period; Risk Factors
PubMed: 29753404
DOI: 10.1016/j.semnephrol.2018.02.008 -
Die Anaesthesiologie Mar 2023
Topics: Humans; Hemoptysis; Immunosuppression Therapy; Immune Tolerance
PubMed: 36583751
DOI: 10.1007/s00101-022-01238-0 -
Experimental Biology and Medicine... May 2016Targeting the immune system with nanomaterials is an intensely active area of research. Specifically, the capability to induce immunosuppression is a promising... (Review)
Review
Targeting the immune system with nanomaterials is an intensely active area of research. Specifically, the capability to induce immunosuppression is a promising complement for drug delivery and regenerative medicine therapies. Many novel strategies for immunosuppression rely on nanoparticles as delivery vehicles for small-molecule immunosuppressive compounds. As a consequence, efforts in understanding the mechanisms in which nanoparticles directly interact with the immune system have been overshadowed. The immunological activity of nanoparticles is dependent on the physiochemical properties of the nanoparticles and its subsequent cellular internalization. As the underlying factors for these reactions are elucidated, more nanoparticles may be engineered and evaluated for inducing immunosuppression and complementing immunosuppressive drugs. This review will briefly summarize the state-of-the-art and developments in understanding how nanoparticles induce immunosuppressive responses, compare the inherent properties of nanomaterials which induce these immunological reactions, and comment on the potential for using nanomaterials to modulate and control the immune system.
Topics: Animals; Drug Carriers; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Nanoparticles
PubMed: 27229901
DOI: 10.1177/1535370216650053 -
Expert Review of Gastroenterology &... 2023Advances in the management of intestinal failure have led to a reduction in the number of intestinal transplants. The number of bowel transplants has been mainly stable... (Review)
Review
INTRODUCTION
Advances in the management of intestinal failure have led to a reduction in the number of intestinal transplants. The number of bowel transplants has been mainly stable even though a slight increase has been observed in the last 5 years.
AREAS COVERED
Standard indication includes patients with a reasonable life expectancy. Recent progress can be deduced by the increased number of intestine transplants in adults: this is due to the continuous improvement of 1-year graft survival worldwide (without differences in 3- and 5-year) associated with better abdominal wall closure techniques. This review aims to provide an update on new indications and changes in trends of pediatric and adult intestine transplantation. This analysis, which stretches through the past 5 years, is based on a collection of related manuscripts from PubMed.
EXPERT COMMENTARY
Intestinal transplants should be solely intended for a group of individuals for whom indications for transplantation are clear and both medical and surgical rehabilitations have failed. Nevertheless, many protocols developed over the years have not yet solved the key question represented by the over-immunosuppression. Novel indications and recent progress in the bowel transplant field, minimal yet consistent, represent a pathway to be followed.
Topics: Adult; Humans; Child; Intestine, Small; Intestines; Immunosuppression Therapy; Digestive System Surgical Procedures; Short Bowel Syndrome
PubMed: 37264646
DOI: 10.1080/17474124.2023.2221433