PMID- 21273149
OWN - NLM
STAT- MEDLINE
DCOM- 20120524
LR  - 20211203
IS  - 1872-9177 (Electronic)
IS  - 1769-7255 (Linking)
VI  - 7
IP  - 7
DP  - 2011 Dec
TI  - [Immunosuppressive treatments: mechanisms of action and clinical use].
PG  - 566-81
LID - 10.1016/j.nephro.2010.12.008 [doi]
AB  - Renal transplantation is the treatment of choice of end stage renal failure. It 
      both improves the quality and the quantity of life compared to other techniques, 
      such as hemodialysis. These results are partly related to the use of 
      immunosuppressive therapy more effective and whose handling has improved over 
      time. Advances in understanding the mechanisms of lymphocyte activation and the 
      phenomena of rejection have in fact better defined the use of these treatments 
      and their associations. Treatments can be broadly classified according to their 
      characteristics (biological or chemical). Among chemical treatments, steroids are 
      widely used, although the question of their avoidance or spearing is still a 
      matter of debate. The cornerstone of immunosuppressive regimens remains the 
      calcineurin inhibitors, characterized by a narrow therapeutic index and the need 
      for therapeutic drug monitoring. Inhibitors of mammalian target of rapamycin 
      (mTOR) have interesting antiproliferative effects that could be important against 
      chronic allograft dysfunction and/or carcinogenesis. However, their safety 
      profile makes them difficult to handle. Inhibitors of purine synthesis are 
      largely based on inhibitors of inosine monophosphate dehydrogenase (IMPDH). Their 
      effectiveness makes them privileged partners of other therapeutic classes. Among 
      biological treatments, it is possible to separate the depleting and non depleting 
      antibodies. Among the former, antithymocyte globulins are mainly active in T 
      cells, whereas rituximab, a monoclonal anti-CD20, is active in B cells involved 
      in the phenomena of humoral rejection. The non depleting antibodies are 
      represented by anti-CD25, directed against the receptor for interleukin-2. In the 
      near future it is likely that the belatacept, a costimulation blockade fusion 
      protein will be used to allow calcineurin inhibitors sparing. Other 
      immunosuppressive agents, acting at different levels of the immune response are 
      being evaluated. In addition, advances in pharmacology offered hope of a better 
      individualization of immunosuppressive therapies and better definition of 
      therapeutic strategies used.
CI  - Copyright (c) 2011. Published by Elsevier SAS.
FAU - Thervet, Eric
AU  - Thervet E
AD  - Service de transplantation renale adulte, hopital Necker-Enfants malades, 149, 
      rue de Sevres, 75015 Paris, France. eric.thervet@nck.aphp.fr
FAU - Zuber, Julien
AU  - Zuber J
FAU - Sberro, Rebecca
AU  - Sberro R
FAU - Canaud, Guillaume
AU  - Canaud G
FAU - Anglicheau, Dany
AU  - Anglicheau D
FAU - Snanoudj, Renaud
AU  - Snanoudj R
FAU - Mamzer-Bruneel, Marie-France
AU  - Mamzer-Bruneel MF
FAU - Martinez, Franck
AU  - Martinez F
FAU - Legendre, Christophe
AU  - Legendre C
LA  - fre
PT  - Journal Article
TT  - Traitements immunosuppresseurs : mecanismes d'action et utilisation clinique.
DEP - 20110126
PL  - France
TA  - Nephrol Ther
JT  - Nephrologie & therapeutique
JID - 101248950
RN  - 0 (Antibodies, Monoclonal, Murine-Derived)
RN  - 0 (Calcineurin Inhibitors)
RN  - 0 (Immunoconjugates)
RN  - 0 (Immunosuppressive Agents)
RN  - 4F4X42SYQ6 (Rituximab)
RN  - 7D0YB67S97 (Abatacept)
RN  - EC 3.1.3.16 (Calcineurin)
RN  - HU9DX48N0T (Mycophenolic Acid)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Abatacept
MH  - Antibodies, Monoclonal, Murine-Derived/therapeutic use
MH  - Calcineurin/pharmacology
MH  - *Calcineurin Inhibitors
MH  - Graft Rejection/*prevention & control
MH  - Humans
MH  - Immunoconjugates/therapeutic use
MH  - *Immunosuppression Therapy/methods/trends
MH  - Immunosuppressive Agents/pharmacology/*therapeutic use
MH  - Kidney Failure, Chronic/surgery
MH  - *Kidney Transplantation/immunology
MH  - Mycophenolic Acid/analogs & derivatives/therapeutic use
MH  - Quality of Life
MH  - Rituximab
MH  - Sirolimus/therapeutic use
MH  - Treatment Outcome
EDAT- 2011/01/29 06:00
MHDA- 2012/05/25 06:00
CRDT- 2011/01/29 06:00
PHST- 2011/01/29 06:00 [entrez]
PHST- 2011/01/29 06:00 [pubmed]
PHST- 2012/05/25 06:00 [medline]
AID - S1769-7255(10)00260-9 [pii]
AID - 10.1016/j.nephro.2010.12.008 [doi]
PST - ppublish
SO  - Nephrol Ther. 2011 Dec;7(7):566-81. doi: 10.1016/j.nephro.2010.12.008. Epub 2011 
      Jan 26.