Individually tailored immunosuppression: is there a role for biomarkers?
| Autor: | Mercè Brunet, Pierre Wallemacq, Michael Oellerich, Gunnar Brandhorst, Alexander A. Vinks, Richard Kowalski |
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| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_treatment
Clinical Biochemistry Context (language use) Bioinformatics 030226 pharmacology & pharmacy Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine medicine Humans Precision Medicine Immunosuppression Therapy medicine.diagnostic_test Mechanism (biology) business.industry Biochemistry (medical) Immunosuppression 3. Good health Transplantation Immunosuppressive drug Therapeutic drug monitoring 030220 oncology & carcinogenesis Pharmacodynamics Immunology Biomarker (medicine) Drug Monitoring business Biomarkers Immunosuppressive Agents |
| Zdroj: | Clinical chemistry. 57(3) |
| ISSN: | 1530-8561 |
| Popis: | Therapeutic drug monitoring (TDM)7 of immunosuppressive drugs has evolved over the last few decades. The use of liquid chromatography–tandem mass spectrometry, for example, now provides robust and highly specific quantification in the clinical laboratory. Nevertheless, the measurement of immunosuppressive drug concentrations, even if carried out accurately and precisely, does not sufficiently reflect the effects of the applied drugs on immune cells, because of the considerable interindividual variation in the sensitivity to suppression of immune function. Irreversible chronic allograft rejection and the long-term side effects of immunosuppressive therapy are still major limiting factors in transplantation medicine. In this context, pharmacodynamic (PD) biomarkers are a potential key for further optimization of immunosuppressive therapy. The PD effects of immunosuppressive drugs can be assessed with the aid of an increasing number of different biomarkers. For achieving an individually tailored immunosuppression, these biomarkers could be helpful for such aspects as the weaning or minimization of immunosuppressive therapy, the optimization of multidrug regimens that takes into account the synergistic and antagonistic effects of immunosuppressive drugs, or even the identification of operationally tolerant patients after solid-organ transplantation. In this Q&A, 4 leading experts in the field of PD monitoring of immunosuppressive drugs share their thoughts on the analytical and clinical requirements, as well as the usefulness, of individual biomarkers. From your perspective, what are the requirements for an ideal biomarker for individualization of immunosuppressive therapy, e.g., after solid-organ transplantation? Merce Brunet: In clinical practice, all biomarkers may have some limitations, and it would be difficult to achieve the status of ideal biomarker. In solid-organ transplantation, biomarkers should be useful tools for optimizing immunosuppressant therapy and identifying patients at risk of rejection. Biomarker monitoring combined with pharmacokinetics (PK) is a requirement to achieve personalized therapy. Some of these biomarkers could be strongly related to the mechanism of … |
| Databáze: | OpenAIRE |
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