Impact of Tocilizumab (Anti-IL-6R) Treatment on Immunoglobulins and Anti-HLA Antibodies in Kidney Transplant Patients With Chronic Antibody-mediated Rejection
| Autor: | Stanley C. Jordan, Ashley Vo, Bong-Ha Shin, Edmund Huang, Matthew J Everly, Xiaohai Zhang, Mieko Toyoda, Jua Choi, Hao Zhang |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Graft Rejection Male Time Factors Plasma Cells Immunoglobulins 030230 surgery Antibodies Monoclonal Humanized Kidney transplant 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Tocilizumab HLA Antigens Isoantibodies medicine Humans Transplantation B-Lymphocytes biology business.industry Graft Survival Interleukin Middle Aged Kidney Transplantation Histocompatibility Treatment Outcome chemistry Antibody mediated rejection Monoclonal Immunology Chronic Disease biology.protein 030211 gastroenterology & hepatology Rituximab Female Antibody business Immunosuppressive Agents medicine.drug |
| Zdroj: | Transplantation. 104(4) |
| ISSN: | 1534-6080 |
| Popis: | Background Chronic antibody-mediated rejection (cAMR) results in the majority of renal allograft losses. Currently, there are no approved therapies. We recently reported on clinical use of tocilizumab (TCZ) for treatment of cAMR in HLA-sensitized kidney transplant patients. IgG1 and IgG3 subclasses of IgG are potent effectors of complement- and antibody-dependent cellular cytotoxicity, which are critical mediators of AMR. Here, we examined the impact of TCZ treatment for cAMR on total IgG, IgG1-4 subclasses, and anti-HLA-IgG (total and subclasses). Methods Archived plasma obtained pre- and post-TCZ treatment (8 mg/kg, 6×, monthly) from 12 cAMR patients who failed standard of care treatment with intravenous immune globulin + rituximab with or without plasma exchange were tested for total IgG and IgG1-4 by ELISA, anti-HLA-total IgG, IgG3 and IgG4, and donor-specific antibody by Luminex assay. Archived plasma from 14 cAMR patients treated with the standard of care were included as controls. Results Total IgG and IgG1-3 were significantly reduced post-TCZ, whereas no reduction was seen post-treatment in the control group. Of 11 patients, 8 (73%) showed reduction of anti-HLA-total IgG and IgG3 post-TCZ, but this was not statistically significant. Conclusions TCZ reduced total IgG and IgG1-3 and anti-HLA-total IgG and IgG3 levels, suggesting that TCZ suppresses Ig production in B cells nonspecifically, likely through inhibition of interleukin 6-mediated signaling to B cells and plasma cells. This may be a contributing factor for the beneficial effect of TCZ on cAMR observed in this patient population. |
| Databáze: | OpenAIRE |
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