Evaluation of recombinant human soluble dimeric tumor necrosis factor receptor for prevention of OKT3-associated acute clinical syndrome

Détails

ID Serval
serval:BIB_D94AE3049A17
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Titre
Evaluation of recombinant human soluble dimeric tumor necrosis factor receptor for prevention of OKT3-associated acute clinical syndrome
Périodique
Transplantation
Auteur(s)
Eason  J. D., Pascual  M., Wee  S., Farrell  M., Phelan  J., Boskovic  S., Blosch  C., Mohler  K. M., Cosimi  A. B.
ISSN
0041-1337
Statut éditorial
Publié
Date de publication
01/1996
Peer-reviewed
Oui
Volume
61
Numéro
2
Pages
224-8
Notes
Clinical Trial
Journal Article
Randomized Controlled Trial --- Old month value: Jan 27
Résumé
Tumor necrosis factor alpha (TNFa) has been shown to be the primary cytokine responsible for the OKT3-induced acute clinical syndrome (OKT3-ACS). Recombinant human soluble tumor necrosis factor receptor (TNFR:Fc) is a dimer of the p80 TNF receptor, which binds both TNFa and lymphotoxin (LT). Renal allograft recipients undergoing OKT3 therapy for steroid-resistant rejection were randomized to receive OKT3 alone or in combination with TNFR:Fc to determine its safety and efficacy in decreasing the severity of OKT3-ACS and in restoring renal function. Six of 12 patients were given TNFR:Fc prior to each of the first two injections of OKT3. All patients were monitored for manifestations of OKT3-ACS and changes in renal function. In addition, serial serum samples were assayed for TNFa and TNFR:Fc levels (ELISA) and TNFa bioactivity (L929). No adverse side effects were identified in patients receiving TNFR:Fc. Patients treated with TNFR:Fc had significantly fewer symptoms by day 2 of OKT3, and had a lower overall incidence of chills and arthralgias. Renal dysfunction reversed within 24 hr in the TNFR:Fc-treated group in contrast to the 48-72-hr delay in the control group. Antigenic TNFa levels increased in the control group from < 10 pg/ml pre OKT3 to a mean peak level of 30 +/- 13 pg/ml on day 1 and decreased to pretreatment levels by day 2. TNFR:Fc-treated patients had a mean peak TNFa level of 235 +/- 135 pg/ml, suggesting a carrier effect of TNFR:Fc. In contrast, bioactivity was barely detectable (mean 20 +/- 14 pg/ml) in the day 1 samples from TNFR:Fc-treated patients, whereas significant bioactivity (peak mean 60 +/- 35 pg/ml) was detected in sera from control patients. TNF receptor levels reached 600 ng/ml in treated patients and remained elevated for up to 18 days confirming the long half-life of TNFR:Fc. This phase 1 trial demonstrates that TNFR:Fc is well tolerated and may limit the severity of OKT3-ACS. The most significant observation was a more rapid improvement in renal function in the TNFR:Fc-treated patients. The absence of TNFa bioactivity indicates that TNFR:Fc functions as a TNF antagonist. Further evaluation of higher doses of TNFR:Fc in OKT3-treated patients is currently in progress.
Mots-clé
Acute Disease Graft Rejection/*prevention & control Humans Immunosuppressive Agents/*adverse effects *Kidney Transplantation Muromonab-CD3/*adverse effects *Receptors, Tumor Necrosis Factor Recombinant Proteins/therapeutic use Syndrome Transplantation, Homologous
Pubmed
Web of science
Création de la notice
29/01/2008 13:52
Dernière modification de la notice
20/08/2019 15:58
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