Terms in this set (26)
IL-2 and IFN gamma
Important signaling molecules in organ rejection
allow the cell to recognize cytokine signals
•Stimulates proliferation of TC, TH, NK, and B cells
•Enhances cytotoxicityof TC, NK cells, and monocytes/macrophages
•Enhances B-cell antibody secretion
•Stimulates T cells to produce IFN-γ and other cytokinesB
Cell types produce IL-2 when stimulated by MHC/antigen complexes
MHC (HLA) Class I
Major histocompatibilitycomplex (MHC) proteins display foreign antigens to T cells through interaction with the T-cell receptor. This triggers the specific immune response
MHC (HLA) Class II
is expressed on antigen-presenting cells (dendriticcells, macrophages, and B cells) and presents antigen to THcells
Process known as when Binding of foreign peptide -MHC complex to T cell receptor signals to the T cell (signals that antigen is recognized)
Effective activation of naïve T cells requires a second signal (the co-stimulatory signal) to be delivered by the same APC. (signal allows T cell longevity in circulation)
Creates differentiation of effectorT cells
Site of drug reactions
MHC class I
Expressed on every cell in the body to recognize self.
IL-2 alpha receptor antagonists
Present only on activated and non resting T cells which is already activated that is removed... but if not activated you cant get rid of it (not useful for rejection)
Rabbit antithymocyteglobulin and antigenic and patient needs to be treated prior to each dose. Have to know if they have rabbits as pet (Big response... bad) if yes pick another drug.
Polyclonal antibodies that binds everything and its dog. This
1st induction agent and it Binds to T cell receptors and everything else related to the immune system. This is why its given only for 5 days.
This is good for treating rejection as well
Tx: for induction and rejection
Binds the CD52 receptor nwhich is present on B and T cells
NK cells and Monocytes and Macrophages.
Humanized murineanti-CD52 monoclonal Ab
Well tolerated and long duration of activity
Prevents IL secretion long term and prevent Tcell proliferation
m-TOR inhibitors (mammalian target of rapamycin)
Induction agents and steriods and cell-cept
Before the organ is placed in the patient we use ...... to prevent the Tcells already there from proliferating. This prevents acute rejection.
DC the induction agents
Day 3-5 from post op
Still using induction agent but now we are getting ready to evaluate the need for a calciurine inhibitor (prolonged exposure can lead to renal dysfunction. At this time we taper high dose steriods and will DC the ........(we will stop them before they leave the hospital). We dont need a massive shut down of the immune system.
Maintenance drugs MMF, reduce CS
Post Op Day 30
You introduce ........
Life long monitor the possibility of organ rejection.
Removal of circulating Immune Cells
Prevent activation of T cells
Prevent cytokine signaling
•Polyclonal, monoclonal antibodies
•IL-2 receptor antagonists
High risk patients
African Americans -recognized in practice to have "increased immunogenicity compared to other races" that can be a problem with rejection.
Preexisting AB so if you have lots of children and or blood transfusion (cirrhosis)
Retransplants have increased risk
Induction agents allow us to avoid steroids.
Then you need to give prophylactic medications to prevent viral, fungal and other pathogens.
Give the right dose to limit ADE
Maintain baseline immunosuppression
Oral medications and in combination therapies
Cyclosporine binds to calcine
Tacrolimus binds to FKBP and prevents the stimulation of the Tcell.
The bioavailability of these drugs is very limited so you have to get therapeutic drug levels to make sure you get the right amount of drug in the body.
Drug interaction with fluconazole
There is a difference in neuro toxicities which is more in tacrolimus and shows up in tremors. If you see this change to cyclosporine.
These pt will develop DM
Tacrolimus will lead to hair loss and change to cyclosporine
Cyclosporine can cause gingival hyperplasia and pt not know the SE of this and dentist may want to remove gum tissue.. just switch them to tacrolimus before this even happens.
Binds FK binding protein, engages target of rapamycinto inhibit cell proliferation at G1 to S phase of cell cycle
Huge list of adverse events
Know that this causes blood products, reduced and mouth ulcers and hepatic artery thrombosis in liver transplants.
Prevents the proliferation of Tcells.
IL2 already there this just prevents explosion load of Tcells
Donor + for.... patient needs to be on Valcyte
if Donor is - for.... then patient can be on Valtrex
Monitoring the patients when on Maintenance Tx
If patient is toxic or has an infection then the dose is too high. So just reduce it.