Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients

Pennington, Catherine A.; Park, Jeong Mi

doi:10.2146/ajhp140322

Cited by 30 publications

(15 citation statements)

References 28 publications

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“…Although some studies are promising, contradictive results exist [ 12 , 14 , 28 , 33 , 45 ]. Tacrolimus has been used as an immunosuppressant drug in transplantations and granulomatous disease [ 73 ]. Alijotas-Reig et al investigated its use in series of seven patients with late-onset adverse events after silicone injection, finding good clinical response [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature

Bachour

Kadouch²,

Niessen

2021

Aesth Plast Surg

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Background Late inflammatory reactions (LIRs) are the most challenging complications after filler use. The immune system plays a prominent role in its etiology, albeit to an unknown extent. Bacterial contamination in situ has been hypothesized to be causative for LIRs. How this relates to the immunological processes involved is unknown. This article aims to provide an overview of immunological and bacterial factors involved in development of LIRs. Methods We undertook a systematic literature review focused on immunological factors and microbiota in relation to LIRs after filler use. This systematic review was performed in accordance with the PRISMA guidelines. PubMed, EMBASE and the Cochrane databases were searched from inception up to August 2019. Included studies were assessed for the following variables: subject characteristics, number of patients, primary indication for filler injection, implant type/amount and injection site, type of complication, follow-up or injection duration, study methods, type of antibiotics or medical therapies and outcomes related to microbiota and immunological factors. Results Data on immunological factors and bacterial contamination were retrieved from 21 included studies. Notably, the presence of histocytes, giant cells and Staphylococcus epidermidis within biopsies were often associated with LIRs. Conclusion This review provides a clear overview of the immunological factors associated with LIRs and provides a hypothetical immunological model for development of the disease. Furthermore, an overview of bacterial contamination and associations with LIRs has been provided. Follow-up research may result in clinical recommendations to prevent LIRs. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors-www.springer.com/00266..

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Section: Discussionmentioning

confidence: 99%

The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature

Bachour

Kadouch²,

Niessen

2021

Aesth Plast Surg

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“…TAC, IR capsules may be opened and administered sublingually by placing the powder contents underneath the tongue for 10–15 minutes. Of note, a sublingual dose may double TAC exposure compared with oral/enteral administration; thus, close therapeutic drug monitoring is necessary and a dose reduction may be warranted 61,62 . Immediate‐release products and SR products are not interchangeable and SR products are not interchangeable with each other 63 .…”

Section: Maintenance Immunosuppression In Pediatric Kidney Transplantmentioning

confidence: 99%

Considerations and controversies of pharmacologic management of the pediatric kidney transplant recipient

2021

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Pediatric kidney transplantation has experienced considerable growth and improvement in patient and allograft outcomes over the past 20 years, in part due to advancements in immunosuppressive regimens and management. Despite this progress, care for this unique population can be challenging due to limited pediatric transplant data and trials, intricacies related to differences in children and adolescents compared with their adult counterparts, and limitations to long‐term survival facing all solid organ transplant populations. Immunosuppression and infection prevention practices vary from one pediatric transplant center to another and clinical controversies exist surrounding treatment and dosing. This review aims to summarize key aspects of pharmacologic management in this population and present pertinent data that describe the influence of practice to serve as a resource for practitioners caring for this unique specialty patient population. Additionally, this review highlights select controversies that exist within pediatric kidney transplantation.

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“…Tacrolimus remains the mainstay in the majority of transplantation drug regimens. The mechanism of action of tacrolimus as an immunosuppressant has been extensively studied [79] and mainly driven by calcineurin phosphatase inactivation [80] via binding to the intracellular protein FKBP12 [81]. This inactivation prevents the transport of nuclear factor of activated T cells (NF-AT), which is required for T-cell activation and expression of several cytokines, including IL-2.…”

Section: Tacrolimusmentioning

confidence: 99%

“…Distribution after absorption appears to vary drastically with representative sites being erythrocytes, lungs, liver, kidneys, pancreas, heart and spleen. Tacrolimus is metabolized in the liver via the CYP3A4 and CYP3A5 isoenzymes in addition to the P-gp efflux pump [81] in the intestinal wall to eight possible metabolites, with the 31-demethyl tacrolimus being the most common which has similar efficacy as tacrolimus [83]. The half-life of tacrolimus is extremely variable from patient to patient (2.1-36 h) with a time to peak onset of 0.5-6 h. Tacrolimus is primarily excreted at an average rate of 30 ml/min/kg in the feces (93%) and <1% is found to be excreted via the kidney in the active form of the drug [84].…”

Section: Tacrolimusmentioning

confidence: 99%

The Hurdles of Nanotoxicity in Transplant Nanomedicine

Nagy

Robbins

2019

Nanomedicine (Lond.)

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Nanomedicine has matured significantly in the past 20 years and a number of nanoformulated therapies are cleared by regulatory agencies for use across the globe. Transplant medicine is one area that has significantly benefited from the advancement of nanomedicine in recent times. However, while nanoparticle-based therapies have improved toxicological profiles of some drugs, there are still a number of aspects regarding the biocompatibility and toxicity of nanotherapies that require further research. The goal of this article is to review toxicological profiles of immunosuppressant therapies and their conversion into nanomedicine formulations as well as introduce future challenges associated with current in vitro and in vivo toxicological models.

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Sublingual tacrolimus as an alternative to oral administration for solid organ transplant recipients

Cited by 30 publications

References 28 publications

The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature

The Aetiopathogenesis of Late Inflammatory Reactions (LIRs) After Soft Tissue Filler Use: A Systematic Review of the Literature

Considerations and controversies of pharmacologic management of the pediatric kidney transplant recipient

The Hurdles of Nanotoxicity in Transplant Nanomedicine

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