Suppression of the humoral immune response by mycophenolate mofetil

Smith, Kenneth G. C.; Isbel, Nicole M.; Catton, Michael; Leydon, Jennie; Becker, Gavin J.; Walker, Rowan G.

doi:10.1093/ndt/13.1.160

Cited by 170 publications

(130 citation statements)

References 15 publications

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“…Among RT patients, those receiving mycophenolic acid had a lower increase in Ab response than those receiving azathioprine. This observation is similar to previous reports pertaining to influenza vaccination (9,11,26). This work brings additional data supporting the safety of influenza vaccination in renal transplant recipients (8,33) and also documents that vaccination does not induce sensitization against HLA or MICA in dialyzed patients, who can become candidates for kidney transplantation.…”

Section: Discussionsupporting

confidence: 90%

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Broeders

Hombrouck²,

Lemy³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives In 2009, the pandemic influenza A/H1N1 accounted for worldwide recommendations about vaccination. There are few data concerning the immunogenicity or the security of the adjuvanted-A/H1N1 vaccine in transplanted and hemodialyzed patients.Design, setting, participants, & measurements Sera from 21 controls, 53 hemodialyzed (HD) patients, and 111 renal transplant recipients (RT) were sampled before (T0) and 1 month after (T1) a single dose of Pandemrix® vaccine (GSK Biologicals, AS03-adjuvanted). We measured the neutralizing antibodies against A/H1N1/2009, the geometric mean (GM) titers, the GM titer ratios (T1/T0) with 95% confidence intervals, and the seroconversion rate (responders: Ն4-fold increase in titer). The HLA and MICA immunization was determined by Luminex technology. ResultsThe GM titer ratio was 38 (19 to 78), 9 (5 to 16), and 5 (3 to 6) for controls, HD patients, and RT patients, respectively (P Ͻ 0.001). The proportion of responders was 90%, 57%, and 44%, respectively (P Ͻ 0.001). In RT patients, the prevalence of histocompatibility leukocyte antigen (HLA) class I, histocompatibility leukocyte antigen class II, and MHC class I-related chain A immunization, was, respectively, 15%, 14%, and 14% before and 14%, 14%, and 11% after vaccination (P ϭ 1, 1, and 0.39). ConclusionsThe influenza A/H1N1-adjuvanted vaccine is of limited efficacy but is safe in renal disease populations. The humoral response is lower in transplanted versus hemodialyzed patients. Further studies are needed to improve the efficacy of vaccination in those populations.

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Section: Discussionsupporting

confidence: 90%

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Broeders

Hombrouck²,

Lemy³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…In vitro, it is able to block antibody production by human B cells almost completely in response to polyclonal mitogens through a T-helper-independent mechanism (12). In vivo, MMF suppresses antibody production in response to influenza vaccination considerably better than azathioprine in kidney transplant patients (10). This study is consistent with our case, in which antibody production occurs under azathioprine therapy and decreases under MMF therapy.…”

Section: Discussionsupporting

confidence: 90%

“…This complication is not surprising as transplant patients are able to mount reduced, but significant, humoral responses. For example, they can produce alloantibodies or antibodies in response to vaccination when receiving classical immunosuppressive treatment (10).…”

Section: Discussionmentioning

confidence: 99%

Recovery from Pure Red Cell Aplasia Caused by Anti Erythropoietin Antibodies After Kidney Transplantation

Snanoudj

Beaudreuil

Arzouk

et al. 2004

American Journal of Transplantation

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The use of recombinant human erythropoietin (rHuEPO) is a major advance in the treatment of patients with anemia caused by chronic renal failure (CRF). The development of antierythropoietin (anti-EPO) antibodies following treatment with rHuEPO has been observed in an increasing number of patients. This causes pure red cell aplasia (PRCA) and requires the definitive withdrawal of rHuEPO. Many patients require immunosuppressive therapy before anti-EPO antibodies disappear completely. We report a case of PRCA owing to anti-EPO in a 20-year-old hemodialyzed man who was receiving immunosuppressive therapy for a liver transplantation carried out in childhood. He required repeated red cell transfusions until a kidney transplantation was performed. He received an induction therapy with antithymocyte globulins and a maintenance regimen consisting of steroids, tacrolimus and mycophenolate mofetil. This new immunosuppressive treatment led to the complete disappearance of anti-EPO antibodies within a few weeks after the kidney transplantation. Erythropoiesis and endogenous erythropoietin synthesis were restored following transplantation, without leading to an increase in the titer of anti-EPO antibodies.

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“…105 Recipients of heart transplants administered cyclosporine-based immunosuppression responded well to pneumococcal vaccination but had a significantly reduced immune response to influenza vaccine. 71 The use of mycophenolate mofetil 72 and cyclosporine 69 was associated with decreased antibody titer toward influenza vaccine in renal transplant recipients. Conversely, corticosteroids did not affect the responsiveness to the vaccine in a different patient population.…”

Section: Vaccinationmentioning

confidence: 99%

Influenza Infection in Patients Before and After Liver Transplantation

Duchini¹

2000

Liver Transplantation

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Infection with influenza virus poses specific problems in pediatric and adult liver transplant recipients, both before and after liver transplantation. These include a higher rate of pulmonary and extrapulmonary complications, development of rejection with graft dysfunction, prolonged shedding of influenza virus, and increased drug-resistance. Hepatic decompensation may occur during influenza infection in patients with cirrhosis. Current prophylaxis includes yearly vaccination with trivalent inactivated vaccine. Appropriate diagnosis and prompt treatment of any upper respiratory infections are indicated in these patients. In this review, we describe a case of influenza viral pneumonia in an adult liver transplant recipient, review basic and clinical aspects of influenza infection in this patient population, and discuss current modes of prevention and treatment in detail. (Liver Transpl 2000;6: 531-542.)

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Suppression of the humoral immune response by mycophenolate mofetil

Cited by 170 publications

References 15 publications

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Influenza A/H1N1 Vaccine in Patients Treated by Kidney Transplant or Dialysis

Recovery from Pure Red Cell Aplasia Caused by Anti Erythropoietin Antibodies After Kidney Transplantation

Influenza Infection in Patients Before and After Liver Transplantation

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