Imlifidase in kidney transplantation
(2024) In Clinical Kidney Journal 17(3).- Abstract
Kidney transplantation, the gold-standard therapeutic approach for patients with end-stage kidney disease, offers improvement in patient survival and quality of life. However, broad sensitization against human leukocyte antigens often resulting in a positive crossmatch against the patient’s living donor or the majority of potential deceased donors in the allocation system represents a major obstacle due to a high risk for antibody-mediated rejection, delayed graft function and allograft loss. Kidney-paired donation and desensitization protocols have been established to overcome this obstacle, with limited success. Imlifidase, a novel immunoglobulin G (IgG)-degrading enzyme derived from Streptococcus pyogenes and recombinantly produced... (More)
Kidney transplantation, the gold-standard therapeutic approach for patients with end-stage kidney disease, offers improvement in patient survival and quality of life. However, broad sensitization against human leukocyte antigens often resulting in a positive crossmatch against the patient’s living donor or the majority of potential deceased donors in the allocation system represents a major obstacle due to a high risk for antibody-mediated rejection, delayed graft function and allograft loss. Kidney-paired donation and desensitization protocols have been established to overcome this obstacle, with limited success. Imlifidase, a novel immunoglobulin G (IgG)-degrading enzyme derived from Streptococcus pyogenes and recombinantly produced in Escherichia coli, is a promising agent for recipients with a positive crossmatch against their organ donor with high specificity towards IgG, rapid action and high efficacy in early pre-clinical and clinical studies. However, the rebound of IgG after a few days can lead to antibody-mediated rejection, making the administration of potent immunosuppressive regimens in the early post-transplant phase necessary. There is currently no comparative study evaluating the efficiency of imlifidase therapy compared with conventional desensitization protocols along with the lack of randomized control trials, indicating the clear need for future large-scale clinical studies in this field. Besides providing a practical framework for the clinical use of the agent, our aim in this article is to evaluate the underlying mechanism of action, efficiency and safety of imlifidase therapy in immunologically high-risk kidney transplant recipients.
(Less)
- author
- Kanbay, Mehmet ; Copur, Sidar ; Guldan, Mustafa ; Topcu, Ahmet U. ; Ozbek, Lasin ; Hasbal, Baris ; Süsal, Caner ; Kocak, Burak ; Callemeyn, Jasper and Segelmark, Mårten LU
- organization
- publishing date
- 2024
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- antibody-mediated rejection, desensitization, donor-specific antibody, imlifidase, kidney transplantation
- in
- Clinical Kidney Journal
- volume
- 17
- issue
- 3
- article number
- sfae033
- publisher
- Oxford University Press
- external identifiers
-
- pmid:38504664
- scopus:85188290787
- ISSN
- 2048-8505
- DOI
- 10.1093/ckj/sfae033
- language
- English
- LU publication?
- yes
- id
- ca0dfc9b-0ac1-4496-9a96-04a92103c8a7
- date added to LUP
- 2024-04-12 12:24:25
- date last changed
- 2024-04-26 14:19:31
@article{ca0dfc9b-0ac1-4496-9a96-04a92103c8a7,
abstract = {{<p>Kidney transplantation, the gold-standard therapeutic approach for patients with end-stage kidney disease, offers improvement in patient survival and quality of life. However, broad sensitization against human leukocyte antigens often resulting in a positive crossmatch against the patient’s living donor or the majority of potential deceased donors in the allocation system represents a major obstacle due to a high risk for antibody-mediated rejection, delayed graft function and allograft loss. Kidney-paired donation and desensitization protocols have been established to overcome this obstacle, with limited success. Imlifidase, a novel immunoglobulin G (IgG)-degrading enzyme derived from Streptococcus pyogenes and recombinantly produced in Escherichia coli, is a promising agent for recipients with a positive crossmatch against their organ donor with high specificity towards IgG, rapid action and high efficacy in early pre-clinical and clinical studies. However, the rebound of IgG after a few days can lead to antibody-mediated rejection, making the administration of potent immunosuppressive regimens in the early post-transplant phase necessary. There is currently no comparative study evaluating the efficiency of imlifidase therapy compared with conventional desensitization protocols along with the lack of randomized control trials, indicating the clear need for future large-scale clinical studies in this field. Besides providing a practical framework for the clinical use of the agent, our aim in this article is to evaluate the underlying mechanism of action, efficiency and safety of imlifidase therapy in immunologically high-risk kidney transplant recipients.</p>}},
author = {{Kanbay, Mehmet and Copur, Sidar and Guldan, Mustafa and Topcu, Ahmet U. and Ozbek, Lasin and Hasbal, Baris and Süsal, Caner and Kocak, Burak and Callemeyn, Jasper and Segelmark, Mårten}},
issn = {{2048-8505}},
keywords = {{antibody-mediated rejection; desensitization; donor-specific antibody; imlifidase; kidney transplantation}},
language = {{eng}},
number = {{3}},
publisher = {{Oxford University Press}},
series = {{Clinical Kidney Journal}},
title = {{Imlifidase in kidney transplantation}},
url = {{http://dx.doi.org/10.1093/ckj/sfae033}},
doi = {{10.1093/ckj/sfae033}},
volume = {{17}},
year = {{2024}},
}