Research and Reports in Immunology

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Mini Review - Research and Reports in Immunology (2023) Volume 6, Issue 5

Prevention and therapy for antibody-mediated rejection

Govindarajan Thangavelu*

Department of Immunology, University of Queensland, Brisbane, Australia

Corresponding Author:
Govindarajan Thangavelu
Department of Immunology
University of Queensland
Brisbane Australia
E-mail: Govindarajanthangavelu@gmail.com

Received: 29-Sep-2023, Manuscript No. AARRI-23-114305; Editor assigned: 03-Oct-2023, Pre QC No. AARRI-23-114305(PQ); Reviewed: 18-Oct-2023, QC No. AARRI-23-114305; Revised: 23-Oct-2023, Manuscript No. AARRI-23-114305(R), Published: 30-Oct-2023,DOI:10.35841/aarri-6.5.175

Citation: Thangavelu G. Prevention and therapy for antibody-mediated rejection. Res Rep Immunol.2023; 6(5):175

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Introduction

Organ transplantation has revolutionized medical science, providing a lifeline for individuals suffering from end-stage organ failure. However, the success of these life-saving procedures is often hindered by antibody-mediated rejection (AMR), a complex immune response that poses a significant threat to graft survival. In recent years, researchers and clinicians have made remarkable strides in understanding and managing AMR, with a focus on both prevention and therapy. This article explores the latest advances in combating AMR, shedding light on strategies to improve the outcomes of organ transplantation. Antibody-mediated rejection occurs when the recipient's immune system produces antibodies against antigens on the transplanted organ. These antibodies, typically directed against human leukocyte antigens (HLAs), complement proteins, or endothelial cells, lead to a cascade of immune responses that result in tissue damage, inflammation, and ultimately graft dysfunction or failure. AMR can occur both in the early and late post-transplantation periods and can affect various solid organ transplants, such as the heart, kidney, lung, and liver [1].

Prevention Strategies

Preventing AMR is a critical aspect of successful organ transplantation. Several strategies have been developed to minimize the risk of AMR:

HLA Matching: Precise HLA matching between donor and recipient remains a cornerstone of transplantation. Improved HLA compatibility reduces the likelihood of antibody development against the graft.

Desensitization Protocols: For patients with pre-existing antibodies against donor antigens, desensitization protocols are used to lower antibody levels. These protocols may include plasmapheresis, intravenous immunoglobulin (IVIG) infusion, and B-cell depletion therapies like rituximab [2].

Therapeutic Drug Monitoring: Close monitoring of immunosuppressive drug levels helps ensure that recipients receive the right amount of medication. This prevents underimmunosuppression, which can lead to AMR.

Personalized Immunosuppression: Tailoring immunosuppressive regimens to an individual's immune profile has shown promise in reducing AMR risk. Biomarkers and genetic testing help identify high-risk patients who may Innovations in Immunotherapy: Emerging therapies, such as costimulation blockade and complement inhibition, are being investigated for their potential in preventing AMR.

When AMR does occur, timely intervention is essential. Managing AMR often requires a multifaceted approach:

Plasmapheresis: Removing antibodies from the patient's bloodstream using plasmapheresis can be an effective shortterm strategy to reduce antibody levels.

Intravenous Immunoglobulin (IVIG): IVIG can help neutralize harmful antibodies and modulate the immune response. It is often used in conjunction with plasmapheresis [3].

Rituximab: This monoclonal antibody targets B-cells, reducing antibody production. Rituximab is used in some AMR cases to deplete B-cells and halt the antibody response.

Eculizumab: Eculizumab is a complement inhibitor that can be beneficial in cases of complement-mediated AMR. It blocks the terminal complement cascade, preventing tissue damage.

Bortezomib: This proteasome inhibitor has shown promise in reducing antibody production and mitigating AMR in some cases.

High-Dose Intravenous Immunoglobulin (IVIG): In certain severe cases of AMR, high-dose IVIG may be administered to suppress the immune response further.

Antibody-Depleting Therapies: Emerging antibody-depleting therapies, such as proteasome inhibitors and anti-plasma cell agents, are under investigation for their potential to treat AMR more effectively.

The landscape of AMR prevention and therapy is evolving rapidly. Ongoing research and clinical trials aim to further refine existing strategies and develop novel approaches.

Genetic and Biomarker-Based Risk Assessment: Advances in genomics and biomarker identification may enable more precise prediction of AMR risk, allowing for targeted interventions [4].

Tolerance Induction: Efforts to induce immune tolerance in transplant recipients are ongoing. These approaches aim to reprogram the immune system to accept the graft without the need for long-term immunosuppression.

Gene Editing: Techniques like CRISPR-Cas9 are being explored for modifying donor organs to reduce their immunogenicity, potentially making them less susceptible to AMR.

Immunomodulatory Therapies: Novel immunomodulatory drugs that can selectively suppress harmful immune responses while preserving protective immunity are a focus of research [5].

Personalized Medicine: The integration of personalized medicine, including genomics and immune profiling, may lead to tailored treatment strategies for AMR.

Conclusion

Antibody-mediated rejection remains a formidable challenge in the field of organ transplantation. However, with advances in our understanding of the underlying mechanisms and the development of innovative prevention and therapy strategies, the outlook for transplant recipients is improving. By implementing precise HLA matching, individualized immunosuppression, and cutting-edge therapies, healthcare providers are moving closer to achieving the ultimate goal: long-term graft survival and improved quality of life for organ transplant recipients. As research continues to advance, the future holds promise for even better outcomes in the fight against antibody-mediated rejection.

References

  1. Kimmig S. Two subsets of naive T helper cells with distinct T cell receptor excision circle content in human adult peripheral blood.J Exp Med.2002;195:789–94.

    2. Indexed at, Google Scholar, Cross Ref

  2. Li HW. Emerging concepts in haematopoietic cell transplantation.Nat Rev Immunol.2012;12:403–16.

    3. Indexed at, Google Scholar,

  3. Tang Q. Regulatory T-cell therapy in transplantation: moving to the clinic.Cold Spring Harbor perspectives in medicine.2013.

    4. Indexed at, Google Scholar, Cross Ref

  4. Pilat N. Treg-Therapy Allows Mixed Chimerism and Transplantation Tolerance Without Cytoreductive Conditioning.Am J Transplant.2010;10(4):751–62.

    5. Indexed at, Google Scholar, Cross Ref

  5. Pilat N. T-regulatory cell treatment prevents chronic rejection of heart allografts in a murine mixed chimerism model.Int Socie  Hea Trans.2014;33(4):429–437.

    6. Indexed at, Google Scholar, Cross Ref

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