title: Sirolimus inhibits oxidative burst activity in transplant recipients.
abstract: Increased susceptibility to bacterial infection is a recognized side-effect of sirolimus treatment after transplantation, which could be caused by inhibition of neutrophil activation. Blood from 24 healthy subjects was equilibrated with 0 to 50 ng/mL sirolimus or 60 microg/mL propofol. Blood was also collected from 23 transplant recipients (13 kidney, 10 liver) with renal impairment, randomized to remain on calcineurin inhibitors (n=12) or to be switched to sirolimus monotherapy (n=11). Phorbol myristate acetate (PMA)-stimulated oxidative burst was measured by flow cytometry at 0 and 3 months after randomization. There was a linear relationship between inhibition of neutrophil activation in vitro and sirolimus concentrations spanning the therapeutic range (P=0.01). Neutrophil activation was decreased significantly in transplant recipients 3 months after switching from calcineurin inhibitors to sirolimus therapy (mean percentage change -24.4%; 95% confidence interval -7.5, -41.2%, P=0.009), but no changes were observed in patients who remained on calcineurin inhibitors.
authors.affiliation: Department of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Gee
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Trull
authors.forename: Susan C
authors.initials: SC
authors.lastname: Charman
authors.forename: Graeme J M
authors.initials: GJ
authors.lastname: Alexander
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D016897:Respiratory Burst / Q000187:drug effects*; D020123:Sirolimus / Q000627:therapeutic use*; D013755:Tetradecanoylphorbol Acetate / Q000494:pharmacology
chemical_list: D007166:Immunosuppressive Agents; D013755:Tetradecanoylphorbol Acetate; D020123:Sirolimus