title: Lack of effect of rapamycin in anti-CCP antibody production in a rheumatoid arthritis kidney allograft recipient.
abstract: Autoimmune diseases may lead to end-stage renal disease and, as a consequence, kidney transplantation. Classical immunosuppressive drugs, such as cyclosporine or corticosteroids, are well-established therapies for both transplantation and autoimmune diseases. Rapamycin is a new immunosuppressant useful for allograft transplantation and with a promising future for autoimmune diseases, although it has not been extensively studied in humans. Here the case of a patient diagnosed with rheumatoid arthritis (RA) who received a renal allograft is reported. She was started on prednisolone, azathioprine and cyclosporine immunosuppression and changed to rapamycin instead of cyclosporine 4 years after transplantation, because of chronic allograft nephropathy. At present, the patient has a functioning graft. However, the arthritis symptoms reappeared after the change in immunosuppressant. Titers of RA-specific anti-cyclic citrullinated peptides antibodies increased whereas rheumatoid factor titers decreased. This case report suggests that rapamycin used for kidney transplantation might have a different influence on the spectrum of RA autoantibodies.
authors.affiliation: Services of Immunology, Hospital Universitario Marques de Valdecilla, Santander, Spain. inmlhm@humv.es
authors.forename: M
authors.initials: M
authors.lastname: Lopez-Hoyos
authors.forename: E
authors.initials: E
authors.lastname: Rodrigo
authors.forename: G
authors.initials: G
authors.lastname: Fernandez-Fresnedo
authors.forename: V M
authors.initials: VM
authors.lastname: Martinez-Taboada
authors.forename: R
authors.initials: R
authors.lastname: Valero
authors.forename: M
authors.initials: M
authors.lastname: Arias
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000209:etiology / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000097:blood / Q000627:therapeutic use*; D016030:Kidney Transplantation; D010456:Peptides, Cyclic / Q000276:immunology*; D012217:Rheumatoid Factor / Q000097:blood; D020123:Sirolimus / Q000097:blood / Q000627:therapeutic use*
chemical_list: D001323:Autoantibodies; D007166:Immunosuppressive Agents; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D016572:Cyclosporine; D012217:Rheumatoid Factor; D020123:Sirolimus