|
Number | Drugs | Mechanism of action | Effect | Reference(s) |
|
1 | Mycophenolate sodium, tacrolimus, and azathioprine | Inhibits signals transmitted by IL-2 binding to IL-2R (antiproliferating effect) | Blocks T-cell activation, decreases both cell-mediated and humoral immunities | [27, 133] |
2 | Glucocorticosteroids: prednisone | Anti-inflammatory | Decreases circulating T-cells and inflammatory cytokines | [27] |
3 | Polyclonal antithymocyte globulin (ATG) or antilymphocyte globulin (ALG) | Leucocyte depletion/depleting antibodies. Eliminates CD4+ T-cell and B-cell interaction causing B-cell toxicity/apoptosis | Modulation of alloantibody production | [27, 91] |
4 | Mycophenolate mofetil | Inhibits inosine monophosphate dehydrogenase (IMPDH), inhibits DNA synthesis and protein glycosylation, suppresses expression of CD25, 71, 154, 28 | Decreases proliferation of B and T-cells | [27, 133] |
5 | Anti-CD3 monoclonal antibody | T-cell activation, opsonization, and depletion of antibodies | | [27, 133] |
6 | Tacrolimus, cyclosporine A | Inhibits interleukin- (IL-) 2 production by T-cell calcineurin antagonist, gene transcription, calcineurin inhibitors; causes decrease in gene expression | Decreases both cell-mediated and humoral immunities | [27, 133] |
7 | Anti-CD 20 monoclonal antibody (chimaeric) | Targets B-cells, depletes B-cell aggregates within allografts | B-cell depletion | [27, 33, 69] |
8 | Anti-CD 25 monoclonal antibodies (IL-2R chain) | Inhibits IL-2 function | | [27] |
9 | Plasmapheresis, mycophenolic acid | Reduction of antibody titers | | [89] |
10 | Intravenous immunoglobulin (IVIG) | Reduces CD19, CD20, and CD40 expression by B-cells | Blocks the binding of donor-reactive antibodies to target Fc receptors. Regulation of T and B lymphocytes | [33, 89, 135] |
11 | Rituximab | B binds with CD20 antibody, inhibits B-cell proliferation, decreases the concentration of antibodies. Antibody-dependent cellular cytotoxicity, direct signaling, and antibody-mediated cytotoxicity | Decreases the population of CD20 B-cells. | [33, 77, 133] |
12 | Plasmapheresis | Removal of DSA in circulation (elimination of DSA) | Reducing the antibody load | [91, 110] |
13 | Immunoadsorption | Treatment of multiple plasma volumes | | [69] |
14 | OKT3 (murine) anti-CD3/TCR monoclonal antibodies | TCR comodulates with CD3 | | [90] |
15 | Eculizumab (humanized monoclonal antibody) | Binds to the C5 protein with high affinity, thereby inhibiting conversion of C5 to C5b. | Preventing formation of the membrane attack complex (C5–9) | [110] |
|