Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Belatacept, a fusion protein that prevents stimulation of the CD28 receptor, does not have the adverse renal, cardiovascular, and metabolic adverse effects associated with calcineurin inhibitors (CNIs). We present data on 8 renal transplant patients with graft dysfunction who were switched from CNI-based immunosuppressive therapy to belatacept in response to patients' specific needs. In patients 1 through 5, the belatacept regimen comprised 5-mg/kg doses on days 1, 15, 28, 43, and 57, then every 28 days with a decrease in the CNI dose. The CNI dose was tapered: 100% on day 1, 60% on day 15, 30% on day 23, and discontinued on day 29. In patients 6, 7, and 8, belatacept was administered at 10 mg/kg on days 1, 5, 15, 28, 60, and 90, and then at 5 mg/kg every 28 days. CNIs were withdrawn completely on day 1. Reasons for switching were intolerance to CNI, CNI toxicity, vascular lesions, interstitial fibrosis/tubular atrophy, or arterial hypertension. Renal function improved in all cases. Belatacept is approved to be used de novo; the uniqueness of our cases is that it was used in conversion and in patients with renal dysfunction. In the short term, patients did not present with any serious adverse events related to belatacept or cellular or humoral acute rejection episodes.
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PMID:Conversion to belatacept-based immunosuppression therapy in renal transplant patients. 2542 Aug 7

Calcineurin inhibitors (CNIs) are used widely for maintenance immunosuppression in renal transplant recipients. However, their side effect profile has led researchers to attempt to find safer alternatives that can maintain effective long-term immunosuppression with less toxicity. Belatacept is a CTLA4-Ig molecule designed to block the costimulatory B7-CD28 signal needed for activation of effector T cells. While it has shown great promise in clinical trials, it has made halting progress towards replacing CNIs in actual clinical practice. The BENEFIT trial revealed some of the advantages of belatacept in terms of maintaining renal function after transplant and reducing some of the metabolic side effects of CNIs related to hypertension and dyslipidemia. Despite that, some cautionary signals have emerged as well, in that belatacept-treated patients experience higher acute rejection rates and greater risk for PTLD. Furthermore, the requirement for monthly intravenous infusions has presented logistical and cost challenges for widespread adoption.
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PMID:Belatacept in kidney transplantation - past and future perspectives. 2906 45

Impaired fertility is common among patients with chronic organ failure, including end-stage renal disease (ESRD). Women of childbearing age undergoing transplantation may experience rapid return of fertility. Pregnancy posttransplant presents numerous risks for the patient, fetus, and allograft. Maternal risks include hypertension and preeclampsia. Allograft risks include acute rejection and failure of the organ, and fetal risks include miscarriage, birth defects from immunosuppressants, premature delivery, and low birth weight. Belatacept, a selective T cell costimulation blocker, was approved for use in kidney transplant recipients in the United States in 2011. Little is known about the safety of belatacept during pregnancy in humans. We describe 2 cases of successful pregnancy and delivery with the use of belatacept-based immunosuppression. The Transplant Pregnancy Registry International (TPR) is a voluntary registry for transplant recipients who have had pregnancies or fathered a pregnancy posttransplant. To date, these 2 cases are the only known exposures to belatacept that have been reported to the TPR.
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PMID:Belatacept during pregnancy in renal transplant recipients: Two case reports. 2971 9