(Suggestions are based on Level III and IV evidence) • In children treated with cyclosporin, 2 h peak cyclosporin level (C2) monitoring should be used in the initial post-transplant period, as the C2 level is a better predictor of cyclosporin exposure than C0 monitoring (Level III evidence). Limited data suggest that the C2 level should be maintained above 1500 ng/mL in the early post-transplan...

Vascularized composite allotransplantation (VCA) has emerged as a viable limb replacement strategy for selected patients with upper limb amputation. However, allograft rejection has been seen in essentially all reported VCA recipients indicating a requirement for substantial immunosuppressive therapy. Calcineurin inhibitors have served as the centerpiece agent in all reported cases, and CNI-ass...

Part I of this article, which appeared in the previous issue of the Journal, reviewed calcineurin inhibitors--ciclosporin and tacrolimus. In part II, we review the pharmacokinetics and therapeutic drug monitoring of mycophenolate and mammalian target of rapamycin inhibitors--sirolimus and everolimus--in thoracic transplantation, and we provide an overall discussion and suggest various areas for...

It is known that PMA (phorbol-12-myristate-13-acetate) can activate the classical and novel protein kinase C isoenzymes (cPKC alpha, beta, gamma and nPKC delta, epsilon, eta, theta), while the calcium ion can induce only the activity of cPKC. Calcineurin binding protein (Cabin 1) belongs to the group of endogenous inhibitors of calcineurin. Cabin 1 becomes hyperphosphorylated in response to PKC...

BACKGROUND Idiopathic membranous nephropathy (IMN) is the most common pathological type for nephrotic syndrome in adults in western countries and China. The benefits and harms of immunosuppressive treatment in IMN remain controversial. OBJECTIVES To assess the efficacy and safety of different immunosuppressive agents in the treatment of nephrotic syndrome caused by IMN. METHODS PubMed, EMBA...

Calcineurin is a serine/threonine phosphatase originally involved in the immune response but is also known for its role as a central mediator in various non-immunological intracellular signals. The nuclear factor of activated T cell (NFAT) proteins are the most widely described substrates of calcineurin, but ongoing work has uncovered other substrates among which are the cytoskeleton organizing...

CONTEXT Preventing acute rejection (AR) after kidney transplantation is of utmost importance because an AR can have a negative impact on long-term allograft survival. EVIDENCE ACQUISITION Directory of Open Access Journals (DOAJ), Google Scholar, PubMed, EBSCO, and Web of Science have been searched. RESULTS At the moment this can be done by using rabbit anti-thymocyte globulins (rATGs) as an...

Sir, Acute intermittent porphyria (AIP) is transmitted as autosomal dominant disorder with incomplete penetrance. It results from a deficiency of the porphobilinogen deaminase enzyme of haeme biosynthesis. Clinical manifestations of acute attacks include abdominal pain, hypertension and neuro-psychiatric dysfunction, and are often triggered by exposure to exogenous precipitating factors, such a...

Atopic dermatitis (AD) is a chronic or chronically relapsing inflammatory skin condition that primarily affects children. Topical corticosteroids have been the mainstay of treatment since the late 1950s. While providing excellent short-term efficacy, topical corticosteroid usage is limited by potential adverse effects, including impairment of the function and viability of Langerhans cells/dendr...

The addition of calcineurin inhibitors, including cyclosporine A (CsA) and FK-506 (tacrolimus), to transplant protocols has markedly reduced acute allograft rejection and prolonged patient survival. Although monitoring of serum drug levels has been shown to be a poor indicator of efficacy, there is little data on calcineurin enzymatic activity in humans. Therefore, we measured calcineurin in is...