immunomodulation either stimulation or suppression has a crucial role in clinical practice dealing with either malignancy or infection organ transplantation also need

1. By
Dr. Salwa M. Elwasif, MD
Fellow of Internal Medicine and Nephrology
Urology and Nephrology Center
Mansoura University
Immunosuppressive therapy in
renal transplantation
31 October , 2021

2. Introduction
 Immunomodulation is the process of change in
immune system either suppression or stimulation

3. Immunosuppression needed in:
 Organ transplantation
 Autoimmune diseases

4. Immune stimulation
 Endogenous immunomodulation
interleukins(IL), interferons (IFN), tumor necrosis
factors (TNF), transforming growth factor-ß (TGF-
ß), colony stimulating factors(CSF), immunoglobulins
 Exogenous immunomodulation
levamisole, vaccine

5. Role of cytokines in the immune response
activation and immunomodulation
 Cytokines participate in many physiological
processes including the regulation of immune and
inflammatory responses.
 These effector molecules are produced transiently
and locally and control the amplitude and duration
of the response.
 The research outcomes have shown that suboptimal
production of these informational molecules may
significantly contribute to the pathophysiology of
various diseases

6. Role of cytokines in the immune response
activation and immunomodulation
 the cytokines released by CD4+ T cells at the onset of
an immune response are decisive for pathological or
physiological consequences. IL-1, IL-4, IL-6, IL-10,
IL-12, TNF-alpha and IFN-alpha, -beta, -gamma,
etc., are known to contribute to the pathophysiology
of autoimmune diseases, infectious diseases, and
allograft rejection

7. Pro-inflammatory cytokines
 An inflammatory or pro-inflammatory cytokine is a
type of signaling molecule that is excreted by the
cells of immune cells such as helper T cells (Th) and
macrophages, and some other cell types which are
known to promote inflammation as a defense
mechanism.

8. Pro-inflammatory cytokines
 The interleukin-1 (IL-1), IL-12, and IL-18, tumor
necrosis factor (TNF), interferon gamma (IFN-γ),
and granulocyte-macrophage colony stimulating
(GM-CSF) factor and play an important role in
mediating and regulating the nonadaptive immune
response.

9. Anti-inflammatory cytokines
 The anti-inflammatory cytokines are a series of
immunoregulatory molecules that control pro-
inflammatory cytokines, production and their response.
The cytokines act in concert with specific cytokine
inhibitors and soluble cytokine receptors with an objective
to regulate the human immune response. Their physiologic
role in provoking inflammatory responses and pathologic
role in systemic inflammatory states are increasingly
recognized.

13. extract of infectious respiratory
bacteria
immunoactive Escherichia coli
( E. coli) fractions
 OM-85 BV has ciliostimulatory
and immunogenic properties
that may be partially responsible
for its observed efficacy as a
respiratory therapeutic.
 The incidence of bacteriuria
(germs > or = 10(5)/ml),
dysuria and leukocyturia was
significantly reduced
Oral immunostimulant in recurrent infection

15. Introduction
 Renal transplantation is the treatment of choice in
selected cases of renal failure.
 Maintenance immunosuppressive drugs is crucial for
graft survival.
 Patient adherence to immunosuppressive drugs is
one of predictor for long lasting graft.

16. compliance
adherence

17. Types of
immunosuppressive
drugs
Induction Maintenance

18. Groups of maintenance immunosuppressive
drugs
steroids
CNI
Antiprolefrative
mTORi

19. Immunosuppression:
Maintenance

20. mTORi: Current Use

21. Steroids

22. Transplantation October 2017;101: 2590–2598
Steroid Withdrawal:
What is the effect on long-term?

23. Tacrolimus
Pediatric Nephrology, Accepted: 10 January 2018

24. Tacrolimus Variability
Major adverse
cardiovascular
events

25. CYP3A5
Transplantation 2008;85: 163–165 . Review

26. University Hospital Heidelberg
CNI and NFAT-RE
Monitoring

27. Q. What Drug is Behind These Signs?
American Journal of Transplantation November 2017; 17: 2782–2789

28. Cutaneous toxicity of immunosuppressive
drugs

30. Am J Kidney Dis. May 2017;69(5):e21-e22
Q. Graft Biopsy:
What is your diagnosis?

31. MPA

32.  Mycophenolic acid (MPA) drugs should be
avoided in women thinking of pregnancy.
However, their use for men who are willing for
fatherhood are absolute safe.
A. True
B. False
Q

33. Renal Transplant CPG:
Conception

34. Immunosuppression:
Impact on Male Reproduction

35. Thank you