Rapamycin is a macrolide antifungal antibiotic isolated from Streptomyces hygroscopicus that has potent immunosuppressive properties. It blocks cell cycle progression from phase G1 to S and inhibits some signal transduction pathways. Besides its inhibitory effects on normal cells of the immune system, rapamycin also inhibits proliferation of transformed cell lines, such as B cells transformed by EBV.

Garcia et al. recently reported two cases of PTLD after renal transplantation that were successfully treated with rituximab in association with rapamycin. This is a potentially useful combination as it allows for the maintenance of some degree of the immunosup-pression necessary to preserve graft function while exerting anti-PTLD effects.41

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