New treatment for antibody-mediated rejection: interleukin-6 inhibitors

Byung Hwa Park; Ye Na Kim; Ho Sik Shin

doi:10.4285/ctr.23.0069

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Clin Transplant Res 2024; 38(1): 1-6

Published online March 31, 2024

https://doi.org/10.4285/ctr.23.0069

New treatment for antibody-mediated rejection: interleukin-6 inhibitors

Byung Hwa Park^1,2,*, Ye Na Kim^1,2,*, Ho Sik Shin^1,2

¹Division of Nephrology, Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
²Transplantation Research Institute, Kosin University College of Medicine, Busan, Korea

Correspondence to: Ho Sik Shin
Division of Nephrology, Department of Internal Medicine, Kosin University Gospel Hospital and Transplantation Research Institute, Kosin University College of Medicine, 262 Gamchen-ro, Seo-gu, Busan 49267, Korea
E-mail: 67920@naver.com

*These authors contributed equally to this work.

Received: December 14, 2023; Revised: February 15, 2024; Accepted: March 1, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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Abstract

Following kidney transplantation, antibody-mediated rejection (AMR) occurs when the antibodies of the immune system attack the transplanted organ, leading to damage of the kidney tissue. De novo human leukocyte antigen donor-specific antibodies (HLA-DSAs) play a key role in AMR. Current therapeutic approaches include intravenous immunoglobulin, anti-CD20 antibodies, and plasmapheresis. In cases resistant to treatment, proteasome inhibitors and C5 inhibitors may be employed. Nevertheless, a pressing need exists for new medications to improve transplant survival and reduce complications. In the context of AMR, interleukin (IL)-6 is instrumental in the development and maturation of B cells into plasma cells, which then produce HLA-DSAs targeting the allograft. IL-6 inhibitors are currently under investigation and show promise due to the essential role of IL-6 in the immune response; however, additional research is necessary.

Keywords: Kidney transplantation, Rejection, Interleukin-6, Antibody

HIGHLIGHTS

Following kidney transplantation, antibody-mediated rejection (AMR) occurs when the antibodies of the immune system attack the transplanted organ, leading to damage of the kidney tissue.
Immunosuppressants play a crucial role in the treatment or prevention of chronic active AMR.
Treatment options include intravenous immunoglobulin, anti-CD20 antibodies, and plasmapheresis.
For resistant cases, proteasome inhibitors and C5 inhibitors may be employed.
Ongoing research is focused on interleukin-6 inhibitors, with studies expected to continue.