[Antibodies and immunomodulation]

When examining immunosuppressor induction one important question is to determine the efficacy of anti-CD25 antibodies or the new compound efalizumab compared with anti-lymphocyte globulins and anti-OKT3 agents known to be very effective but with important side effects. DACLIZUMAB: Recent work has shown that 2 injections at 1 mg/kg (one on day 1 the other between day 10 and day 14) completely block interleukin-2 receptor for more than 10 weeks in 98% of the recipients. Instead of the 5 injections every 15 days as indicated by the recommendations, this new protocol is easier to institute and less costly. The efficacy remains to be demonstrated. BASILIXIMAB: This chimeric monoclonal antibody has affinity for the IL-2 receptor. Balisiximab is administered in 2 doses at 20 mg, one on day 0 and the other one on day 4. A unique 40 mg dose on day 1 has a comparable efficacy. OTHER PROTOCOLS: Among the different induction molecules with promising properties, particular attention should be given to efalizumab. The antisense oligonucleotide (ICAM-1; ISIS 2302) appears to show relatively poor tolerance and no therapeutic efficacy. In association with plasmapheresis and intravenous immunoglobulins, it has been shown to be very effective when given to graft candidates with a positive cross match or after transplantation in case of acute rejection.