Pharmacogenomic considerations for immunosuppressive therapy

Immunosuppression, the art of suppressing the endogenous immune system to allow organ transplantation or treatment of autoimmune disease, is a clinico-pharmacological field that has markedly developed over the past three decades with the advent of highly potent and rationally targeted immunosuppressive agents. Pharmacogenomics, the art of providing tailored pharmacological therapy with the highest therapeutic index based on the genomic composition of the individual, is a science that has rapidly developed over the past decade, along with the advances in the human genome project and in biotechnology. Pharmacogenomics of immunosuppression is the combined art of tailoring specific immunosuppressive drug therapy to specific immune-mediated clinical entities which require immunosuppression, with optimum matching of the drug to the individual's genomic makeup. Timely and judicious application of pharmacogenomics to clinical immunosuppression should direct the clinician to the best immunosuppressive drug for any given clinical condition, and markedly increase its efficacy as well as decreasing the incidence of side effects and toxicity, thereby decreasing morbidity and prolonging survival. Is this a description of an ongoing clinical evolution in immunosuppression or a prediction of future events? The promises of pharmacogenomics of immunosuppression are high, yet the availability and/or application and/or realization of the promises of this highly specialized clinical science are very slow to come.