One tool, multiple gains: anti-CD38 therapy in antibody-mediated rejection

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Antibody-mediated rejection (AMR) causes significant kidney allograft loss.
• Conventional therapies for AMR have limited efficacy.
• Targeting plasma cells offers a novel therapeutic strategy.

Purpose of the Study:

• To review the current understanding of AMR.
• To present updates on the Banff 2022 diagnostic framework.
• To critically evaluate anti-CD38 therapies for AMR in kidney transplantation.

Main Methods:

• Review of current literature on AMR and anti-CD38 therapies.
• Synthesis of emerging clinical data.
• Analysis of Banff 2022 diagnostic criteria.

Main Results:

• Anti-CD38 monoclonal antibodies show potential in reducing donor-specific antibodies and inflammation.
• These therapies demonstrate promising efficacy with an acceptable safety profile.
• Transient effects and impact on regulatory immune cells present limitations and risks.

Conclusions:

• Anti-CD38 agents represent a novel approach for AMR treatment in kidney transplantation.
• Further research is needed to address variability and potential risks to immune balance.
• Precision immunotherapy with anti-CD38 agents may reshape future treatment paradigms if guided by mechanistic insights and clinical evaluation.