Rapamycin and Regulatory T Cells in Renal Transplant Patients: a Two-year Randomized Prospective Study
试验速览
- 阶段
- 2 期
- 状态
- 已完成
- 发起方
- 入组人数
- 56
- 试验地点
- 1
- 主要终点
- The absolute number of T-reg after renal transplant in patients in treatment with rapamycin compared to patients treated with cyclosporine
研究概览
简要总结
The immune system response is mediated by the interaction between the antigen presenting cell (APC), CD4+ T helper cells (Th) and CD4+ CD25+ regulatory T cells, a subgroup of CD4+ T cell which express IL-2 receptor (CD25) and the transcriptional factor foxp3. Regulatory T cell may contribute to the maintenance of tolerance by suppressing the immune response to normal or tumor associated antigens.
Regulatory T cell emerge from the thymus during ontogenesis and they represent about 10 % of the peripheral Cd4+ t cells.
Rapamycin is one the most use treatment to prevent renal allograft failure. Differently from calcineurin inhibitors (cyclosporine and tacrolimus), that inhibit T-cell activation through the inhibition of calcineurin activation, rapamycin inhibits cellular proliferation by impairing the progression of the cellular cycle, in particular by interaction with mTOR. Recently Battaglia et al. have demonstrated a Treg amplification in murine CD4+ lymphocytes treated with rapamycin in vitro.
Aim of the study is to evaluate the effect of different immunosuppressive regimens on regulatory T cell and to verify the hypothesis that rapamycin may induce tolerance in kidney transplanted patients, more than cyclosporine treatment.
详细描述
It is two years randomised controlled trial in parallel groups.
It has been resolved to compare different immunosuppressive regimens:
- cyclosporine+ mycophenolate+prednisone
- rapamycin + mycophenolate + prednisone, this treatment should be introduced after one month from renal transplantation.
Patient should visited at month 1-6-12-24 from the transplant. During the control we will reported the following data: physical examination, blood test (blood count, creatinin, BUN, immunosuppressive blood concentration, histological response of surveillance renal biopsy), blood pressure, attendant change of current therapy, pathological variation, or any hospitalisation both ordinary or in DH regimen.
Moreover in all control visit it will be collected a blood sample for evaluation of regulatory t cells.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Treatment
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 75 Years（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Male and female aged from 18 to 75 years
- •Transplanted patients from cadaveric donors
- •Patients who has given written informed consensus
排除标准
- •Legally unable patients
- •Patients who have been participated to others studies in the last 3 months
- •Addicted to alcohol or smoking
研究组 & 干预措施
Rapamycin
Maintenance treatment with rapamycin + mycophenolate + prednisone. This treatment will be introduced one month after renal transplantation.
干预措施: Rapamycin (Drug)
cyclosporine
Maintenance treatment with cyclosporine + mycophenolate + prednisone. This treatment will be introduced one month after renal transplantation.
干预措施: Cyclosporins (Drug)
结局指标
主要结局
The absolute number of T-reg after renal transplant in patients in treatment with rapamycin compared to patients treated with cyclosporine
时间窗: Every 6 months after the transplantation
次要结局
- Adverse events developed during the duration of the clinical study, that damage the patient, that is not part of the natural history of the disease.(Every two months during the follow-up)
研究者
Carmelo Libetta
MD
Fondazione IRCCS Policlinico San Matteo di Pavia