Zentralinstitut für Klinische Chemie und Laboratoriumsmedizin, Klinikum Stuttgart, Stuttgart, Germany.
Ther Drug Monit. 2010 Oct;32(5):560-72. doi: 10.1097/FTD.0b013e3181efb3d2.
Therapeutic drug monitoring is a well-established approach in transplantation medicine to guide immunosuppressive therapy. However, it cannot always predict the effects of immunosuppressive drugs on immune cells, because it does not reflect any aspect of an individual patient's immune system. Pharmacodynamic monitoring is a more recent strategy to provide information about the biologic effect of a specific drug or drug combination on the individual transplant patient. Currently, there is a large number of different biomarkers that either directly (specific markers) or indirectly (global markers) relate to the pharmacodynamic effects of immunosuppressive drugs and are under investigation as potential candidates to be introduced in clinical practice. Such biomarkers may be useful to identify patients at risk of developing acute rejection, infection, or cancer as well as patients who are suitable for minimization of immunosuppressant therapy and may be helpful to manage the timing and rate of immunosuppressant weaning. Serial longitudinal monitoring may allow maintenance of an individualized immunosuppressive regimen. Thus, biomarker monitoring is a potential complementary tool to therapeutic drug monitoring. This review summarizes the current state of knowledge about the use of a number of global or drug-specific pharmacodynamic biomarkers. It is not a comprehensive overview of the literature available, but rather an evidence-based reflection by experts who are intensively involved in scientific work in this field.
治疗药物监测是移植医学中一种成熟的方法，用于指导免疫抑制治疗。然而，它并不能总是预测免疫抑制药物对免疫细胞的作用，因为它不能反映个体患者免疫系统的任何方面。药效学监测是一种较新的策略，可以提供关于特定药物或药物组合对个体移植患者的生物学效应的信息。目前，有大量不同的生物标志物，它们直接（特异性标志物）或间接（整体标志物）与免疫抑制药物的药效学相关，并作为潜在的候选标志物正在进行研究，以引入临床实践。这些生物标志物可用于识别发生急性排斥反应、感染或癌症风险较高的患者，以及适合减少免疫抑制剂治疗的患者，并有助于管理免疫抑制剂的停药时间和速度。连续纵向监测可能允许维持个体化的免疫抑制方案。因此，生物标志物监测是治疗药物监测的一种潜在补充工具。本文综述了目前关于使用多种整体或药物特异性药效学生物标志物的知识状况。这不是对现有文献的全面综述，而是由深入参与该领域科学工作的专家进行的循证思考。
