Medical Department I, Nephrology Section, Ulm University, Ulm, Germany.
Ther Drug Monit. 2013 Apr;35(2):233-9. doi: 10.1097/FTD.0b013e3182804c9b.
Drug blood levels can only serve as a surrogate because of the lack of information on the drug's direct pharmacological effects in the individual patient. Measurement of the mammalian target of rapamycin (mTOR) activity dependent on the phosphorylation status of p70 S6 kinase (p70 S6K) offers a practical way for monitoring pharmacodynamic drug activity, with the potential to better assess the state of immunosuppression in individual patients.
Here, we established a novel in vitro model system by treating Jurkat cells and peripheral blood mononuclear cells with different concentrations of sirolimus after stimulation with phorbol 12-myristate 13-acetate.
A dose-dependent reduction of the p70 S6K phosphorylation status was demonstrated by Western blot and a newly established enzyme-linked immunosorbent assay (ELISA). Relative phospho-p70 S6K values from ELISA and relative densities from Western blot analysis in peripheral blood mononuclear cells revealed a strong correlation (Spearman correlation coefficient r s = 0.7, P = 0.01). Finally, parallel assays confirmed a sirolimus dose-dependent reduction of cytokine production and cell proliferation in the in vitro model.
Pharmacodynamic monitoring of mTOR inhibition with a p70 S6K ELISA could guide mTOR inhibitor immunosuppression therapy toward a more individualized therapy. The usage of this technique now has to be evaluated in a clinical series of patients.
由于缺乏个体患者中药物直接药理作用的信息,药物血药浓度只能作为替代指标。依赖于磷酸化 p70 S6 激酶 (p70 S6K) 的哺乳动物雷帕霉素靶蛋白 (mTOR) 活性的测量为监测药效动力学药物活性提供了一种实用的方法,有可能更好地评估个体患者的免疫抑制状态。
在这里,我们通过用佛波醇 12-肉豆蔻酸 13-乙酸酯刺激后用不同浓度的西罗莫司处理 Jurkat 细胞和外周血单核细胞,建立了一种新的体外模型系统。
通过 Western blot 和新建立的酶联免疫吸附试验 (ELISA) 证明了 p70 S6K 磷酸化状态的剂量依赖性降低。ELISA 中的相对磷酸化 p70 S6K 值和外周血单核细胞中 Western blot 分析的相对密度显示出很强的相关性(Spearman 相关系数 rs = 0.7,P = 0.01)。最后,平行试验证实了体外模型中细胞因子产生和细胞增殖的西罗莫司剂量依赖性降低。
使用 p70 S6K ELISA 进行 mTOR 抑制的药效动力学监测可以指导 mTOR 抑制剂免疫抑制治疗向更个体化的治疗方向发展。现在必须在一系列临床患者中评估该技术的应用。