Transplantation Center, Third Xiangya Hospital of Central South University, Engineering and Technology Research Center for Transplantation Medicine of National Ministry of Health, Changsha, Hunan, China (mainland).
Med Sci Monit. 2019 Feb 10;25:1102-1104. doi: 10.12659/MSM.914340.
Widespread usage of the calcineurin inhibitors tacrolimus and cyclosporine A as post-transplantation immunosuppressive agents is fraught with severe nephrotoxic and diabetogenic side effects. More recently, tapering of calcineurin inhibitor-based immunotherapies with concurrent administration of the mammalian target of rapamycin (mTOR) inhibitors sirolimus and everolimus has been employed within pharmacological regimens designed to achieve better safety and efficacy for preservation of allograft kidney function. Collected preclinical data and recent clinical study, however, indicate that usage of calcineurin inhibitors and/or mTOR blockers as immunosuppressive agents promotes equivalent diabetogenic side effects. Based on a wealth of validating preclinical studies, we contend that the favorable metabolic effects of mineralocorticoid receptor antagonists, such as spironolactone, support their inclusion in novel immunosuppressive strategies to inhibit new onset type II diabetic symptoms in post-transplantation patient populations.
环孢素 A 和他克莫司作为移植后免疫抑制剂的广泛应用伴随着严重的肾毒性和致糖尿病副作用。最近，在设计用于更好地保护同种异体肾功的药理学方案中，已采用减少钙调磷酸酶抑制剂的方法，同时给予雷帕霉素和依维莫司的哺乳动物靶标（mTOR）抑制剂。然而，临床前数据和最近的临床研究表明，钙调磷酸酶抑制剂和/或 mTOR 阻滞剂作为免疫抑制剂可导致同等的致糖尿病副作用。基于大量有效的临床前研究，我们认为，醛固酮受体拮抗剂（如螺内酯）的良好代谢作用支持将其纳入新型免疫抑制策略，以抑制移植后患者人群中新发的 II 型糖尿病症状。
