Nakagawa Koji, Sugiyama Rikikazu
Center for Reproductive Medicine and Implantation Research Sugiyama Clinic Shinjuku Tokyo Japan.
Reprod Med Biol. 2024 Jan 9;23(1):e12558. doi: 10.1002/rmb2.12558. eCollection 2024 Jan-Dec.
Tacrolimus is an immunosuppressive drug that works as a calcineurin inhibitor to improve the reproductive outcomes for women who have experienced multiple implantation failures (RIF) and show elevated type 1 helper T (Th1)/Th2 cell ratios.
In the first part of this review, we indicate how we re-evaluated the cut-off index for selecting the participants in a tacrolimus regimen via transferred euploid blastocysts. In the second part, we cite cases where tacrolimus has improved the live birth rate for women who have experienced recurrent pregnancy losses (PRL) and we introduce the utility of tacrolimus treatment to prevent obstetrical complications.
After reconsideration of the cut-off index (Th1/Th2 ≥ 11.8), however, the pregnancy rates of women with tacrolimus were significantly higher than those of women without tacrolimus. The PRL women treated with tacrolimus showed significantly lower rates of biochemical pregnancy, but higher live-birth rates compared with women who were not treated with tacrolimus. Moreover, prior severe obstetrical complications could be controlled via the administration of tacrolimus during pregnancy.
Tacrolimus has become indispensable in the field of solid-organ transplantation, and in the near future, it should become an essential agent in the reproductive field, as well.
他克莫司是一种免疫抑制药物，作为钙调神经磷酸酶抑制剂，可改善经历多次植入失败（RIF）且1型辅助性T（Th1）/Th2细胞比率升高的女性的生殖结局。
在本综述的第一部分，我们指出了我们如何通过移植整倍体囊胚重新评估他克莫司治疗方案中参与者的截断指数。在第二部分，我们列举了他克莫司提高经历复发性流产（PRL）女性活产率的案例，并介绍了他克莫司治疗预防产科并发症的效用。
然而，重新考虑截断指数（Th1/Th2≥11.8）后，使用他克莫司的女性的妊娠率显著高于未使用他克莫司的女性。与未接受他克莫司治疗的女性相比，接受他克莫司治疗的PRL女性生化妊娠率显著降低，但活产率更高。此外，既往严重的产科并发症可通过孕期使用他克莫司得到控制。
他克莫司在实体器官移植领域已变得不可或缺，在不久的将来，它也应成为生殖领域的重要药物。
