INHIBITION OF THE EFFECTS OF TNF IN RENAL-ALLOGRAFT RECIPIENTS USING RECOMBINANT HUMAN DIMERIC TUMOR-NECROSIS-FACTOR RECEPTORS

Tumor necrosis factor alpha (TNFa) and lymphotoxin (LT) or TNF beta ar e closely linked cytokines produced by macrophages and activated T lym phocytes, which play important regulatory roles in the immune response to allografts. They have also been implicated as mediators of the adv erse reactions observed during OKT3 therapy. Therefore, anti-TNF agent s could be useful both for immunosuppression and for limiting the syst emic response observed in patients receiving OKT3. Recombinant TNFR:Fc is a fusion protein that binds TNFa and LT, thereby neutralizing thei r effects in vitro. The present study investigates the potential clini cal application of TNFR:Fc in a nonhuman primate renal allograft model . Cynomolgus renal allograft recipients were treated with TNFR:Fc indu ction therapy alone or in combination with subtherapeutic doses of cyc losporine. Control animals received no immunosuppression or subtherape utic cyclosporine. TNFR:Fc, administered as the only immunosuppressive agent, successfully prolonged renal allograft survival in the majorit y of treated animals. The prolongation of allograft survival was even more impressive when TNFR:Fc was combined with subtherapeutic doses of cyclosporine. Onset of rejection was significantly delayed as well in the TNFR:Fc treated groups. No adverse side effects were observed in any of the TNFR:Fc treated animals. Precursor cytotoxic T cells were d etected in peripheral blood samples of treated recipients but the leve l of effector CTLs in vivo was below the threshold of detection. These results demonstrate that TNFR:Fc can be safely administered and is ef fective in prolonging renal allograft survival and in delaying the ons et of rejection when administered alone or in combination with cyclosp orine.