Anticorps monoclonaux en transplantation

Abstract

Dans les années 1970, les anticorps polyclonaux antilymphocytes ont démontré leur efficacité en transplantation. Puis, après leur découverte par Kohler et Milstein en 1975, les anticorps monoclonaux (Acm) ont été utilisés pour affiner la spécificité de l’immunosuppression. Certains ont connu un développement clinique et font désormais partie de l’arsenal thérapeutique. Beaucoup d’autres sont encore en développement et ont pour ambition de se substituer à l’immunosuppression pharmacologique en induisant des mécanismes de régulation immunologique.

Polyclonal anti-lymphoyctes antibodies were first successfully used in the 1970 in organ transplantation, but ten years later, monoclonal antibodies (mAb) emerged as a new class of immunosuppressive agents in transplantation with the potential to target highly specifically immune cells responsible for acute rejection. Some have proved their efficacy, such as mAb recognizing CD3- and CD25-positive T cells and have been extensively studied in clinical trials. Others such as mAb against CD52 and CD20, are still under investigation; finally, the next challenge is, based on our improved understanding of the mechanisms of immune recognition and allograft rejection, to use these mAb either alone or in combination with standard immunosuppressive regimens to manipulate the allogenic response to reach antigen-specific tolerance desired in solid-organ transplantation.