Displaying publications 21 - 40 of 150 in total

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  1. Appraisal of immunomodulatory potential of Spirulina fusiformis: an in vivo and in vitro study
    Rasool M, Sabina EP
    J Nat Med, 2009 Apr;63(2):169-75.
    PMID: 19093070 DOI: 10.1007/s11418-008-0308-2
    In recent years, Spirulina has gained more and more attention from medical scientists as a nutraceutical and a source of potential pharmaceuticals. The present study was conducted to elucidate the immunomodulatory effect of Spirulina fusiformis (a cyanobacterium of the family Oscillatoriaceae) in vivo and in vitro. The in vivo effect of S. fusiformis (400 or 800 mg/kg body wt.) on humoral immune response, cell-mediated immune response and tumour necrosis factor alpha was investigated in mice. We also evaluated the effect of S. fusiformis (50 or 100 microg/ml) in vitro on mitogen (phytohaemagglutinin)-induced T lymphocyte proliferation in heparinized human peripheral blood. For comparison, dexamethasone was used as a standard. In mice, S. fusiformis (400 or 800 mg/kg body wt.) administration significantly inhibited the humoral immune response, cell-mediated immune response (delayed-type hypersensitivity reaction (DTH)) and tumour necrosis factor alpha in a dose-dependent manner. In vitro, S. fusiformis (50 or 100 microg/ml) decreased the mitogen (phytohaemagglutinin)-induced T lymphocyte proliferation in a concentration-dependent manner when compared with control cells. These observations clearly suggest that S. fusiformis has a remarkable immunosuppressive effect, which provides a scientific validation for the popular use of this drug, and helped us in further work on investigating its complete mechanism of action.
    Matched MeSH terms: Immunosuppressive Agents/administration & dosage; Immunosuppressive Agents/isolation & purification; Immunosuppressive Agents/pharmacology*
  2. Defining a threshold for tacrolimus intra-patient variability associated with late acute cellular rejection in paediatric kidney transplant recipients
    Abu Bakar K, Mohamad NA, Hodi Z, McCulloch T, Williams A, Christian M, et al.
    Pediatr Nephrol, 2019 12;34(12):2557-2562.
    PMID: 31520127 DOI: 10.1007/s00467-019-04346-z
    BACKGROUND: Late acute cellular rejection (LACR) is associated with poorer graft outcomes and non-adherence. Non-adherence to tacrolimus can be indirectly assessed by the intra-patient variability (IPV) of tacrolimus trough levels. The threshold of IPV associated with rejection is not known.

    METHODS: We conducted a case-control study comparing 25 patients with biopsy-proven LACR against 25 stable controls matched for age group, primary diagnosis and time post-transplant. IPV was calculated using coefficient of variance (CV) and mean absolute deviation (MAD) using tacrolimus levels in the preceding 12 months. We also assessed the percentage time for tacrolimus levels

    Matched MeSH terms: Immunosuppressive Agents/administration & dosage*; Immunosuppressive Agents/blood; Immunosuppressive Agents/pharmacokinetics
  3. Effect of diarrhoea on Tacrolimus trough level in a post liver transplant patient
    Tan ST, Yoong BK
    Med J Malaysia, 2020 11;75(6):734-735.
    PMID: 33219186
    Tacrolimus, which bonds to an immunophilin, FK506 binding protein (FKBP) has emerged as one of the most widely used immunosuppressant post solid organ transplantation. It offers excellent patient survival rates post-transplantation and a lesser number of acute rejections as compared to cyclosporine. Tacrolimus has a narrow therapeutic window with overexposure leading to acute and chronic forms of nephrotoxicity. Remarkably few data have been published on the overexposure to tacrolimus following mild diarrhoea in post-transplant patients who received treatment with tacrolimus. We observed a post-liver transplant patient with increased trough level of tacrolimus during severe diarrhoea with no complications following a timely adjustment on the dose of tacrolimus.
    Matched MeSH terms: Immunosuppressive Agents
  4. Fulltext Cyclosporine-induced gingival overgrowth in a patient with hepatitis C virus infection - a case report
    Subramaniam, U.
    Malaysian Dental Journal, 2007;28(2):103-106.
    MyJurnal
    Gingival overgrowth is a well-recognized unwanted effect associated with three major drugs / drug groups - phenytoin, cyclosporine and the calcium channel blockers. Cyclosporine is the first-choice immunosuppressant for preventing allograft rejection in patients who have received organ or bone marrow transplants. This report aims to highlight a case in which the patient on cyclosporine therapy had also contracted Hepatitis C virus infection.
    Matched MeSH terms: Immunosuppressive Agents
  5. Development of improved dosing regimens for mycophenolate mofetil based on population pharmacokinetic analyses in adults with lupus nephritis
    Abd Rahman AN, Tett SE, Abdul Gafor HA, McWhinney BC, Staatz CE
    Eur J Drug Metab Pharmacokinet, 2017 Dec;42(6):993-1004.
    PMID: 28536776 DOI: 10.1007/s13318-017-0420-3
    BACKGROUND AND OBJECTIVE: Mycophenolic acid (MPA) provides effective treatment for lupus nephritis patients. Owing to its large pharmacokinetic variability, it is questionable whether standard fixed dose therapy can achieve optimal MPA exposure. The aim of this study was to develop a population pharmacokinetic model of MPA and its metabolite, 7-O-MPA-β-glucuronide (MPAG), to identify important covariate influences and better predict patient dosing requirements.
    METHODS: MPA and MPAG concentration-time profiles were collected from 25 patients receiving mycophenolate mofetil (MMF) with or without cyclosporine (CsA) co-therapy. Samples were collected pre-dose and at 1, 2, 4, 6 and 8 h post-dose on one or two occasions.
    RESULTS: A total of 225 and 226 concentration-time measurements of MPA and MPAG, respectively, were used to develop the model, utilizing NONMEM® software. A two-compartment model with first-order absorption and elimination for MPA and a one-compartment model with first-order elimination and enterohepatic circulation (EHC) for MPAG best described the data. Apparent clearance of MPAG (CL/F MPAG) significantly decreased with reducing renal function and extent of EHC was reduced with concomitant CsA use. Simulations using the final model showed that a 70-kg subject with a creatinine clearance of 90 mL/min receiving concomitant CsA would require 1.25 g of MMF twice daily while a similar subject who did not receive concomitant CsA would require 0.75 g twice daily to achieve a MPA area under the concentration-time curve from 0 to 12 h (AUC0-12) of 45 mg·h/L.
    CONCLUSION: A 'tiered' dosing approach considering patient renal function and CsA co-therapy, rather than a 'one dose fits all' approach, would help individualize MMF therapy in adult lupus nephritis patients to ensure more patients have optimal MPA exposure.
    Study site: Nephrology and Systemic Lupus Erythematosus (SLE) Clinics, Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM), Kuala Lumpur, Malaysia
    Matched MeSH terms: Immunosuppressive Agents/blood; Immunosuppressive Agents/pharmacokinetics; Immunosuppressive Agents/therapeutic use
  6. Fulltext Safety and efficacy of two tacrolimus formulations (Prograf® and Advagraf®) in Malaysian renal transplant patients: a comparative study
    Mac Guad, R., Zaharan, N.L., Wan Md Adnan, W.A.H., Gan, S.H., Chik, Z.,
    JUMMEC, 2019;22(1):20-26.
    MyJurnal
    Aim: A once-daily formulation of tacrolimus, Advagraf®, is increasingly being used in place of twice-daily
    tacrolimus, Prograf®, as a standard immunosuppressive agent for transplant patients. In this study, the
    clinical safety and efficacy of Advagraf® were compared with Prograf®, among multi-ethnic Malaysian renal
    transplanted population.

    Method: This retrospective study identified renal transplant patients who were converted from Prograf® to
    Advagraf® at the University Malaya Medical Centre (UMMC) (n=69). Clinical notes and laboratory records,
    including tacrolimus daily dose and trough levels, were obtained for one-year, pre-and post-conversion. Causality
    assessment of suspected adverse events were based on the WHO-Uppsala Monitoring Center criteria. Renal
    biopsy records were re-evaluated based on the updated Banff 2007 classification for biopsy-confirmed acute
    rejection (BPAR).

    Results: Following conversion to Advagraf®, the mean tacrolimus trough level and daily dose decreased
    significantly (p
    Matched MeSH terms: Immunosuppressive Agents
  7. Fulltext Asian Pacific Association of Gastroenterology (APAGE) Inflammatory Bowel Disease (IBD) Working Party guidelines on IBD management during the COVID-19 pandemic
    Ling KL, Hilmi I, Raja Ali RA, Leong RWL, Leung WK, Ng SC, et al.
    JGH Open, 2020 Jun;4(3):320-323.
    PMID: 32514431 DOI: 10.1002/jgh3.12362
    The COVID-19 pandemic, secondary to SARS-CoV-2, has resulted in high mortality and morbidity worldwide. As inflammatory bowel disease (IBD) is a chronic disease, and most patients are on long-term immunosuppressive agents, there is understandable concern, particularly in terms of therapy. In view of this, experts in IBD across the Asia Pacific region were invited to put together recommendations based on their experience and the currently available data. In general, most IBD therapies (with a few exceptions) can be continued safely, and the general consensus is that maintaining disease control should remain the main principle of management. In addition, social distancing measures and the appropriate use of personal protective equipment should be strictly adhered to. During the current pandemic, face-to-face clinic follow ups and non-urgent procedures should be kept to a minimum.
    Matched MeSH terms: Immunosuppressive Agents
  8. Fulltext Enhanced immunosuppressive effects of 3,5-bis[4(diethoxymethyl)benzylidene]-1-methyl-piperidin-4-one, an α, β-unsaturated carbonyl-based compound as PLGA-b-PEG nanoparticles
    Arshad L, Jantan I, Bukhari SNA
    Drug Des Devel Ther, 2019;13:1421-1436.
    PMID: 31118577 DOI: 10.2147/DDDT.S185191
    Background: 3,5-Bis[4-(diethoxymethyl)benzylidene]-1-methyl-piperidin-4-one (BBP), a novel synthetic curcumin analogue has been revealed to possess strong in vitro and in vivo immunosuppressive effects. Purpose: The aim of present study was to prepare and characterize BBP-encapsulated polylactic-co-glycolic acid-block-polyethylene glycol (PLGA-b-PEG) nanoparticles and to evaluate its in vivo efficacy against innate and adaptive immune responses. Methods: Male BALB/c mice were orally administered with BBP alone and BBP- encapsulated nanoparticles equivalent to 5, 10 and 20 mg/kg of BBP in distilled water for a period of 14 days. The immunomodulatory potential was appraised by determining its effects on non-specific and specific immune parameters. Results: The results showed that BBP was successfully encapsulated in PLGA-b-PEG polymer with 154.3 nm size and high encapsulation efficiency (79%) while providing a sustained release for 48 hours. BBP nanoparticles showed significant enhanced dose-dependent reduction on the migration of neutrophils, Mac-1 expression, phagocytic activity, reactive oxygen species (ROS) production, serum levels of ceruloplasmin and lysozyme, immunoglobulins and myloperoxidase (MPO) plasma levels when compared to unencapsulated BBP. Enhanced dose-dependent inhibition was also observed on lymphocyte proliferation along with the downregulation of effector cells expression and release of cytokines, and reduction in rat paw oedema in BBP nanoparticles treated mice. At higher doses the suppressive effects of the BBP nanoparticles on various cellular and humoral parameters of immune responses were comparable to that of cyclosporine-A at 20 mg/kg. Conclusion: These findings suggest that the immunosuppressive effects of BBP were enhanced as PLGA-b-PEG nanoparticles.
    Matched MeSH terms: Immunosuppressive Agents/chemical synthesis; Immunosuppressive Agents/pharmacology*; Immunosuppressive Agents/chemistry
  9. Are we ready for combination therapy in moderate-to-severe ulcerative colitis?
    Lee YY, Gangireddy V, Khurana S, Rao SS
    Gastroenterology, 2014 Aug;147(2):544.
    PMID: 24976027 DOI: 10.1053/j.gastro.2014.03.053
    Matched MeSH terms: Immunosuppressive Agents/therapeutic use*
  10. Fulltext Missed perforation presenting as sympathetic ophthalmia in an adolescent Malay girl
    Bastion ML, Mohamad MH
    BMJ Case Rep, 2012;2012.
    PMID: 22914237 DOI: 10.1136/bcr-2012-006525
    To describe the rare presentation of sympathetic ophthalmia in a teenage girl with no previous known ocular injury.
    Matched MeSH terms: Immunosuppressive Agents/therapeutic use
  11. Use of prednisolone to aid propagation of Toxoplasma gondii in mice
    Puvanesuaran VR, Nowroji K, Sreenivasan S, Noordin R, Balakrishnan V
    Eur Rev Med Pharmacol Sci, 2012 Aug;16(8):1028-32.
    PMID: 22913152
    AIM: To determine the usefulness of prednisolone in increasing the number of Toxoplasma (T.) gondii tachyzoites and bradyzoites in mice.
    MATERIALS AND METHODS: The mice were water-fasted prior to being immunosuppressed with oral inoculation of prednisolone. Tachyzoites of 7T gondii RH strain were inoculated into mice and the number of the parasites in the intraperitoneal fluids was then determined at 96 hs post-infection. In addition, tachyzoites of T. gondii ME49 strains were orally introduced into mice and the number of brain cysts formed was observed by microscopic observation at 45 days post-infection.
    RESULTS: T. gondii propagation was found to be significantly improved by introduction of the prednisolone (p = 0.0004); and the number of parasite showed positive correlation with the increment in dosage of prednisolone (r = 0.9051).
    CONCLUSIONS: The use of prednisolone greatly improved the number of parasite formed in mice: both tachyzoite and cyst forms.
    Matched MeSH terms: Immunosuppressive Agents/pharmacology*
  12. Oral lichen planus and lichenoid reactions: etiopathogenesis, diagnosis, management and malignant transformation
    Ismail SB, Kumar SK, Zain RB
    J Oral Sci, 2007 Jun;49(2):89-106.
    PMID: 17634721
    Lichen planus, a chronic autoimmune, mucocutaneous disease affects the oral mucosa (oral lichen planus or OLP) besides the skin, genital mucosa, scalp and nails. An immune mediated pathogenesis is recognized in lichen planus although the exact etiology is unknown. The disease most commonly affects middle-aged females. Oral lichenoid reactions (OLR) which are considered variants of OLP, may be regarded as a disease by itself or as an exacerbation of an existing OLP, by the presence of medication (lichenoid drug reactions) or dental materials (contact hypersensitivity). OLP usually presents as white striations (Wickham's striae), white papules, white plaque, erythema, erosions or blisters. Diagnosis of OLP is established either by clinical examination only or by clinical examination with histopathologic confirmation. Direct immunofluorescence examination is only used as an adjunct to the above method of diagnosis and to rule out specific autoimmune diseases such as pemphigus and pemphigoid. Histopathologic features of OLP and OLR are similar with suggestions of certain discriminatory features by some authors. Topical corticosteroids are the treatment of choice for OLP although several other medications have been studied including retinoids, tacrolimus, cyclosporine and photodynamic therapy. Certain OLP undergo malignant transformation and the exact incidence and mechanisms are still controversial. In this paper, etiopathogenesis, diagnosis, management and malignant transformation of OLP and OLR have been reviewed.
    Matched MeSH terms: Immunosuppressive Agents/therapeutic use
  13. Post renal transplant Castleman's disease resolved after graft nephrectomy: a case report
    Al Otaibi T, Al Sagheir A, Ludwin D, Meyer R
    Transplant Proc, 2007 May;39(4):1276-7.
    PMID: 17524952
    Angiofollicular lymphoid hyperplasia (Castleman's disease) is a lymphoproliferative process thought to be mediated by overexpression of II interleukin-6. Castleman's disease has two variants: Castleman's disease has two variants: Hyaline vascular type and plasma cell variant (multicentric Castleman's disease). The hyaline vascular type tends to be localized, and the plasma cell variant shows more systematic signs and carriers a worse clinical prognosis. Castleman's disease is associated with B-cell lymphoma, Kaposi sarcoma, Human herpes virus 8 (HHV-8), and Epstein-Barr virus. Castleman's disease have been described thrice post kidney transplant. In this report, we document the course of a renal recipient who developed the plasma cell variant of Castleman's disease at 16 months after failure of his allograft and return to dialysis. He displayed clinical resolution of this complication after graft nephrectomy. To our knowledge, this is the first case where the disease manifestations disappeared after graft removal. Our patient experienced chronic renal allograft rejection which may have driven all the systematic manifestations of multicentric castleman's disease and possibly reactivated a latent HHV-8 infection. In this case immunohistochemical testing for HHV-8 was not available to prove a role for this agent.
    Matched MeSH terms: Immunosuppressive Agents/therapeutic use
  14. Fulltext The use of mycophenolate mofetil in treating patients with non responding aplastic anemia
    Gan GG, Leong CF, Sangkar JV, Teh A, Goh KY, Cheong SK
    Med J Malaysia, 2005 Aug;60(3):311-3.
    PMID: 16379185
    Aplastic anemia is a relatively uncommon disease and conventional management options include immunosuppressive drugs and/or haematopoeitic stem cell transplantation. It is now known that the pathogenesis of aplastic anemia is immune mediated. Mycophenolate mofetil is a common immunosuppressive drug now used mainly in prophylaxis of graft rejection in organ transplant and also for prevention/treatment for graft versus host disease in haemtopoeitic stem cell transplantation. It is thought that mycophenolate mofetil may be useful in this group of patients. In this short report, mycophenolate mofetil was tried in 6 patients who had severe aplastic anemia with variable doses for a minimum duration of 9 months. The result has however not been encouraging.
    Matched MeSH terms: Immunosuppressive Agents/administration & dosage*
  15. Cyclosporine rescue therapy in autoimmune liver cirrhosis: a case report
    Wah-Kheong C, Jaganathan V, Sanjiv M
    Turk J Gastroenterol, 2012;23(5):599-603.
    PMID: 23161309
    Autoimmune hepatitis is an inflammatory condition of the liver that can lead to significant morbidity and mortality. Corticosteroids with or without azathioprine have been shown to improve outcome and are the current standard of care in autoimmune hepatitis patients. However, long-term use of corticosteroids and use of azathioprine could be associated with significant adverse effects that prevent their continued use at optimal dosages or may even require complete cessation. We present a patient with autoimmune liver cirrhosis who was intolerant of corticosteroid and azathioprine, who was successfully treated with cyclosporine. To our knowledge, cyclosporine use has not been reported previously in autoimmune cirrhosis, although it has been used in autoimmune hepatitis patients with reported success and good tolerability. We conclude that cyclosporine seems to be an effective alternative to azathioprine as a steroid-sparing agent in both non-cirrhotic and cirrhotic autoimmune hepatitis.
    Matched MeSH terms: Immunosuppressive Agents/administration & dosage
  16. Haemophagocytic lymphohistiocytosis in Malaysian children
    Ariffin H, Lum SH, Cheok SA, Shekhar K, Ariffin WA, Chan LL, et al.
    J Paediatr Child Health, 2005 Mar;41(3):136-9.
    PMID: 15790325
    To study the clinical presentation, therapy and outcome of children diagnosed with both primary and secondary haemophagocytic lymphohistiocytosis (HLH) at the University of Malaya Medical Centre.
    Matched MeSH terms: Immunosuppressive Agents/therapeutic use*
  17. Cyclosporine-associated encephalopathy: a case report and literature review
    Chang SH, Lim CS, Low TS, Chong HT, Tan SY
    Transplant Proc, 2001 12 26;33(7-8):3700-1.
    PMID: 11750577
    Matched MeSH terms: Immunosuppressive Agents/adverse effects*
  18. Fulltext Outcome of 85 lupus nephritis patients treated with intravenous cyclophosphamide: a single centre 10 year experience
    Chan AYK, Hooi LS
    Med J Malaysia, 2000 Mar;55(1):14-20.
    PMID: 11072485
    Retrospective analysis was done on 85 patients (76 female, 9 male) with lupus nephritis who started intravenous cyclophosphamide between 1/1/1989 and 31/12/1998. The initial renal biopsy (World Health Organisation) classification was III (4.7%), IV (89.4%) and V (5.9%). Average serum creatinine at time of biopsy was 0.12 +/- 0.12 mmol/l. Median duration of nephritis before biopsy was 2 months (range 0-133). Median duration of follow-up from time of biopsy to outcome (death or end-stage renal failure) was 3.3 years (range 0.3-11.8). Nineteen patients died. The calculated proportion alive at 5 years was 75% and at 10 years 64%. The calculated proportion alive with renal function was 74% and 54% at 5 and 10 years respectively. Fifty-two patients completed cyclophosphamide therapy at the end of the study. There were ten episodes of herpes zoster, the most common infection seen. No malignancy was reported.
    Matched MeSH terms: Immunosuppressive Agents/therapeutic use*
  19. Pneumocystis carinii pneumonia in patients with systemic lupus erythematosus
    Liam CK, Wang F
    Lupus, 1992 Dec;1(6):379-85.
    PMID: 1304406 DOI: 10.1177/096120339200100607
    At the University Hospital, Kuala Lumpur, Malaysia, nine patients with systemic lupus erythematosus (SLE) were treated for Pneumocystis carinii pneumonia (PCP) between January 1987 and December 1988. When they developed PCP all the patients' SLE disease course was active and eight of them were on prednisolone. Four of these eight patients were also receiving cyclophosphamide. Patients who were on more intensive immunosuppressive therapy were found to develop more severe PCP. All the patients except one were treated with high-dose cotrimoxazole. Four patients responded to antipneumocystis treatment and survived, while PCP was responsible for the death of the five non-survivors.
    Matched MeSH terms: Immunosuppressive Agents/adverse effects
  20. Immunosuppressive effects of the standardized extract of Zingiber zerumbet on innate immune responses in Wistar rats
    Ghazalee NS, Jantan I, Arshad L, Haque MA
    Phytother Res, 2019 Apr;33(4):929-938.
    PMID: 30618097 DOI: 10.1002/ptr.6285
    Zingiber zerumbet rhizome has been used in traditional medicine mainly for the treatment of various immune-inflammatory related ailments and has been shown to exhibit a wide spectrum of biological effects especially antioxidant and anti-inflammatory activities. The present study was aimed to investigate the immunosuppressive effects of the standardized 80% ethanol extract of Z. zerumbet at 100, 200, and 400 mg/kg on the innate immune responses in male Wistar rats. The immune parameters determined were chemotaxis of neutrophils, Mac-1 expression, engulfment of Escherichia coli by neutrophils, reactive oxygen species production, and plasma lysozyme and ceruloplasmin levels. Zerumbone was qualitatively and quantitatively determined in the extract by using a validated reversed-phase HPLC, whereas liquid chromatography tandem-mass spectrometry (LC -MS/MS) was used to profile the secondary metabolites. Z. zerumbet significantly inhibited the migration of neutrophils, expressions of CD11b/CD18 integrin, phagocytic activity, and production of reactive oxygen species in a dose-dependent manner. The extract also dose-dependently inhibited the expressions of lysozyme and ceruloplasmin in the rat plasma. Z. zerumbet extract possessed strong inhibitory effects on the innate immune responses and has potential to be developed into an effective immunosuppressive agent.
    Matched MeSH terms: Immunosuppressive Agents/pharmacology*
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