Treatment of Chronic Allograft Nephropathy at Late Stages Using Everolimus or FTY720 in Combination With Cyclosporine

Abstract Objective In this study, we used combined treatment with cyclosporine (CsA)/everolimus (EVR) or CsA/FTY720 to affect ongoing chronic allograft nephropathy (CAN) compared with monotherapy with EVR or FTY720. Background CAN is an important cause of renal allograft loss. Immunosuppressive therapy is based on calcineurin inhibitors, which are associated with nephrotoxicity and decreasing graft function. Thus, alternative treatment regimens, including new immunosuppressants, such as EVR or FTY720, are of interest. We asked whether the combination of CsA with EVR or FTY720 ameliorated the development of CAN more effectively than monotherapy with EVR and/or FTY720 during the later stages of CAN. Methods Kidneys from Fisher rats were orthotopically transplanted into Lewis rats. Animals received CsA (1.5 mg/kg/d) for the first 10 days after transplantation. Animals were assigned to 6 groups: EVR (0.5 mg/kg/d), FTY720 (0.5 mg/kg/d), CsA (1.5 mg/kg/d), CsA+EVR (1.5 + 0.5 mg/kg/d), CsA+FTY720 (1.5 + 0.5 mg/kg/d), and vehicle (VEH). Treatment started at week 20. The observation period ended after 28 weeks. Results Treatment with EVR and FTY720 reduced proteinuria and glomerulosclerosis, suppressed lymphocyte and macrophage infiltration, and resulted in a greater number of apoptotic tubular and interstitial cells compared with the combined treatment groups and controls. Conclusion Although EVR and FTY720 monotherapy delayed the progression of CAN, their combination with CsA had no beneficial effect.