Abstract：
Antibody-mediated rejection (ABMR) is a leading cause of kidney allograft failure. Its therapy continues to be challenge, and no treatment has been approved for the market thus far.
In this article, we discuss the pathophysiology and phenotypic presentation of ABMR, the current level of evidence to support the use of available therapeutic strategies, and the emergence of tailored drugs now being evaluated in systematic clinical trials. We searched PubMed, Clinicaltrials.gov and Citeline\'s Pharmaprojects for pertinent information on emerging anti-rejection strategies, laying a focus on phase II and III trials.
Currently, we rely on the use of apheresis for alloantibody depletion and intravenous immunoglobulin (referred to as standard of care), preferentially in early active ABMR. Recent systematic trials have questioned the benefits of using the CD20 antibody rituximab or the proteasome inhibitor bortezomib. However, there are now several promising treatment approaches in the pipeline, which are being trialed in phase II and III studies. These include interleukin-6 antagonism, CD38-targeting antibodies, and selective inhibitors of complement. On the basis of the information that has emerged so far, it seems that innovative treatment strategies for clinical use in ABMR may be available within the next 5-10 years.
In this article, we discuss the pathophysiology and phenotypic presentation of ABMR, the current level of evidence to support the use of available therapeutic strategies, and the emergence of tailored drugs now being evaluated in systematic clinical trials. We searched PubMed, Clinicaltrials.gov and Citeline\'s Pharmaprojects for pertinent information on emerging anti-rejection strategies, laying a focus on phase II and III trials.
Currently, we rely on the use of apheresis for alloantibody depletion and intravenous immunoglobulin (referred to as standard of care), preferentially in early active ABMR. Recent systematic trials have questioned the benefits of using the CD20 antibody rituximab or the proteasome inhibitor bortezomib. However, there are now several promising treatment approaches in the pipeline, which are being trialed in phase II and III studies. These include interleukin-6 antagonism, CD38-targeting antibodies, and selective inhibitors of complement. On the basis of the information that has emerged so far, it seems that innovative treatment strategies for clinical use in ABMR may be available within the next 5-10 years.
摘要：
抗体介导的排斥反应（ABMR）是同种异体肾移植失败的主要原因。它的治疗仍然是挑战，到目前为止，还没有批准用于市场的治疗方法。
在本文中,我们讨论了ABMR的病理生理学和表型表现，支持使用可用治疗策略的当前证据水平，以及目前正在系统临床试验中评估的定制药物的出现。我们搜索了PubMed,Clinicaltrials.gov和Citeline的Pharmaprojects，以获取有关新兴反排斥策略的相关信息，重点放在II期和III期试验上.
目前,我们依靠单采术用于同种抗体消耗和静脉免疫球蛋白（称为护理标准），优先于早期活动性ABMR。最近的系统试验质疑使用CD20抗体利妥昔单抗或蛋白酶体抑制剂硼替佐米的益处。然而,现在有几种有希望的治疗方法正在酝酿中，正在II期和III期研究中进行试验。这些包括白细胞介素-6拮抗作用，CD38靶向抗体，和选择性补体抑制剂。根据目前所掌握的资料,在未来5-10年内,ABMR临床应用的创新治疗策略可能会出现.
在本文中,我们讨论了ABMR的病理生理学和表型表现，支持使用可用治疗策略的当前证据水平，以及目前正在系统临床试验中评估的定制药物的出现。我们搜索了PubMed,Clinicaltrials.gov和Citeline的Pharmaprojects，以获取有关新兴反排斥策略的相关信息，重点放在II期和III期试验上.
目前,我们依靠单采术用于同种抗体消耗和静脉免疫球蛋白（称为护理标准），优先于早期活动性ABMR。最近的系统试验质疑使用CD20抗体利妥昔单抗或蛋白酶体抑制剂硼替佐米的益处。然而,现在有几种有希望的治疗方法正在酝酿中，正在II期和III期研究中进行试验。这些包括白细胞介素-6拮抗作用，CD38靶向抗体，和选择性补体抑制剂。根据目前所掌握的资料,在未来5-10年内,ABMR临床应用的创新治疗策略可能会出现.
