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Introduction Solid-organ transplantation (SOT) remains the best therapeutic option for end-stage organ disease. Regrettably, SOT recipients are disproportionately affected by nosocomial infections produced by multidrug-resistant (MDR) microorganisms and antimicrobial adverse events. Both have a negative impact on the patient´s outcome. Methods Description of data concerning the antimicrobial stewardship program (ASP) in SOT recipients of the University Hospital “12 de Octubre”, and review of...

Lymphocyte depletion and blockade of T-cell activation and trafficking serve as therapeutic strategies for an enlarging number of immune-mediated diseases and malignancies. This review summarizes the infection risks associated to monoclonal antibodies that bind to the α chain of the interleukin-2 receptor, the cell surface glycoprotein CD52, and members of α4- and β2-integrin families acting as cell-adhesion molecules. An outline of the mechanisms of action, approved indications and...

The role of the structurally related interleukin-(IL) 12 and IL-23, as key drivers of Th1 and Th17 differentiation, in the pathogenesis of inflammatory chronic conditions has led to the development of various monoclonal antibodies targeted either at the common p40 subunit shared both cytokines (ustekinumab) or at the IL-23-specific p19 subunit (guselkumab, tildrakizumab, and risankizumab). These IL-12/23-targeted agents are currently approved for the treatment of plaque psoriasis, psoriatic...

Solid organ transplantation (SOT) is the best treatment option for end-stage organ disease. Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection, particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis. Active tuberculosis (TB) after SOT is a significant cause of morbidity and mortality. Most cases of posttransplant TB are secondary to reactivation of latent...

This chapter is focused on the agents targeting lymphoid and myeloid cell surface antigens CD22, CD30, CD33, CD38, CD40, SLAMF-7 (CD319), and CCR-4. Over the past 20 years, many monoclonal antibodies targeting these antigens have been developed and introduced into clinical practice. Many of them are used successfully for the treatment of leukemia, lymphoma, multiple myeloma, and systemic autoimmune diseases (e.g. systemic lupus erythematosus, Sjogren’s syndrome) both in monotherapy and in...

Agents targeting the CD19, CD20 and CD52 surface antigens on lymphoid cells have been increasingly used in the past three decades in various haematologic, rheumatologic and autoimmune diseases. The impact these agents have on the immune system and their consequent infectious complications depend on the agent, dose, underlying disease and concomitant or previous immunosuppressive treatments.

Sphingosine-1-phosphate receptor (S1PR) modulators have and are being evaluated for numerous conditions. To date, the main indication of this group of drugs is for multiple sclerosis (MS). Multiple sclerosis is a chronic inflammatory disease of the central nervous system (CNS) leading to demyelination and neurodegeneration. Therapeutic approaches are focused on both inflammation and neurodegeneration that are present from early stages of the disease. Sphingosine-1-phosphate receptor (S1PR)...

Tumor necrosis factor-α (TNF-α) plays a central role in the immunopathogenesis of a wide variety of inflammatory conditions from diseases such as rheumatoid arthritis to inflammatory bowel diseases. Development of TNF-α inhibitors (TNFI) has revolutionized the ability to treat these conditions, resulting in substantial improvement in clinical outcomes. Since the introduction of infliximab and etanercept in 1998, indications for the use of TNFI have expanded, and these medications are...

This review aims to analyze, from an infectious disease perspective, the safety profile of antineoplastic therapies targeting cell surface receptors and associated signaling pathways among cancer patients and to suggest recommendations.

Small-molecule inhibitors have revolutionized the treatment of cancer and autoimmune disease. Inhibitors of the mammalian target of rapamycin (mTOR), Janus kinases (JAK), and B-cell lymphoma-2 (BCL-2) are three of the most successful therapeutics developed. They target intracellular signaling pathways involved in cell survival, proliferation, and metabolism, processes that are frequently dysregulated in autoimmunity and neoplasia. The inhibition of such pathways also affects physiological...

Introduction and Aims: Inhibition of the IL-1 pathway has been the target of treatments for several inflammatory conditions. This clinical review aims to summarize the risk of infectious complications associated with the use of interleukin-1 (IL-1) targeted therapy.

IL-6 has a key role in supporting immunocompetent responses to all type of infections, especially bacterial events. Agents targeting IL-6 and/or its receptor may result in severe and potentially life-threatening infections with significant discrepancy in both clinical and laboratory markers. Current evidence on the infection risk associated with the use of IL-6 or IL-6R-targeted agents consists mostly of studies including patients treated for a chronic autoimmune condition, such as...

Tyrosine kinases inhibitors (TKIs) are small molecules that have been developed as targeted therapies for various medical conditions. They act specifically on tyrosine kinases, a family of membrane-bound or intracellular molecules that regulate a variety of important cellular functions. TKIs have emerged as treatment for hematologic malignancies and autoimmune diseases. Each class of TKI has unique features and often acts on a specific receptor, minimizing the risk of adverse effects and...

Integrins are transmembrane receptors that play a key role in cell adhesion and intracellular signaling. Leukocyte integrins are essential for the recruitment of leukocytes from the vasculature to the tissues and are used as therapeutic targets to modulate inflammation. The monoclonal antibody natalizumab targets the α4 subunit of α4β1 and α4β7 integrins, implicated in the entry of lymphocytes in the central nervous system (CNS) and the gut mucosa, respectively. These integrins are involved...

Immune costimulatory checkpoints are crucial in regulating both lymphocyte activation and function. They also serve a major role in foreign antigen specificity and self-tolerance. The two major families of checkpoint inhibitors target the CTLA-4/B7s and the PD-1/PD-L1 axis. Inhibition of either of these two pathways intends to enhance the antitumor activity of lymphocytes. The risk of infections associated with checkpoint inhibition can be explained by two major mechanisms: the use of...

Chimeric antigen receptor (CAR) T cells targeting the B-cell-specific antigen, CD19, has revolutionized the management and prognosis of patients with relapsing/refractory B-cell malignancies. Such patients often present immunosuppressed due to previous treatments and baseline malignancy. Lymphodepletion chemotherapy is administered prior to CAR T therapy, causing profound cytopenias and mucositis. Cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome...

Infection is a common complication in kidney transplant recipients (KTRs). The usefulness of antimicrobial stewardship programs (ASP) and hospital-acquired infection control (HAIC) initiatives in the general inpatient population is well established. We performed a quasi-experimental study to evaluate a joint ASP/HAIC initiative focused on KTRs. A dedicated ASP team optimized antimicrobial prescriptions in consecutive KTRs during the intervention period (June 2015-March 2016). A multifaceted,...

Background Liver transplantation is increasing worldwide with underlying pathologies dominated by metabolic and alcoholic diseases in developed countries. Methods We provide a narrative review of invasive aspergillosis (IA) in liver transplant (LT) recipients. We searched PubMed and Google Scholar for references without language and time restrictions. Results The incidence of IA in LT recipients is low (1.8%), while mortality is high (∼50%). It occurs mainly early (<3 months) after LT. Some...