Clinical trial NCT03955172: Efficiency of Everolimus for the Treatment of Kidney Transplanted Patients Presenting a Missing Self-induced NK-mediated Rejection
Official title: Efficiency of Everolimus for the Treatment of Kidney Transplanted Patients Presenting a Missing Self-induced Natural Killer Cells Mediated (NK-mediated) Rejection
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Kidney Transplant Failure and Rejection
Keywords: Missing self
NK cells
Rejection
mTOR inhibitors
Kidney transplanted patients
Lead sponsor: Hospices Civils de Lyon
Sponsor class: OTHER
First posted: 2019-05-20
Enrollment: 20
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: TREATMENT

Brief summary: Background:

Long-term success of organ transplantation is limited by the inexorable loss of graft function due to rejection. Prevalent dogma defends that allograft rejection is exclusively mediated by the adaptive immune system: T cells are responsible for cellular rejections and B cells producing Donor Specific Antibodies (DSA) are responsible for humoral rejection. Recently, we demonstrated that innate NK cells could be implicated in the generation of chronic vascular rejections lesions by sensing the absence of expression of self Major Histocompatibility Complex (MHC) class I molecules ("missing self") on graft endothelial cells with their Killer cell immunoglobulin-like (KIR) receptors. Using human in vitro and murine in vivo models, we also showed that Mammalian Target Of Rapamycin (mTOR) inhibitors could efficiently prevent this new kind of rejection.

Objective:

The aim of our project is therefore to test in a cohort of kidney transplanted patients the efficiency of mTOR inhibitors to treat this new kind of rejection

Methods:

A cohort of 20 kidney transplant patients with a missing self on their graft responsible for a NK-mediated rejection will be established prospectively. An mTOR inhibitor will be introduced in these patients for 6 months in association with a calcineurin inhibitor and corticosteroids. Graft function, histological lesions and NK activability will be monitored following this modification of treatment.


Eligibility criteria: Inclusion Criteria:

* Patient aged \> 18 years
* Kidney transplanted patient
* Having microvascular inflammation lesion on his graft biopsy associated to mild chronic lesions
* In absence of donor specific antibodies
* In presence of a missing self

Exclusion Criteria:

* Proteinuria/urinary creatinin \> 100 mg/mmol
* Antecedent of poor tolerance or hypersensibility to everolimus or sirolimus
* Severe chronic lesions
* Presence of donor specific antibodies

Primary outcomes:
measure: Change in Estimated glomerular filtration rate
timeFrame: 6 months after start of Everolimus treatment
Secondary outcomes:
measure: Change in the severity of rejection lesions on allograft biopsy
timeFrame: 6 months after start of Everolimus treatment
measure: Change in NK cell activability
timeFrame: 6 months after start of Everolimus treatment
measure: Change in proteinuria
timeFrame: 6 months after start of Everolimus treatment
Other outcomes:
Locations:
city: Lyon
country: France
facility: Service de transplantation, néphrologie et immunologie clinique, Hôpital Edouard Herriot (HCL)
Study officials:
References: