The Question
A 42-year old man received a living, unrelated donor kidney
transplant six months ago for IgA nephropathy. An acute rejection episode
within the first month resolved with corticosteroid therapy. He received
valganciclovir for CMV
prophylaxis for four
months. His current immunosuppression regimen is tacrolimus, mycophenolate
mofetil, and prednisone. The patient feels well, but serum creatinine has risen
from 1.4 mg/dL to 2.0 mg/dL during the past two weeks. He returns to your
office today for follow-up.
On examination,
afebrile, pulse rate is 80 per minute, and blood pressure is 146/90 mm Hg. The
kidney allograft is nontender to palpation.
Laboratory Studies
Serum creatinine: 2.2 mg/dL
Whole blood tacrolimus (trough) 8 ng/mL (therapeutic: 6-10)
Urinalysis: 1+ protein; 10-15 WBCs, 5-10 tubular epithelial
cells/hpf
Ultrasonography shows a normal allograft and vessels; no
obstruction is seen.
Biopsy reveals an interstitial lymphocytic infiltrate.
Which of the following
additional tests of the biopsy specimen is most appropriate?
A. Immunostaining for IgA deposition
B. Immunostaining for polyomavirus (BK type)
C. Immunostaining for CD4 and CD8 quantitation
D. Polymerase chain reaction assay for CMV
E. In situ hybridization for TGF-β expression
(Source: Dr. Brad Denker, Beth Israel Deaconess Medical Center/Harvard Medical School)
B. Immunostaining for polyomavirus (BK type)
ReplyDeleteTypes of molecular targeted therapy
ReplyDeleteThe reason why the molecular targeted therapy be closely watched, and cause researchers' interest, because it change the characteristics of the tumor cells as a target at the same time play a stronger anti-tumor activity, less toxic to normal cells side effects. This targeted treatment for cancer treatment indicate a new direction.
According to the target and the nature of the role of drugs, the major molecular targeted therapy drugs are divided into the following categories:
1 small molecule epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors, such as gefitinib imatinib (Gefitinib, Iressa, Iressa); erlotinib (Erlotinib, Tarceva);
(2) anti-EGFR monoclonal antibody, cetuximab (Cetuximab, Erbitux);
Anti-HER-2 monoclonal antibody, such as Herceptin (Trastuzumab Herceptin);
4.Bcr-ABL tyrosine kinase inhibitors such as imatinib (Imatinib);
Vascular endothelial growth factor receptor inhibitors, such as Bevacizumab (Avastin Avastin), Endostar;
6 anti-CD20 monoclonal antibody, rituximab (Rituximab);
7.IGFR-1 kinase inhibitors, such as NVP-AEW541;
8.mTOR kinase inhibitors, such as CCI-779;
Ubiquitin - proteasome inhibitor, bortezomib (bortezomib, Velcade);
10, such as Aurora kinase inhibitors, histone deacetylases (HDACs) inhibitors.
Medchemexpress Can provide the above product,its website:www.medchemexpress.com
Tandutinib
KW-2449
Quizartinib
AST 487
Linifanib
Canertinib
Canertinib dihydrochloride
CP-724714 (E-Double bond)
2-Methoxyestradiol
GSK1904529A