OKT3-associated adverse reactions: mechanistic basis and therapeutic options

Am J Kidney Dis. 1989 Nov;14(5 Suppl 2):39-44.

Abstract

OKT3, a prototypic monoclonal antibody directed at the lineage-specific CD3 antigen expressed on mature T cells, is an effective immunosuppressant in organ graft recipients. Unfortunately, a variety of adverse reactions are observed following the first and second doses of OKT3. In a series of experiments designed to examine the signaling repertoire of OKT3, it was found that (1) OKT3 is an effective substitute for the alloantigen stimulus in the activation of antigen-specific memory T cells; (2) OKT3 is a potent inducer of cytolytic activity (secondary cytotoxic T-cell activity as well as natural killer-cell activity); (3) OKT3 is also an inducer of interleukin-2 and interferon gamma production; and (4) of the immunosuppressants currently in clinical use, cyclosporine greater than methylprednisolone greater than 6-mercaptopurine (an in vivo cleavage product of azathioprine) in curtailing T-cell activation with OKT3. Collectively, these observations suggest a potential mechanistic basis for the adverse reactions associated with OKT3 and provide experimental support for therapeutic strategies that include the use of cyclosporine and/or methylprednisolone before OKT3 administration.

MeSH terms

  • Antibodies, Monoclonal / adverse effects*
  • Antigens, CD / immunology
  • Humans
  • Immunologic Memory
  • Immunosuppression Therapy*
  • Immunosuppressive Agents / pharmacology
  • In Vitro Techniques
  • Interferon-gamma / immunology
  • Interleukin-2 / immunology
  • Killer Cells, Natural / immunology
  • Lymphocyte Activation / immunology*
  • Lymphocyte Culture Test, Mixed
  • Muromonab-CD3
  • T-Lymphocytes / immunology*
  • T-Lymphocytes, Cytotoxic / immunology

Substances

  • Antibodies, Monoclonal
  • Antigens, CD
  • Immunosuppressive Agents
  • Interleukin-2
  • Muromonab-CD3
  • Interferon-gamma