Modern-day immunosuppression relies heavily on calcineurin inhibitors (CNIs) such as cyclosporine and tacrolimus. While dramatically reducing the rates of acute cellular rejection over the last couple of decades, these agents have numerous undesirable metabolic and cosmetic side effects. In the past, immunosuppression was based on small molecular therapy, including CNIs, prodrugs of mycophenolate mofetil, and these drugs had many undesirable side effects. Biological agents are now more frequently tested for immunosuppression, including monoclonal antibodies, agents that block stimulatory pathways, and specific receptors. Recent studies with the agent belatacept have shown promise in terms of eliminating CNIs and also eliminating the burden of toxicities that accompany their use.
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