Bio

Clinical Focus


  • Hepatobiliary Surgery
  • Cancer of Biliary Tract
  • Portal Hypertension
  • Live-donor Liver Transplantation
  • General Surgery
  • Kidney and Pancreas Transplantation
  • Intestinal Transplantation
  • Pediatric Transplantation
  • Liver Transplantation
  • Cancer, Liver

Academic Appointments


Honors & Awards


  • Fellow, American College of Surgeons (2000-present)

Professional Education


  • Internship:Cornell University Medical College (1992) NY
  • Fellowship:University of Pittsburgh Medical Center (1997) PA
  • Board Certification: General Surgery, American Board of Surgery (1995)
  • Residency:Texas Tech University (1994) TX
  • Medical Education:University of Oklahoma (1989) OK

Research & Scholarship

Current Research and Scholarly Interests


Tolerance induction in liver transplantation.
Hepatocyte transplantation.

Clinical Trials


  • PII of SBRT & Chemo for Unresectable Cholangiocarcinoma Followed by Liver Transplantation Not Recruiting

    The purpose of this study is to determine progression-free survival at 12 months for stereotactic body radiotherapy (SBRT) and chemotherapy for unresectable hilar cholangiocarcinoma (CCA). Investigators hope to learn more about neoadjuvant SBRT and chemotherapy for unresectable CCA, and if SBRT followed by chemotherapy can lead to successful liver transplantation. This knowledge is important for this patient group as this disease is a highly lethal malignancy that often presents as unresectable, however surgery or transplantation are the only curative options.

    Stanford is currently not accepting patients for this trial. For more information, please contact Laurie Ann Columbo, (650) 736 - 0792.

    View full details

Teaching

2013-14 Courses


Publications

Journal Articles


  • Pediatric combined heart-liver transplantation performed en bloc: A single-center experience PEDIATRIC TRANSPLANTATION Hill, A. L., Maeda, K., Bonham, C. A., Concepcion, W. 2012; 16 (4): 392-397

    Abstract

    Pediatric CHLT is rarely performed in transplant centers and even fewer are performed en bloc. In the hands of an experienced surgeon with the appropriate patient selection, CHLT performed en bloc may have several operative and immunologic benefits, thereby resulting in improved outcomes for the transplant recipient. A single-institutional, retrospective review from 1/1/06 to 12/31/10 was conducted. Three pediatric patients with end-stage heart and liver disease who were considered low immunologic risk were included. All were managed by the same surgeon with a herein-described CHLT donor and recipient operation. Data were collected on patient and graft survival, rejection episodes, infectious complications, operative time, intraoperative transfusion requirements, and immunosuppression regimens. One-yr patient and graft survival rates were 100%. No patients experienced antibody-mediated or cell-mediated rejection. No patients had postoperative infections, and all patients were free of opportunistic infections at one-yr post-transplant. All patients were maintained safely on steroid-free immunosuppression. There were no intraoperative complications. In pediatric end-stage heart and liver disease patients with low immunologic risk, it is reasonable to proceed with en bloc CHLT so long as there is an experienced surgeon to perform the case. This offers operative and immunologic advantages to the recipient while maintaining equivalent, if not improved, recipient and graft outcomes.

    View details for DOI 10.1111/j.1399-3046.2012.01695.x

    View details for Web of Science ID 000303998800024

    View details for PubMedID 22583978

  • Portal Venous Remodeling After Endovascular Reduction of Pediatric Autogenous Portosystemic Shunts JOURNAL OF VASCULAR AND INTERVENTIONAL RADIOLOGY Stewart, J. K., Kuo, W. T., Hovsepian, D. M., Hofmann, L. V., Bonham, C. A., Sze, D. Y. 2011; 22 (8): 1199-1205

    Abstract

    Patients with autogenous native vessel portosystemic shunts, whether surgical or congenital, may experience complications of excess shunt flow, including hepatopulmonary syndrome (HPS), hepatic encephalopathy (HE), and hepatic insufficiency. The authors explored endovascular reduction or occlusion of autogenous portosystemic shunts using methods commonly employed in transjugular intrahepatic portosystemic shunt (TIPS) reduction in four pediatric patients. Before treatment, the patients had hypoplastic, atrophic, or thrombosed portal veins. Following intervention, symptoms of overshunting resolved or improved in all patients without major complications. The innate plasticity of the pediatric portal venous system allowed for hypertrophy or development and maturation of cavernous transformations to accommodate increased hepatopetal blood flow and pressure.

    View details for DOI 10.1016/j.jvir.2011.01.438

    View details for Web of Science ID 000293482700020

    View details for PubMedID 21801995

  • Hepatic Epithelioid Hemangioendothelioma DIGESTIVE DISEASES AND SCIENCES Liu, Y. I., Brown, S. S., Elihu, A., Bonham, C. A., Concepcion, W., Longacre, T. A., Kamaya, A. 2011; 56 (2): 303-306

    View details for DOI 10.1007/s10620-010-1470-4

    View details for Web of Science ID 000286664900006

    View details for PubMedID 21053076

  • Hepatic Arteriovenous Malformations from Hereditary Hemorrhagic Telangiectasia: Treatment with Liver Transplantation DIGESTIVE DISEASES AND SCIENCES Lee, M., Sze, D. Y., Bonham, C. A., Daugherty, T. J. 2010; 55 (11): 3059-3062

    View details for DOI 10.1007/s10620-010-1353-8

    View details for Web of Science ID 000283300400008

    View details for PubMedID 20844961

  • Fulminant Clostridium difficile Colitis in a Post-Liver Transplant Patient DIGESTIVE DISEASES AND SCIENCES Lee, M., Shelton, A. A., Concepcion, W. L., Bonham, C. A., Daugherty, T. J. 2010; 55 (9): 2459-2462

    View details for DOI 10.1007/s10620-010-1318-y

    View details for Web of Science ID 000280595500006

    View details for PubMedID 20635145

  • Management of Biliary Strictures Following Liver Transplantation DIGESTIVE DISEASES AND SCIENCES Alexopoulos, S. P., Henningsen, J. A., Jeffrey, R. B., Bonham, C. A., Ahmed, A., Gonzalez, S. A. 2009; 54 (1): 25-27

    View details for DOI 10.1007/s10620-008-0626-y

    View details for Web of Science ID 000261653400007

    View details for PubMedID 19034649

  • Pediatric intestinal transplantation at Packard children's hospital/Stanford University medical center: Report of a four-year experience TRANSPLANTATION PROCEEDINGS Castillo, R. O., Zarge, R., Cox, K., Strichartz, D., Berquist, W., Bonham, C. A., Esquivel, C. O. 2006; 38 (6): 1716-1717

    Abstract

    We report a 4-year experience of a new program in pediatric intestinal transplantation. Among 50 children referred for evaluation, 27 were listed for transplantation. Two children originally listed for combined liver/small bowel transplant were changed to isolated intestinal transplant as rehabilitation efforts resulted in full recovery of hepatic function. Eighteen children received 18 grafts: 12 liver/intestine, 5 isolated intestine, and 1 multivisceral. Mean age at transplant was 3.6 year with 75% of patients aged 0 to 2 years. Five listed children died while waiting and four were still on the list. Immunotherapy included antithymocyte globulin induction and tacrolimus, sirolimus, and prednisone maintenance. At 1 year, patient and graft survivals were 75% and 67%, respectively. For isolated intestine, 1 year survivals were 100% and 75%, while for combined liver/intestine, they were 71% for both. Enteral autonomy is 100% with total parenteral nutrition stopping by 35.8 days (mean). We had two patients develop posttransplant lymphoproliferative disorder and three, exfoliative rejection, one of whom recovered completely. In conclusion, our program in pediatric intestinal transplantation has become well established with a high proportion of smaller/younger children receiving grafts. Outcomes achieved levels expected based on The Intestinal Transplant Registry and UNOS criteria, which were better than expected for isolated intestinal transplants and achievement of enteral autonomy.

    View details for DOI 10.1016/j.transproceed.2006.05.038

    View details for Web of Science ID 000240051700022

    View details for PubMedID 16908259

  • Induction of tumor immunity and cytotoxic t lymphocyte responses using dendritic cells transduced by adenoviral vectors encoding HBsAg: comparison to protein immunization JOURNAL OF CANCER RESEARCH AND CLINICAL ONCOLOGY Qiu, S. J., Lu, L., Qiao, C. P., Wang, L. F., Wang, Z., Xiao, X., Qian, S. G., Fung, J. J., Ye, S. L., Bonham, C. A. 2005; 131 (7): 429-438

    Abstract

    Dendritic cells (DC) are specialized antigen-presenting cells with powerful immunostimulatory properties. Their use for induction of anti-tumor immunity has been limited by several factors, including identification of appropriate tumor-associated antigens, delivery of antigens to DC, and maintaining DC in a highly activated state. Here, DC propagated in vitro were transduced with an adenoviral (Ad) vector to express hepatitis B surface antigen (HBsAg), an antigen present in hepatocellular carcinoma (HCC). Many patients with HCC demonstrate evidence of prior HBV exposure, suggesting that the presence of the virus in a quiescent state may promote tumorigenesis. Ad-HBsAg-transduced DC stimulated strong cytotoxic T lymphocyte (CTL) responses to HBsAg-expressing tumor cells, and protected mice from lethal tumor challenge. Immunity was antigen-specific, as wild-type tumor (HBsAg -) grew normally. Furthermore, DC transduced with an irrelevant vector had no effect. Vaccination with HBsAg protein, a clinically utilized preparation that confers immunity to HBV infection, did not protect against tumor challenge even though it induced a strong antibody response. These studies describe for the first time the contributions of humoral and cellular immune responses to tumor immunity induced by Ad-transduced DC compared to protein vaccination.

    View details for DOI 10.1007/s00432-004-0616-1

    View details for Web of Science ID 000229641700003

    View details for PubMedID 15818505

  • Mechanistic insights into impaired dendritic cell function by rapamycin: Inhibition of Jak2/Stat4 signaling pathway JOURNAL OF IMMUNOLOGY Chiang, P. H., Wang, L. F., Bonham, C. A., Liang, X. Y., Fung, J. J., Lu, L., Qian, S. G. 2004; 172 (3): 1355-1363

    Abstract

    The suppressive effect of rapamycin on T cells has been extensively studied, but its influence on the function of APC is less clear. The data in this study demonstrated that immunostimulatory activity of B10 (H2(b)) dendritic cells (DC) exposed to rapamycin (rapa-DC) was markedly suppressed as evidenced by the induction of low proliferative responses and specific CTL activity in allogeneic (C3H, H2(k)) T cells. Administration of rapa-DC significantly prolonged survival of B10 cardiac allografts in C3H recipients. Treatment with rapamycin did not affect DC expression of MHC class II and costimulatory molecules or IL-12 production. Rapamycin did not inhibit DC NF-kappaB pathway, however, IL-12 signaling through Janus kinase 2/Stat4 activation was markedly suppressed. Indeed, Stat4(-/-) DC similarly displayed poor allostimulatory activity. The Stat4 downstream product, IFN-gamma, was also inhibited by rapamycin, but DC dysfunction could not solely be attributed to low IFN-gamma production as DC deficient in IFN-gamma still exhibited vigorous allostimulatory activity. Rapamycin did not affect DC IL-12R expression, but markedly suppressed IL-18Ralpha and beta expression, which may in turn down-regulate DC IL-12 autocrine activation.

    View details for Web of Science ID 000188378700004

    View details for PubMedID 14734710

  • Marked prolongation of cardiac allograft survival by dendritic cells genetically engineered with NF-kappa B oligodeoxyribonucleotide decoys and adenoviral vectors encoding CTLA4-Ig JOURNAL OF IMMUNOLOGY Bonham, C. A., Peng, L. S., Liang, X. Y., Chen, Z. Y., Wang, L. F., Ma, L. L., Hackstein, H., Robbins, P. D., Thomson, A. W., Fung, J. J., Qian, S. G., Lu, L. 2002; 169 (6): 3382-3391

    Abstract

    Bone marrow-derived dendritic cells (DCs) can be genetically engineered using adenoviral (Ad) vectors to express immunosuppressive molecules that promote T cell unresponsiveness. The success of these DCs for therapy of allograft rejection has been limited in part by the potential of the adenovirus to promote DC maturation and the inherent ability of the DC to undergo maturation following in vivo administration. DC maturation occurs via NF-kappaB-dependent mechanisms, which can be blocked by double-stranded "decoy" oligodeoxyribonucleotides (ODNs) containing binding sites for NF-kappaB. Herein, we describe the combined use of NF-kappaB ODNs and rAd vectors encoding CTLA4-Ig (Ad CTLA4-Ig) to generate stably immature murine myeloid DCs that secrete the potent costimulation blocking agent. These Ad CTLA4-Ig-transduced ODN DCs exhibit markedly impaired allostimulatory ability and promote apoptosis of activated T cells. Furthermore, administration of Ad CTLA4-Ig ODN-treated donor DCs (C57BL10; B10(H-2b)) before transplant significantly prolongs MHC-mismatched (C3HHeJ; C3H(H-2k)) vascularized heart allograft survival, with long-term (>100 days) donor-specific graft survival in 40% of recipients. The mechanism(s) responsible for DC tolerogenicity, which may involve activation-induced apoptosis of alloreactive T cells, do not lead to skewing of intragraft Th cytokine responses. Use of NF-kappaB antisense decoys in conjunction with rAd encoding a potent costimulation blocking agent offers promise for therapy of allograft rejection or autoimmune disease with minimization of systemic immunosuppression.

    View details for Web of Science ID 000177958200072

    View details for PubMedID 12218160

  • The interaction between antiretroviral agents and tacrolimus in liver and kidney transplant patients LIVER TRANSPLANTATION Jain, A. K., Venkataramanan, R., Shapiro, R., Scantlebury, V. P., Potdar, S., Bonham, C. A., Ragni, M., Fung, J. J. 2002; 8 (9): 841-845

    Abstract

    Solid organ transplantations have been performed successfully in selected HIV-positive patients with highly active antiretrovirus therapy (HAART). However, some of the medications in the HAART regimen require metabolism via the cytochrome P4503A, the same enzyme complex responsible for clearance of the calcineurin inhibitors cyclosporine and tacrolimus. Several case reports have described significant interactions between the agents used in HAART and immunosuppressive drugs. The goal of this report is to examine the extent of potential drug interactions between antiretroviral agents and tacrolimus after liver and kidney transplantation. Seven liver transplant (LTx) patients (M = 6, F = 1) and four kidney transplant (KTx) patients (M = 4) infected with HIV underwent surgery between September 1997 and January 2001. Initial immunosuppression consisted of tacrolimus and steroids for LTx patients or tacrolimus, steroids, and mycophenolate mofetil for KTx recipients. Their current baseline immunosuppression and HAART regimen were examined retrospectively. Of the seven liver recipients, one (case 4) died 2 weeks after LTx and never received HAART therapy posttransplantation. The remaining six patients were placed on a regimen consisting of two nucleoside reverse transcriptase inhibitors (NRTI) and one protease inhibitor (PI) (nelfinavir in 5, indinavir in 1) based on known viral sensitivities or history of a previous clinical response. Kidney recipients received NRTI and nonnucleoside reverse transcriptase inhibitors (NNRTI). The mean dose of tacrolimus in liver recipients was 0.6 mg/d, with mean trough concentration of 9.7 mg/mL. Compared with historic controls (liver transplant patients not on HAART), the average tacrolimus dose was 16-fold lower in patients on HAART. In contrast to liver recipients, HIV-positive kidney recipients not on PI therapy required a mean tacrolimus dose of 9.5 mg/d to maintain a mean trough concentration of 9.6 ng/mL. Of the two protease inhibitors used, nelfinavir seems to have a more profound effect than indinavir. When patients on nelfinavir alone (n = 5) were compared with a control group not on antiretroviral therapy, the need for a tacrolimus dose was 38 times lower (mean dose, 0.26 mg/d). Profound drug interactions between PI and tacrolimus have been observed requiring up to 50-fold reductions in dosage. This effect seems to be most pronounced with the use of nelfinavir as opposed to indinavir, although further experience is required to confirm this observation. In contrast, HAART using NRTI and NNRTI without the use of PI, as shown in kidney recipients, produces less significant effects on tacrolimus metabolism. Great caution and frequent drug level monitoring are necessary when HAART is introduced or withdrawn in HIV-positive recipients of organ transplants.

    View details for DOI 10.1053/jlts.2002.34880

    View details for Web of Science ID 000177738500018

    View details for PubMedID 12200788

  • Inhibition of IL-12 signaling Stat4/IFN-gamma pathway by rapamycin is associated with impaired dendritc cell function TRANSPLANTATION PROCEEDINGS Chiang, P. H., Wang, L., Liang, Y., Liang, X., Qian, S., Fung, J. J., Bonham, C. A., Lu, L. 2002; 34 (5): 1394-1395

    View details for Web of Science ID 000177369700012

    View details for PubMedID 12176411

  • Reduction in the circulating pDC1/pDC2 ratio and impaired function of ex vivo-generated DC1 in chronic hepatitis B infection CLINICAL IMMUNOLOGY Beckebaum, S., Cicinnati, V. R., Dworacki, G., Muller-Berghaus, J., Stolz, D., Harnaha, J., Whiteside, T. L., Thomson, A. W., Lu, L., Fung, J. J., Bonham, C. A. 2002; 104 (2): 138-150

    Abstract

    Dendritic cells (DCs) induce and regulate T-cell-mediated immune responses. Circulating precursor (p)DC1 and pDC2 from patients with chronic hepatitis B virus (HBV) infection were quantified by flow cytometry. To assess their function, DC1 were cultured from patients and compared to those of healthy volunteers. HBV patients exhibited a significant decrease in the proportion of freshly isolated pDC1 to pDC2. DC1 propagated from patients showed lower expression of costimulatory molecules and impaired allostimulatory capacity in comparison to controls. After exposure to proinflammatory cytokines, expression of costimulatory molecules, secretion of interleukin-12 (IL-12) and allostimulatory properties increased, but capacity for T-cell stimulation and IL-12 production remained inferior to that of control DCs. HBV-DNA was amplified by polymerase chain reaction in DC1 cultured from all patients. Viral particles were visible in DC1 by electron microscopy. These results suggest that intracellular presence of HBV impairs DC1 functional maturation and subsequent deficits in T-lymphocyte activation may contribute to viral persistence.

    View details for DOI 10.1006/clim.2002.5245

    View details for Web of Science ID 000178054500006

    View details for PubMedID 12165275

  • Interaction between tacrolimus and antiretroviral agents in human immunodeficiency virus-positive liver and kidney transplantation patients TRANSPLANTATION PROCEEDINGS Jain, A. K., Venkataramanan, R., Shapiro, R., Scantlebury, V. P., Potdar, S., Bonham, C. A., Pokharna, R., Rohal, S., Ragni, M., Fung, J. J. 2002; 34 (5): 1540-1541

    View details for Web of Science ID 000177369700075

    View details for PubMedID 12176474

  • Liver-derived DEC205(+)B220(+)CD19(-) dendritic cells regulate T cell responses JOURNAL OF IMMUNOLOGY Lu, L. N., Bonham, C. A., Liang, X. Y., Chen, Z. Y., Li, W., Wang, L. F., Watkins, S. C., Nalesnik, M. A., Schlissel, M. S., Demestris, A. J., Fung, J. J., Qian, S. G. 2001; 166 (12): 7042-7052

    Abstract

    Leukocytes resident in the liver may play a role in immune responses. We describe a cell population propagated from mouse liver nonparenchymal cells in IL-3 and anti-CD40 mAb that exhibits a distinct surface immunophenotype and function in directing differentiation of naive allogeneic T cells. After culture, such cells are DEC-205(bright)B220+CD11c-CD19-, and negative for T (CD3, CD4, CD8alpha), NK (NK 1.1) cell markers, and myeloid Ags (CD11b, CD13, CD14). These liver-derived DEC205+B220+ CD19- cells have a morphology and migratory capacity similar to dendritic cells. Interestingly, they possess Ig gene rearrangements, but lack Ig molecule expression on the cell surface. They induce low thymidine uptake of allogeneic T cells in MLR due to extensive apoptosis of activated T cells. T cell proliferation is restored by addition of the common caspase inhibitor peptide, benzyloxycarbonyl-Val-Ala-Asp-fluoromethyl ketone (zVAD-fmk). T cells stimulated by liver-derived DEC205+B220+D19- cells release both IL-10 and IFN-gamma, small amounts of TGF-beta, and no IL-2 or IL-4, a cytokine profile resembling T regulatory type 1 cells. Expression of IL-10 and IFN-gamma, but not bioactive IL-12 in liver DEC205+B220+CD19- cells was demonstrated by RNase protection assay. In vivo administration of liver DEC205+B220+CD19- cells significantly prolonged the survival of vascularized cardiac allografts in an alloantigen-specific manner.

    View details for Web of Science ID 000170949000006

    View details for PubMedID 11390448

  • Lamivudine after hepatitis B immune globulin is effective in preventing hepatitis B recurrence after liver transplantation LIVER TRANSPLANTATION Dodson, S. F., de Vera, M. E., Bonham, C. A., Geller, D. A., Rakela, J., Fung, J. J. 2000; 6 (4): 434-439

    Abstract

    The prevention of recurrent hepatitis B virus (HBV) infection after orthotopic liver transplantation (OLT) with hepatitis B immunoglobulin (HBIG) is expensive and requires indefinite parenteral administration. Lamivudine is a nucleoside analogue capable of inhibiting HBV replication. The aim of this study is to determine the efficacy of lamivudine in the prevention of recurrent HBV infection after a course of HBIG in patients who were hepatitis B surface antigen (HBsAg) positive and hepatitis Be antigen (HBeAg) negative before OLT. Patients at high risk for recurrent HBV infection (HBeAg positive and HBV DNA positive) were excluded. Thirty HBsAg-positive, HBeAg-negative patients underwent OLT from January 1993 to June 1997. All 30 patients were administered HBIG after OLT and, after 2 years, were given the option of continuing with HBIG or switching to lamivudine. Five patients were excluded: 3 patients were lost to follow-up and 2 patients died of technical complications. Three patients terminated HBIG therapy at 8, 24, and 29 months after OLT, and reinfection with HBV occurred in 1 patient. Six patients elected to continue HBIG therapy for life; 1 patient died of melanoma and the remaining 5 patients are HBsAg negative, with an average follow-up of 73 months. Sixteen patients were converted to lamivudine after a course of HBIG, and all 16 patients are HBsAg negative, with an average follow-up of 51 months after OLT. Five patients have been on lamivudine monotherapy for more than 24 months. These results suggest that lamivudine administered after a posttransplantation course of HBIG can effectively prevent the recurrence of HBV infection in patients who are HBsAg positive and HBeAg negative before OLT.

    View details for Web of Science ID 000088523100007

    View details for PubMedID 10915164

  • Prolongation of cardiac allograft survival using dendritic cells treated with NF-kappa B decoy oligodeoxyribonucleotides MOLECULAR THERAPY Giannoukakis, N., Bonham, C. A., Qian, S. G., Zhou, Z. Y., Peng, L., Harnaha, J., Li, W., Thomson, A. W., Fung, J. J., Robbins, P. D., Lu, L. 2000; 1 (5): 430-437

    Abstract

    Dendritic cells (DC) classically promote immune responses but can be manipulated to induce antigen-specific hyporesponsiveness in vitro. The expression of costimulatory molecules (CD40, CD86, CD80) at the DC cell surface correlates with their capacity to induce or suppress immune responses. Expression of these molecules is associated with NF-kB-dependent transcription of their genes. DC tolerogenicity has been associated with impaired NF-kB-dependent transcription of costimulatory genes as well as NF-kB translocation to the nucleus. In this report, we demonstrate that double-stranded oligodeoxyribonucleotides containing binding sites for NF-kB (NF-kB ODN) are efficiently incorporated by bone marrow-derived DC and specifically inhibit NF-kB-dependent transcription of a reporter gene. Moreover, exposure of DC to the oligonucleotide decoys inhibited lipopolysaccharide (LPS)-induced nitric oxide production, a marker of DC maturation. Treatment of bone marrow-derived DC progenitors with NF-kB ODN selectively suppressed the cell-surface expression of costimulatory molecules without interfering with MHC class I or class II expression. Furthermore, NF-kB ODN DC induced allogeneic donor-specific hyporesponsiveness in mixed leukocyte cultures, and this was associated with inhibition of Th1-type cytokine production. Finally, infusion of NF-kB ODN-modified bone marrow-derived DC into allogeneic recipients prior to heart transplantation resulted in significant prolongation of allograft survival in the absence of immunosuppression. Specific interference with NF-kB and other transcriptional pathways involved in immune stimulation in DC using ODN decoy approaches could be one means to promote tolerance induction in organ transplantation.

    View details for Web of Science ID 000090048100008

    View details for PubMedID 10933964

  • Is the pathologic TNM staging system for patients with hepatoma predictive of outcome? CANCER Marsh, J. W., Dvorchik, I., Bonham, C. A., Iwatsuki, S. 2000; 88 (3): 538-543

    Abstract

    The pathologic TNM (pTNM) staging system was designed to aid in determining the prognosis of cancer patients and in planning and evaluating their treatment. The current pTNM classification system was not found to be predictive for patients undergoing orthotopic liver transplantation (OLTx) in the presence of hepatocellular carcinoma (HCC). Therefore, the authors examined the current system to determine whether improvements would allow the development of a more predictive system.Three hundred seven patients with HCC underwent OLTx between 1981 and 1997. Risk factors for recurrence were identified using the Kaplan-Meier method with the log rank test. The Cox proportional hazards model was used to identify factors independently predictive of recurrence which were then used to create a new staging system.There was neither a direct correlation between the current pTNM system and tumor free survival nor homogeneity in outcomes for patients within certain current pTNM categories. Depth of vascular invasion, lobar distribution, lymph node status, and largest tumor size were found to be independent predictors of tumor free survival; tumor number was not found to be significant in multivariate analysis. A new staging system is proposed, which takes into account the results of the multivariate analysis in which tumor free survival correlates directly with stage.The proposed staging system is superior to the current pTNM staging system in predicting tumor free survival following OLTx with HCC. Further studies will determine the appropriateness of this system for staging HCC after subtotal hepatic resection.

    View details for Web of Science ID 000084874900007

    View details for PubMedID 10649244

  • Prevention of de novo hepatitis B infection in recipients of hepatic allografts from anti-HBc positive donors TRANSPLANTATION Dodson, S. F., Bonham, C. A., Geller, D. A., Cacciarelli, T. V., Rakela, J., Fung, J. J. 1999; 68 (7): 1058-1061

    Abstract

    The shortage of donor organs occasionally mandates the use of hepatic allografts from anti-HBc+ donors in recipients who are susceptible to de novo hepatitis B virus (HBV) infection. The efficacy of hepatitis B immune globulin and lamivudine to prevent de novo HBV infection in anti-HBs negative recipients of allografts from anti-HBc+ donors has not been investigated.After liver transplantation with an allograft from a donor positive for anti-HBc, recipients who were anti-HBs-, HbsAg- received hepatitis B immune globulin (HBIG) 10,000 IU i.v. daily for 7 days and monthly for 6 months. After 6 months, 1000 IU of HBIG was given IM. every 2 weeks for 18 months. Patients transplanted after 4/1/97 were given lamivudine 150 mg daily starting postoperative day 1.Between 8/14/96 and 6/10/98, 264 orthotopic liver transplants were performed and 16 anti-HBs-, HbsAg- patients received an hepatic allograft from a donor positive for anti-HBc. HBIG mono-therapy was administered to one patient. HBIG and lamivudine combination therapy was administered to 15 patients. Of the 16 patients, 8 were positive only for anti-HBc before transplant, and 8 were naive (anti-HBs-, anti-HBc-). The single patient who received HBIG monotherapy became HbsAg+ at 6 months. All patients receiving combination therapy with HBIG and lamivudine have remained HbsAg-. The average follow-up is 459 days (range 170-754). Two patients died from unrelated causes.Combination therapy with HBIG and lamivudine may prevent de novo HBV infection in anti-HBs-, HbsAg- recipients of hepatic allografts from anti-HBc+ donors.

    View details for Web of Science ID 000083163800028

    View details for PubMedID 10532552

  • Adenoviral delivery of CTLA4Ig into myeloid dendritic cells promotes their in vitro tolerogenicity and survival in allogeneic recipients GENE THERAPY Lu, L., Gambotto, A., Lee, W. C., Qian, S., Bonham, C. A., Robbins, P. D., Thomson, A. W. 1999; 6 (4): 554-563

    Abstract

    Dendritic cells (DC) are highly specialized antigen-presenting cells (APC) that initiate and modulate immune responses. They are essential for naive T cell activation, but may also play roles both in central and peripheral tolerance. Blockade of costimulatory pathways that provide the crucial second signal for lymphocyte activation is one strategy to augment the potential tolerogenicity of DC. Here, in vitro propagated DC were transduced using an adenoviral (Ad) vector to express the gene encoding cytotoxic T lymphocyte antigen 4-immunoglobulin (CTLA4lg), which blocks interaction of CD80 and CD86 on DC with CD28 on T cells. Supernatants of AdCTLA4lg-transduced DC strikingly inhibited mixed leukocyte reactions (MLR) induced by non-transduced DC. Whereas transduction of marker genes (LacZ or enhanced green fluorescence protein (EGFP)) did not alter their potent allostimulatory activity, DC transduced with CTLA4lg exhibited striking reductions in cell surface staining for CD86, but not MHC class II, and were poor stimulators of T cell proliferation and cytotoxic T lymphocyte (CTL) responses. In addition, they induced alloantigen-specific T cell hyporesponsiveness. They were detected, following local injection, in significantly increased numbers in the lymphoid tissue of unmodified allogeneic recipients. This is the first report of the functional properties of DC genetically engineered to express CTLA4lg.

    View details for Web of Science ID 000079560200012

    View details for PubMedID 10476215

  • Central nervous system lesions in liver transplant recipients - Prospective assessment of indications for biopsy and implications for management TRANSPLANTATION Bonham, C. A., Dominguez, E. A., Fukui, M. B., Paterson, D. L., Pankey, G. A., Wagener, M. M., Fung, J. J., Singh, N. 1998; 66 (12): 1596-1604

    Abstract

    Precise diagnosis of central nervous system (CNS) lesions in liver transplant recipients remains problematic. Brain biopsies are often not feasible as a result of coagulopathy. We sought to determine whether selected clinical or radiologic characteristics can predict the likely etiology of CNS lesions in liver transplant recipients and thus obviate the need for diagnostic brain biopsies.A 4-year prospective, observational, cohort study was conducted at liver transplant centers at four geographically diverse medical institutions. A total of 1730 consecutive liver transplant recipients were evaluated for CNS lesions; 60 patients with radiologically documented CNS lesions comprised the study sample.Vascular events (52%, 31/60), infections (181%, 11/60), immunosuppressive associated leukoencephalopathy (12%, 7/60), central pontine myelinolysis (8%, 5/60), and malignancy (3%, 2/60) were the predominant etiologies of CNS lesions. CNS lesions were most likely to occur within 30 days of transplantation (43%, 26/60); central pontine myelinolysis, subdural hematoma, acute infarcts, and Aspergillus brain abscesses were the predominant etiologies during this time. All brain abscesses were fungal; 73% (8/11) of these patients concurrently had documented extraneural (pulmonary) infection as a result of the same fungal pathogen. Thus, a diagnostic brain biopsy is not warranted in these patients. Patients on dialysis were more likely to have ischemic or infectious CNS lesions (P=0.03). Vascular events were more likely to occur in repeat transplant recipients (P=0.03). Twenty-five percent (15/60) of the CNS lesions occurred more than 1 year after transplantation; small vessel ischemic lesions, malignancy, or non-Aspergillus fungal brain abscesses accounted for all such lesions.A presumptive etiologic diagnosis can be established in a vast majority of CNS lesions in liver transplant recipients based on identifiable presentation that includes time of onset, unique risk factors, and neuroimaging characteristics. Empiric therapy of brain abscesses in liver transplant recipients should include antifungal and not antibacterial agents.

    View details for Web of Science ID 000077958500005

    View details for PubMedID 9884245

  • Immunosuppressive agents: Recent developments in molecular action and clinical application TRANSPLANTATION PROCEEDINGS Gerber, D. A., Bonham, C. A., Thomson, A. W. 1998; 30 (4): 1573-1579

    View details for Web of Science ID 000074150800262

    View details for PubMedID 9636637

  • Surgical complications in 123 consecutive pancreas transplant recipients: Comparison of bladder and enteric drainage TRANSPLANTATION PROCEEDINGS Sugitani, A., Gritsch, H. A., Shapiro, R., Bonham, C. A., Egidi, M. F., Corry, R. J. 1998; 30 (2): 293-294

    View details for Web of Science ID 000072657300036

    View details for PubMedID 9532047

  • Striking augmentation of hematopoietic cell chimerism in noncytoablated allogeneic bone marrow recipients by FLT3 ligand and tacrolimus TRANSPLANTATION Iyengar, A. R., Bonham, C. A., Antonysamy, M. A., Subbotin, V. M., Khanna, A., Murase, N., Rao, A. S., Starzl, T. E., Thomson, A. W. 1997; 63 (9): 1193-1199

    Abstract

    The influence of granulocyte-macrophage colony-stimulating factor (GM-CSF) and the recently identified hematopoietic stem-progenitor cell mobilizing factor flt3 ligand (FL) on donor leukocyte microchimerism in noncytodepleted recipients of allogeneic bone marrow (BM) was compared. B10 mice (H2b) given 50x10(6) allogeneic (B10.BR [H2k]) BM cells also received either GM-CSF (4 microg/day s.c.), FL (10 microg/day i.p.), or no cytokine, with or without concomitant tacrolimus (formerly FK506; 2 mg/kg) from day 0. Chimerism was quantitated in the spleen 7 days after transplantation by both polymerase chain reaction (donor DNA [major histocompatibility complex class II; I-E(k)]) and immunohistochemical (donor [I-E(k)+] cell) analyses. Whereas GM-CSF alone significantly augmented (fivefold) the level of donor DNA in recipients' spleens, FL alone caused a significant (60%) reduction. Donor DNA was increased 10-fold by tacrolimus alone, whereas coadministration of GM-CSF and tacrolimus resulted in a greater than additive effect (28-fold increase). A much more striking effect was observed with FL + tacrolimus (>125-fold increase in donor DNA compared with BM alone). These findings were reflected in the relative numbers of donor major histocompatibility complex class II+ cells (many resembling dendritic cells) detected in spleens, although quantitative differences among the groups were less pronounced. Evaluation of cytotoxic T lymphocyte generation by BM recipients' spleen cells revealed that FL alone augmented antidonor immunity and that this was reversed by tacrolimus. Thus, although FL may potentiate antidonor reactivity in nonimmunosuppressed, allogeneic BM recipients, it exhibits potent chimerism-enhancing activity when coadministered with recipient immunosuppressive therapy.

    View details for Web of Science ID A1997WZ23100001

    View details for PubMedID 9158008

  • Generation of nitric oxide by mouse dendritic cells and its implications for immune response regulation DENDRITIC CELLS IN FUNDAMENTAL AND CLINICAL IMMUNOLOGY, VOL 3 Bonham, C. A., Lu, L., Hoffman, R. A., SIMMONS, R. L., Thomson, A. W. 1997; 417: 283-290

    View details for Web of Science ID A1997BJ40F00046

    View details for PubMedID 9286374

  • Induction of nitric oxide synthase in mouse dendritic cells by IFN-gamma, endotoxin, and interaction with allogeneic T cells - Nitric oxide production is associated with dendritic cell apoptosis JOURNAL OF IMMUNOLOGY Lu, L. N., Bonham, C. A., Chambers, F. G., Watkins, S. C., Hoffman, R. A., SIMMONS, R. L., Thomson, A. W. 1996; 157 (8): 3577-3586

    Abstract

    Nitric oxide (NO) is an important effector molecule that is involved in immune regulation and host defense. In this study, highly purified NLDC 145+ (DEC-205+) MHC class II(bright) B7-2+ dendritic cells (DC) propagated from normal mouse bone marrow in response to granulocyte-macrophage CSF + IL-4 were induced to produce NO by IFN-gamma and LPS. NO production was inhibited by the nitric oxide synthase (NOS) inhibitor N(G)-monomethyl-L-arginine (NMMA). Nitrite also accumulated in mixed leukocyte culture supernatants as the result of coculture of DC with purified naive allogeneic T cells. Furthermore, NO production was induced by CD40 ligation. Suboptimal T cell proliferation observed at high relative concentrations of DC correlated with increased NO production and was mitigated by NMMA. Induction of mRNA for an inducible NOS (iNOS) in DC was confirmed by Northern blotting, whereas intracellular iNOS was visualized by two-color flow cytometry and by both immunofluorescent and immunogold labeling in a subpopulation of IFN-gamma + LPS-stimulated cells. Both endogenous NO production and exposure of unstimulated DC to the NO donor S-nitroso-N-acetyl-penicillamine (SNAP) resulted in DC apoptosis. Thus, although DC function initially as the most potent APCs for T cell activation, DC induced to synthesize NOS by IFN-gamma may inhibit (allogeneic) T cell proliferation: NO may suppress lymphocyte proliferation and also induce apoptosis of the most potent source of alloantigenic stimulation.

    View details for Web of Science ID A1996VP22600047

    View details for PubMedID 8871658

  • TGF-beta 1 pretreatment impairs the allostimulatory function of human bone marrow-derived antigen-presenting cells for both naive and primed T cells. Transplant immunology Bonham, C. A., Lu, L., Banas, R. A., Fontes, P., Rao, A. S., Starzl, T. E., Zeevi, A., Thomson, A. W. 1996; 4 (3): 186-191

    Abstract

    Transforming growth factor-beta (TGF-beta) exhibits strong antiproliferative effects upon lymphocytes and inhibits many of the effector functions of activated immune cells. However, its influence on the inductive phase of immune responses, and in particular its effect on antigen-presenting cells (APC), has not been well studied. In this investigation, we examined the influence of human TGF-beta 1 on the antigen-presenting function of human bone marrow (BM)-derived APC propagated in liquid culture for 11-17 days in response to granulocyte/macrophage colony-stimulating factor (GM-CSF). These cells were predominantly macrophages, accompanied by a minor population of dendritic cells. TGF-beta 1 had no effect upon the allostimulatory function of vertebral body whole BM cells cultured for 3-5 days in GM-CSF. However, it markedly reduced the allostimulatory capacity of BM-derived APC exposed to the cytokine for the last 3 days of culture. This inhibitory action could not be ascribed to cytokine 'carry-over', or to any consistent changes in the expression of cell surface molecules implicated in antigen presentation (HLA-DR), intercellular adhesion (ICAM-1; CD54), or costimulatory activity (B7-1; CD80). Mechanisms that may underlie the inhibitory action of TGF-beta on APC function and the immunologic and possible clinical implications of the findings are discussed.

    View details for PubMedID 8893447

  • ANTIINFLAMMATORY AGENTS IN ALLERGIC DISEASES CLINICAL AND EXPERIMENTAL IMMUNOLOGY Bonham, C. A., Thomson, A. W. 1995; 102 (1): 1-5

    View details for Web of Science ID A1995RY73500001

    View details for PubMedID 7554374

Conference Proceedings


  • Hepatocyte-induced apoptosis of activated T cells, a mechanism of liver transplant tolerance, is related to the expression of ICAM-1 and hepatic lectin Qian, S., Wang, Z., Lee, Y., Chiang, Y., Bonham, C., Fung, J., Lu, L. ELSEVIER SCIENCE INC. 2001: 226-226

    View details for Web of Science ID 000167629900097

    View details for PubMedID 11266790

  • Causes of death after liver transplantation in 4000 consecutive patients: 2 to 19 year follow-up Kashyap, R., Jain, A., Reyes, J., Demetris, A. J., Elmagd, K. A., Dodson, S. F., Marsh, W., Madariaga, V., Mazariegos, G., Geller, D., Bonham, C. A., Cacciarelli, T., Fontes, P., Starzl, T. E., Fung, J. J. ELSEVIER SCIENCE INC. 2001: 1482-1483

    View details for Web of Science ID 000167629900690

    View details for PubMedID 11267383

  • Causes of retransplantation after primary liver transplantation in 4000 consecutive patients: 2 to 19 years follow-up Kashyap, R., Jain, A., Reyes, J., Demetris, A. J., Elmagd, K. A., Dodson, S. F., Marsh, W., Madariaga, V., Mazariegos, G., Geller, D., Bonham, C. A., Cacciarelli, T., Fontes, P., Starzl, T. E., Fung, J. J. ELSEVIER SCIENCE INC. 2001: 1486-1487

    View details for Web of Science ID 000167629900692

    View details for PubMedID 11267385

  • A novel subset of dendritic cells propagated from the liver promotes differentiation of T regulatory cells and enhances allograft survival Lu, L., Liang, X., Li, W., Chen, Z., Nalesnick, M., Bonham, C., Fung, J., Qian, S. ELSEVIER SCIENCE INC. 2001: 229-229

    View details for Web of Science ID 000167629900099

    View details for PubMedID 11266792

  • Long-term survival after liver transplantation in 4,000 consecutive patients at a single center Jain, A., Reyes, J., Kashyap, R., Dodson, F., Demetris, A. J., Ruppert, K., Abu-Elmagd, K., Marsh, W., Madariaga, J., Mazariegos, G., Geller, D., Bonham, C. A., Gayowski, T., Cacciarelli, T., Fontes, P., Starzl, T. E., Fung, J. J. LIPPINCOTT WILLIAMS & WILKINS. 2000: 490-498

    Abstract

    To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time.Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, with continual improvements in patient survival as a result of advances in immunosuppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few reports have examined factors that affect long-term survival after liver transplantation.Four thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at the time of transplantation, recipient gender, diagnosis, and year of transplantation were compared. Rates of retransplantation, causes of retransplantation, and cause of death were also examined.The overall patient survival for the entire cohort was 59%; the actuarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age-related complications being the major factors for loss.Significantly improved patient and graft survival has been observed over time, and graft loss from acute or chronic rejection has emerged as a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival.

    View details for Web of Science ID 000089602400007

    View details for PubMedID 10998647

  • Potential use of marginal donors for pancreas transplantation Bonham, C. A., Kapur, S., Dodson, S. F., Dvorchik, I., Corry, R. J. ELSEVIER SCIENCE INC. 1999: 612-613

    View details for Web of Science ID 000078960600268

    View details for PubMedID 10083259

  • Excision and immediate revascularization for hepatic artery pseudoaneurysm following liver transplantation Bonham, C. A., Kapur, S., Geller, D., Fung, J. J., Pinna, A. ELSEVIER SCIENCE INC. 1999: 443-443

    View details for Web of Science ID 000078960600189

    View details for PubMedID 10083180

  • Strategies to expand the donor pool for pancreas transplantation Kapur, S., Bonham, C. A., Dodson, S. F., Dvorchik, I., Corry, R. J. LIPPINCOTT WILLIAMS & WILKINS. 1999: 284-290

    Abstract

    Our organ procurement organization has been forced to liberalize the donor criteria in order to expand the donor pool for pancreas transplantation. In this report, we describe our experience using whole organ pancreatic grafts from "marginal" donors, which include grafts obtained from donors over 45 years of age and from donors who were identified to be hemodynamically unstable at the time of organ retrieval.A prospective study was performed between July 1994 and March 1998, during which time 137 pancreas transplants were performed at our center using organs procured by our own surgeons (organs sent by other teams were excluded). The rapid en bloc technique was used exclusively. The use of pancreatic grafts from marginal donors was analyzed for short-term and overall graft survival, and for delayed graft function and complications.Overall pancreas graft survival for our series was 83%, with a mean follow-up of 23 months. There were 22 pancreas grafts from donors over 45 years of age, 13 of whom were greater than 50 years of age. The actual graft survival rate of the over-45 donor group was 86%. Fifty-one grafts were removed from hemodynamically unstable donors on high-dose vasopressors. The actual graft survival in this group was 86%. There was no significant difference found in graft survival between recipients of pancreatic grafts from marginal and nonmarginal donors. Delayed graft function was exhibited by more recipients of grafts from donors on high-dose vasopressors (P<0.05), but this had no effect on long-term graft survival and endocrine function. Recipients of marginal donor grafts did not have higher rates of complication compared to recipients of nonmarginal grafts.Based on our results, we currently employ a graft selection strategy not limited by donor age or hemodynamic stability. Our selection of pancreas organs for transplantation is based on careful inspection of the pancreas and determination of the adequacy of the ex vivo flush. Our results suggest that the current pancreas donor pool may be expanded substantially.

    View details for Web of Science ID 000078352000017

    View details for PubMedID 10075595

  • Nitric oxide production by dendritic cells is associated with impairment of T cell responses Bonham, C. A., Lu, L., Hoffman, R. A., SIMMONS, R. L., Thomson, A. W. ELSEVIER SCIENCE INC. 1997: 1116-1117

    View details for Web of Science ID A1997WM12700491

    View details for PubMedID 9123225

  • Nitric oxide production by mouse bone marrow-derived dendritic cells - Implications for the regulation of allogeneic T cell responses Bonham, C. A., Lu, L., Li, Y. P., Hoffman, R. A., SIMMONS, R. L., Thomson, A. W. WILLIAMS & WILKINS. 1996: 1871-1877

    Abstract

    Dendritic cells (DC) are the most potent known antigen presenting cells, and play important roles both in immunity and tolerance induction. Nitric oxide (NO) is an important effector molecule that is involved in numerous aspects of the immune response. There have been no accounts to date of efforts to determine NO generation by well-characterized DC. In this report we describe the production of NO by highly purified DEC 205+ DC propagated from mouse bone marrow in response to granulocyte/macrophage-colony stimulating factor (GM-CSF) + interleukin-4 (IL-4). NO synthesis was induced in DC by interferon-gamma (IFN-gamma) and lipopolysaccharide (LPS), and was blocked by the inhibitor of nitric oxide synthase (NOS), NG-monomethyl-L-arginine (NMMA). Both "mature" B7-2+ (CD86+) DC and B7-2- (CD86-) DC progenitors could be induced to release NO. NO was also recovered from the supernatants of primary mixed leukocyte cultures containing comparatively high concentrations of B7-2+ DC in relation to purified allogeneic T cells. Furthermore, inhibition of NO release in these cultures by NMMA resulted in an increase in T cell proliferation. These observations suggest that NO may be an important soluble mediator of the interaction between DC and activated T cells. In addition to its ability to inhibit T cell proliferation, NO was also shown to induce programmed cell death in DC. This was visualized by the detection of DNA strand breaks with in situ nick translation. The percentage of DC apoptosis correlated with the level of NO in the cultures. Apoptosis was inhibited by the addition of NMMA. These results indicate that DC have the capacity both to stimulate and potentially limit the same allogeneic T cell response, in accordance with their production of NO.

    View details for Web of Science ID A1996WA91600033

    View details for PubMedID 8990379

  • MODE OF ACTION OF TACROLIMUS (FK506) - MOLECULAR AND CELLULAR MECHANISMS Thomson, A. W., Bonham, C. A., Zeevi, A. LIPPINCOTT-RAVEN PUBL. 1995: 584-591

    Abstract

    Tacrolimus, formerly known as FK506, is a macrolide antibiotic with immunosuppressive properties. Although structurally unrelated to cyclosporin A (CsA), its mode of action is similar. It exerts its effects principally through impairment of gene expression in target cells. Tacrolimus bonds to an immunophilin, FK506 binding protein (FKBP). This complex inhibits calcineurin phosphatase. The drug inhibits calcium-dependent events, such as interleukin-2 gene transcription, nitric oxide synthase activation, cell degranulation, and apoptosis. Tacrolimus also potentiates the actions of glucocorticoids and progesterone by binding to FKBPs contained within the hormone receptor complex, preventing degradation. The agent may enhance expression of the transforming growth factor beta-1 gene in a fashion analogous to that demonstrated for CsA. T cell proliferation in response to ligation of the T cell receptor is inhibited by tacrolimus. Type 1 T helper cells appear to be preferentially suppressed compared with type 2 T helper cells. T cell-mediated cytotoxicity is impaired. B cell growth and antibody production are affected indirectly by the suppression of T cell-derived growth factors necessary for these functions. Antigen presentation appears to be spared. The molecular events affected by tacrolimus continue to be discovered.

    View details for Web of Science ID A1995TF69700007

    View details for PubMedID 8588225

  • Inhibition of T lymphocyte activation and apoptotic cell death by cyclosporin A and tacrolimus (FK506) - Its relevance to therapy of HIV infection Thomson, A. W., Bonham, C. A. PLENUM PRESS DIV PLENUM PUBLISHING CORP. 1995: 211-216

    Abstract

    Theoretically, drugs that inhibit programmed cell death could be used to inhibit the increased apoptotic decay of lymphocyte populations in human immunodeficiency virus (HIV) infection. The concept that immunopathologic processes cause immune suppression provides a further rationale for the use of agents such as cyclosporin A (CsA) or tacrolimus (formerly known as FK506) early in HIV infection to reduce cytotoxic CD8+ T cell-mediated destruction of HIV-infected target cells.

    View details for Web of Science ID A1995BD53D00018

    View details for PubMedID 7572394

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