Prolongation of cardiac allograft survival in rats by anti-TNF and cyclosporine combination therapy.

Cyclosporine is well known to have many adverse side effects. However, while decreasing the dosage of CsA can reduce its toxicity, this also lowers its immunosuppressive effectiveness. Additionally, anti-tumor necrosis factor has been demonstrated to have immunosuppressive activity and been shown to prolong cardiac allograft survival. This current study therefore investigated the efficacy of a combined therapy of anti-TNF with low-dose CsA in a rat heterotopic cardiac transplant model utilizing Brown-Norway donors and Lewis recipients. Control transplant recipients received no immunotherapy. Experimental animals received single-dose anti-TNF intraperitoneally on posttransplant days 0, 3, or 5 and/or low-dose CsA (1.5 mg/kg/day) intramuscularly from days 0 to 14 after transplantation. Rejection was determined by the lack of contractions in the transplanted heart. No animal received any other form of immunosuppression. Graft survival was significantly prolonged with combination CsA and anti-TNF therapy, suggesting a synergistic effect against acute cardiac allograft rejection, possibly from CsA and anti-TNF interacting at different levels of the recipient immune response. This form of combination therapy may hold promise for future immunosuppressive techniques.