02199nas a2200229   4500000000100000008004100001260001700042653001400059653001600073653001100089653002900100653001800129653002000147653001600167100001400183700001500197245008300212300001100295490000700306520164200313022001401955       2004                            d  c2004 Sep-Oct10aCytokines10aForecasting10aHumans10aImmunosuppressive Agents10aImmunotherapy10aKidney Diseases10aThalidomide1 aPanichi V1 aPaoletti S00a[Anti-cytokine therapy: present status and future perspectives in nephrology].  a446-530 v213 a<p>The increasing understanding of the role of cytokines in chronic inflammatory disease, autoimmunity and neoplastic disease has led to a new generation of therapeutic agents, the anti-cytokine blocking agents. In this article, we review current knowledge of two different available approaches: the use of Thalidomide and the anti-cytokine antibody immune therapy. Thalidomide is an immunodulatory and antiangiogenic drug; the most pronounced effect of this drug is the inhibition of tumor necrosis factor-alpha (TNF-alpha ) production. A few years after its withdrawal from the European and Canadian markets due to severe teratogenic effects, the unexpected activity of Thalidomide in reactive lepromatous leprosy stimulated further study. After some confirmatory placebo-controlled trials, multiple researches are now in progress to evaluate the optimal dose of Thalidomide in several autoimmune and neoplastic diseases. Both passive and active immunization can safely, transiently and effectively be used, as documented by animal experimentation and confirmed by clinical trials. Novel anti-cytokine therapeutic compounds, based on passive antibody immunization, are now available to treat rheumatoid arthritis and have been shown to help in Crohn's disease and in several other autoimmune diseases, and to control neoangiogenesis in cancer patients. The durability of the benefit, safety and pharmacoeconomic issues will determine whether this early success will prove to be a major breakthrough in the treatment of these painful and incurable diseases and eventually of other chronic inflammatory conditions in uremic patients.</p>  a1724-5990