The textbook Immunotherapy in Transplantation: Principles and Practice provides a novel perspective to the reader regarding the development and utilization of agents in the field of transplantation. While most textbooks addressing pharmacotherapy in transplantation attempt to synthesize transplant immunosuppression into one or a few chapters that by definition become quite broad and lack in sufficient detail with respect to key pharmacological features and pivotal clinical trials, the editors of this book offer a different approach. The book is thematically divided into three sections, one in which an overview of transplant immunology is provided in a total of six chapters, a second section (five chapters) in which the principles of clinical pharmacology, drug development and study design are described and finally a third section of 18 chapters that reviews individual agents commonly used in the clinical setting.
The first section of the textbook is a very focused description of the immune response to the allograft, and importantly each chapter links the critical experimental observations with efforts to target immunological mechanisms with today's current and potential pharmacological agents. Succinct and not technical, without detailed discussion of experimental findings but adequately referenced, these chapters would be well suited to the clinician desiring a review of the current understanding of transplant immunology and also would be an excellent resource for training programs in transplantation.
The second section that addresses aspects of clinical pharmacology may be the most novel approach for a textbook on transplantation, as it provides a transplant-focused approach to pharmacokinetics, therapeutic dose monitoring and drug development. For the nonpharmacologist, the pharmacokinetics chapter may be daunting in its detail; in other chapters, the reader will appreciate the pitfalls of therapeutic drug monitoring and the potential of the developing fields of pharmacogenomics and pharmacometrics, to influence clinical trial design. These chapters may serve as essential primers for those interested in drug development and translational research, and provide a vocabulary for clinical-scientific-regulatory collaboration.
The final section provides a chapter-by-chapter description of specific immunomodulatory therapies, from the standard (e.g. corticosteroids, cyclosporine) to the relatively novel (e.g. CTLA4-Ig, IVIg, anti-CD20) to the exploratory (antisense technology and novel agents targeting inhibition of costimulation). These chapters are tightly connected to the earlier sections, with descriptions of the historical development of each agent, a review of critical clinical trials that supported their use, important differentiating pharmacokinetic and pharmacodynamic features that help describe the rationale not only for efficacy but also for the toxicity and side-effect profile of each agent, and when possible a pharmacogenomic application. These chapters are of high educational value to clinicians desiring a detailed review of a given agent and its use in transplantation and for clinical pharmacologists wishing to link the drug/agents' pharmacologic properties with clinical observations.
Novel aspects of this textbook that are particularly notable are the summary chapter 6 in which K. J. Wood and T. B. Strom summarize the current understanding of immunoregulation and briefly review agents in development that may help or hinder the attainment of regulatory tolerance, and the overview of pharmacogenomics by G. J. Burckart and R. M. Watanabe. The concepts provided within these chapters are carried out throughout many of the accompanying sections.
Overall, the text is highly structured, well presented and applicable to transplant clinicians and pharmacologists in particular. Distinctly different from other texts that focus on clinical aspects of transplantation, this book provides a more detailed, mechanistic approach to transplant immunosuppression. Those wishing to advance their understanding of transplant immunology, the technologies and techniques used for drug monitoring, the drug development pipeline and the basis for use of current agents in transplantation will find their interests more than satisfied.