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Therapeutic immunosuppression has very broad applications in clinicalmed- icine, ranging from prevention and treatment of organ and bone marrow transplant rejection, management of various autoimmune disorders (e. g. rheumatoid arthritis) skin disease, and asthma. Whereas traditionally, only a small repertoire of immunosuppressive agents was available for clinical use, recent discoveries have significantly increasedthe number ofapproved agents, resulting in numerous trials to further evaluate their potential. In addition, products of the biotechnology industry, - monoclonal antibodies, cytokines, cytokine antagonists and other products of genetic engineering that target key molecular pathways in disease pathogenesis, have either already made, or are on the verge of making an important impact on treat- ment. There is also considerable interest in the potential ofcell-based thera- pies (particularly hematopoietic stem and dendritic celltherapy) ofallo-and autoimmunity. Important recent advances in the immunotherapy of allergic diseases are also covered in this book.Gene therapy offers considerable promise for suppressing pathogenic processes in either transplantation or autoimmune disorders. The possibility of combining these important new advances to maximize benefit to the patient, and to minimize possible untoward effects (that are also given extensive coverage in this book)is one ofthe most exciting challenges ofcontemporary medicine. This volume is intended both forpracticing physicians and surgeons and for biomedical scientists at the graduate/postdoctoral levels, and is designed to provide the theory behind these various approaches to immunosuppres- sion, and to provide state-of-the-artreviews ofcurrent developments in each area. Each chapter is contributed by an expert(s) in the field.
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Cyclosporin has had a remarkable effect on clinical organ transplantation. Prior to its introduction, considerable advances had been made in the grafting of vital organs, particularly the kidney, heart and liver. In many developed countries, however, transplantation was not considered wo-rthwhile in terms of gain for the investment of resources. The improved results of kidney grafts following the use of cyclosporin has changed this attitude. For all types of organ transplantation, cyclosporin has resulted in an improvement of functional graft survival and has allowed a reduction in steroid dose and, in some cases, no steroids at all. It has permitted the first successful experimental transplantation of the heart and lungs in primate species by Reitz and colleagues and their results were applied directly to the clinic. It was largely due to the introduction of cyclosporin that the Washington Consensus Meeting on Liver Transplantation came to a favourable recommendation and the result has been the proliferation of units performing liver transplantation, approximately fifty in North America and another fifty in Europe, where previously there had been a handful. Having been involved in cyclosporin for organ grafting from the beginning, I have been able to witness these developments which have far exceeded my expectations once the nephrotoxicity of cyclosporin was demonstrated in man. It is fitting that Dr.