In the immunostimulation setting after transplant, rapamycin

decreases lymphocyte proliferation and reduces rejection [39]. Nevertheless, in the setting of renal injury, where organ repair depends on tubular cell proliferation and well-orchestrated apoptosis, rapamycin may be harmful. Lieberthal et al. [40] have demonstrated that rapamycin inhibits proliferation and increases apoptosis of renal tubular epithelial cells in vitro and in vivo. Furthermore, there is evidence of pharmacokinetic interactions between rapamycin and CNI that augment ischaemic injury and inhibit tissue repair when used in combination [41]. Conversely, our results may demonstrate that the combination of rapamycin and tacrolimus administered to donors MAPK Inhibitor Library cost decreases apoptosis and necrosis in the graft in a syngeneic rat model. The difference

observed in our experiments, Sirolimus compared to Lieberthal et al. [40], may result from the administration setting. Once the injury is caused, rapamycin delays ATN recovery but the early administration of rapamycin, i.e. before the injury is caused, may explain the different beneficial effects observed in this exploratory study. Immunosuppressive treatment was administered in a single dose only to donor animals, 12 h before ablation. Several authors using the transplant model with rapamycin exposure after I/R injury support the hypothesis that rapamycin compromises renal function by impairing recovery rather than increasing injury severity [19,40]. In particular, Fuller et al. have demonstrated that serum creatinine in rapamycin-treated groups takes longer to recover [42]. These results show coherence regarding the specific impact of rapamycin on injured kidney. The data presented in our exploratory Cepharanthine work could provide new evidence for the use of rapamycin as a potent non-nephrotoxic immunosuppressant for its use

in donors in the DGF setting. The exact mechanism underlying the effect described for rapamycin or tacrolimus on renal I/R injury has not been explained completely. The protection by donor preconditioning has been associated with a reduction in the inflammatory response to reperfusion. Accordingly, the proinflammatory cytokines TNF-α and IL-6 were reduced by donor preconditioning with immunosuppressive treatment drugs. Other studies have also described that rapamycin suppresses IL-6 production, and that this may be associated with regulatory T cell (Treg) induction and with a decrease in the T helper 17 (Th1) population [43,44]. Regarding apoptosis, the improvement observed in the rapamycin group could be explained by in-situ up-regulation of Bcl-2, a specifically anti-apoptotic gene.