Why some patients with kidney diseases respond well to certain medications and others do not has continued to stump physicians. With no means to test the medications besides trial and error, finding the right treatment is often a frustrating experience for physicians and their patients.
Now, research at Johns Hopkins may help provide some answers to the puzzle.
By harvesting white blood cells from patients, placing the cells in tissue culture plates and exposing them to common steroid and immunosuppressant medications, scientists can predict in some cases what medications might work best for each patient.
If a patient's white blood cells are suppressed by the medications, it is hoped that the patient will respond favorably to treatment. By contrast, if the cells are insensitive to the medications, the test suggests that the traditional approach to treatment may be ineffective, and that either higher doses or more than one drug may be required.
An article on this research in the Journal of Clinical Pharmacology recently was selected by the American College of Clinical Pharmacology as the most promising article of the past year.
William A. Briggs, M.D., associate professor of nephrology, was principal investigator.
Briggs, of Timonium, Md., will be presented with the college's 1997 McKeen Cattell Memorial Award on September 18 in Phoenix at the association's 26th annual meeting. The award is named in memory of the late McKeen Cattell, first editor of the Journal of Clinical Pharmacology and co-founder of the college. It is presented annually to an author publishing an outstanding research paper in the journal.
"Individualizing treatment plans for patients is not a new idea in medicine, but this is the first time this notion has been applied to improve glomerular diseases," says Briggs. "A major problem in caring for these patients has been the lack of reliable clinical or laboratory techniques for estimating a favorable response to treatment. Although our work is preliminary, further refinement of this technique might contribute to improved treatment results."
The award-winning article describes how researchers studied 16 patients with various diseases of the glomerulus, a network of blood capillaries that filter waste products from the blood into the kidneys. They tested different combinations of glucocorticoids (steroids) and cyclosporine (a drug that suppresses the immune system) on patients' white blood cells in tissue plates, and found a wide range of responses among the patients. Therefore, they concluded that such tests might assist physicians in developing a treatment strategy for their individual patients.
Further work in this area by the Hopkins team on additional patients has shown that some patients -- who previously had not been helped much by medication -- have responded quickly to medications found effective in the assays. Others have been helped by a lower dose of medication than previously thought necessary.
More investigation still needs to be done on this technique, says Briggs, because these types of tests do not necessarily predict how the drugs will respond inside the body. Patients who wish to volunteer for the studies can call (410) 955-5268.
The paper's other authors were Zu-Hua Gao, M.D.; Luis F. Gimenez, M.D.; Paul J. Scheel, Jr., M.D.; Michael J. Choi, M.D.; and James F. Burdick, M.D.
Journal
The Journal of Clinical Pharmacology