High-Dimensional Renal Profiling: Towards a Better Understanding of Renal Transplant Immune Suppression

Purpose of Review The goal of this review is to discuss new approaches to avoid calcineurin inhibitor (CNI)/corticosteroids (CCS) toxicities with a focus on new biologics and new methods to understand transplant rejection at the single-cell level. Recent Findings Recently developed biologics hold significant promise as the next wave of therapeutics designed to promote CNI/CCS-free long-term allograft acceptance. Indeed, belatacept, soluble CTLA4-Ig, is largely devoid of CNI-like toxicities, although it is accompanied by an increased frequency of acute rejection. Besides belatacept, other biologics hold promise as CNI-free immune suppressive approaches. Finally, powerful new single-cell approaches can enable characterization of cellular populations that drive rejection within the rejecting allograft. Summary We propose that the incorporated single-cell profiling into studies investigating new biologics in transplantation could be tailored to each patient, correlated with potential biomarkers in the blood and urine, and provide a platform where therapeutic targets can be rationally defined, mechanistically based, and exploited.