Anti-inflammatory agents, specifically corticosteroids, are frequently used to reduce the inflammatory reaction to organ allografts. The proposed mechanism of action of these natural hormones and their synthetic analogues is to block the synthesis and secretion of cytokines, including tumor necrosis factor (TNF) and IL-1, and other inflammatory mediators, such as prostaglandins, reactive oxygen species, and nitric oxide, produced by macrophages and other inflammatory cells. The net result of this therapy is reduced leukocyte recruitment, inflammation, and graft damage. Very high doses of corticosteroids may inhibit T cell secretion of cytokines or even kill some T cells, but it is unlikely that the levels of corticosteroids achieved in vivo act in this way. Newer anti-inflammatory agents are in clinical trials, including soluble cytokine receptors and anticytokine antibodies.
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