News & Views | Published:


IdeS to desensitize organ allograft recipients

Nature Reviews Nephrology volume 13, pages 666668 (2017) | Download Citation

HLA sensitization greatly increases the risk of transplant rejection and failure. An IgG endopeptidase derived from Streptococcus pyogenes (IdeS) may be an attractive new therapy for desensitization. Recent data indicate that IdeS effectively depletes anti-HLA IgG, creating a therapeutic window for successful renal transplantation in sensitized recipients.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.


All prices are NET prices.


  1. 1.

    , & The impact of donor-specific anti-HLA antibodies on late kidney allograft failure. Nat. Rev. Nephrol. 8, 348–357 (2012).

  2. 2.

    et al. Complete removal of extracellular IgG antibodies in a randomized dose-escalation phase I study with the bacterial enzyme IdeS — a novel therapeutic opportunity. PLoS One 10, e0132011 (2015).

  3. 3.

    et al. IgG endopeptidase in highly sensitized patients undergoing transplantation. N. Engl. J. Med. 377, 442–453 (2017).

  4. 4.

    et al. Quantifying the risk of incompatible kidney transplantation: a multicenter study. Am. J. Transplant. 14, 1573–1580 (2014).

  5. 5.

    et al. Post-listing survival for highly sensitised patients on the UK kidney transplant waiting list: a matched cohort analysis. Lancet 389, 727–734 (2017).

  6. 6.

    et al. Terminal complement inhibition decreases antibody-mediated rejection in sensitized renal transplant recipients. Am. J. Transplant. 11, 2405–2413 (2011).

  7. 7.

    et al. A phase I/II trial of the interleukin-6 receptor-specific humanized monoclonal (tocilizumab) + intravenous immunoglobulin in difficult to desensitize patients. Transplantation 99, 2356–2363 (2015).

  8. 8.

    , , , & The bacterial enzyme IdeS cleaves the IgG-type of B cell receptor (BCR), abolishes BCR-mediated cell signaling, and inhibits memory B cell activation. J. Immunol. 195, 5592–5601 (2015).

  9. 9.

    et al. Prospective iterative trial of proteasome inhibitor-based desensitization. Am. J. Transplant. 15, 101–118 (2015).

  10. 10.

    et al. Deceased donor kidney transplantation across donor-specific antibody barriers: predictors of antibody-mediated rejection. Nephrol. Dial. Transplant. 31, 1342–1351 (2016).

Download references

Author information


  1. Department of Medicine III, Medical University of Vienna, Währinger Gürtel 18–20, A-1090 Vienna, Austria.

    • Georg A. Böhmig
  2. Service de Néphrologie, Hémodialyse, Aphérèses et Transplantation, Centre Hospitalier Universitaire Grenoble-Alpes, Avenue du maquis du Grésivaudan, 38700 La Tronche, France.

    • Lionel Rostaing


  1. Search for Georg A. Böhmig in:

  2. Search for Lionel Rostaing in:

Competing interests

G.A.B. has received lecture fees from Fresenius and Miltenyi, who provide immunoadsorption devices for antibody depletion in transplantation. L.R. has received lecture fees from Fresenius and HaemaT, who provide apheresis technology for antibody elimination in transplantation.

Corresponding author

Correspondence to Georg A. Böhmig.

About this article

Publication history



Newsletter Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing