Abstract: FR-PO1233
Improvement of Calciphylaxis Lesions with Tocilizumab, a US Food and Drug Administration (FDA)-Approved IL-6R Inhibitor, in a Patient with CKD
Session Information
- Transplantation: Clinical - Rejection, Biomarkers, and Pharmacology
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- O'Neill-Dee, Connor, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States
- Francis, Jean M., Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States
- Chitalia, Vipul C., Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, United States
Introduction
Calciphylaxis is a catastrophic dermal disorder in CKD patients with microvascular thrombosis resulting in painful cutaneous necrosis with no approved therapies. We hypothesized that thrombosis, not calcification, is the final pathogenic event driving ischemic dermal necrosis. This work resulted in the first human tissue–level evidence demonstrating that interleukin-6 (IL-6)–driven endothelial activation and tissue factor (TF)–mediated microvascular thrombosis constituted a central disease axis. Based on this molecular framework, we hypothesized that tocilizumab may have therapeutic benefits for calciphylaxis
Case Description
We report a 62-year-old woman with a failed kidney transplant and a diagnosis of calciphylaxis supported by skin biopsy refractory to sodium thiosulfate. The patient presented with both new crops of excruciating, painful, erythematous, violaceous lesions on her thigh and old ulcerated lesions on her buttocks. Skin biopsy showed strong IL-6 and TF staining in thrombosed dermal microvessels. With IRB approval and FDA IND exempt status, we used tocilizumab to treat the patient’s calciphylaxis lesions. Tocilizumab produced immediate pain relief, reduced analgesic burden, and improved the new lesions after two doses (Figure 1) but did not improve the ulcerated lesions. Lesions recurred after discontinuation of tocilizumab.
Discussion
This case provides first-in-human evidence that IL6 blockade may modify the biology of calciphylaxis. Pain is a major driver of morbidity, hospitalization, and end-of-life decisions in calciphylaxis. The immediate and reproducible pain relief and reduction of analgesic burden following tocilizumab, preceding visible lesion regression, suggest a therapeutic effect that extends beyond lesion improvement. Moreover, dynamic measurements of IL-6 and TF activity in endothelial cells in response to serum may serve as mechanistically grounded biomarkers of disease activity and therapeutic response, supporting further exploration of IL-6- targeted interventions for this devastating condition.