Abstract
CYTOTOXIC immunosuppressive agents have a longstanding important role in pharmacological immunosuppression. Azathioprine was among the first immunosuppressive drugs used in organ transplantation, and further development in this field was landmarked by the introduction of ALKYLATING AGENTS (i.e., cyclophosphamide) and ANTIMETABOLITES (i.e., fludarabine, METHOTREXATE and mycophenolic acid) in therapeutic regimens for the prevention of graft rejection (see chapter C12) and the treatment of AUTOIMMUNE DISEASES (see chapter C15) because of their well-documented lymphocytolytic effect.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Barshes NR, Goodpastor SE, Goss JA. Pharmacologic immunosuppression. Front Biosci 2004; 9: 411–420
Germani G, Pleguezuelo M, Villamil F, Vaghjiani S, Tsochatzis E, Andreana L, Burroughs AK. Azathioprine in liver transplantation: a reevaluation of its use and a comparison with mycophenolate mofetil. Am J Transplant 2009; 9: 1725–1731
Mueller XM Drug immunosuppression therapy for adult heart transplantation. Part 1: immune response to allograft and mechanism of action of immunosuppressants. Ann Thorac Surg 2004; 77: 354–362
Sauer H, Hantke U, Wilmanns W. Azathioprine lymphocytotoxicity. Potentially lethal damage by its imidazole derivatives. Arzneimittelforschung 1988; 38: 820–884
Evans WE. Pharmacogenetics of thiopurine S-methyltransferase and thiopurine therapy. Ther Drug Monit 2004; 26: 186–191
El-Azhary RA. Azathioprine: current status and future considerations. Int J Dermatol 2003; 42: 335–341
Gold R, Schneider-Gold C. Current and future standards in treatment of myasthenia gravis. Neurotherapeutics 2008; 5: 535–541
de Jong DJ, Goullet M, Naber TH Side effects of azathioprine in patients with Crohn’s disease. Eur J Gastroenterol Hepatol 2004; 16: 207–212
Marcen R, Pascual J, Tato AM, Teruel JL, Villafruela JJ, Fernandez M, Tenorio M, Burgos FJ, Ortuno J. Influence of immunosuppression on the prevalence of cancer after kidney transplantation. Transplant Proc 2003; 35: 1714–1716
Hengstler JG, Hengst A, Fuchs J, Tanner B, Pohl J, Oesch F. Induction of DNA crosslinks and DNA strand lesions by cyclophosphamide after activation by cytochrome P450 2B1. Mutat Res 1997; 373: 215–223
Allison AC. Immunosuppressive drugs: the first 50 years and a glance forward. Immunopharmacology 2000; 47: 63–83
Pette M, Gold R, Pette DF, Hartung HP, Toyka KV. Mafosfamide induces DNA fragmentation and APOPTOSIS in human T-lymphocytes. A possible mechanism of its immunosuppressive action. Immunopharmacology 1995; 30: 59–69
Sulkowska M, Sulkowski S, Skrzydlewska E, Farbiszewski R. Cyclophosphamide-induced generation of reactive oxygen species. Comparison with morphological changes in type II alveolar epithelial cells and lung capillaries. Exp Toxicol Pathol 1998; 50: 209–220
Alan V, Boddy AV, Yule SM. Metabolism and pharmacokinetics of oxazaphosphorines. Clin Pharmacokinet 2000; 38: 291–304
Rinaldi L, Perini P, Calabrese M, Gallo P. Cyclophosphamide as second-line therapy in multiple sclerosis: benefits and risks. Neurol Sci 2009; 30 Suppl 2: S171–S173
Esdaile JM. How to manage patients with lupus nephritis. Best Practice Res Clin Rheumatol 2002; 16: 195–210
Mosca M, Ruiz-Irastorza G, Khamashta MA, Hughes GRV. Treatment of systemic lupus erythematosus. Int Immunopharmacol 2001; 1: 1065–1075
Langford CA. Management of systemic vasculitis. Best Practice Res Clin Rheumatol 2001; 15: 281–297
Huang Z, Roy P, Waxman DJ. Role of human liver microsomal CYP3A4 and CYP2B6 in catalyzing N-dechloroethylation of cyclophosphamide and ifosfamide. Biochem Pharmacol 2000; 59: 961–972
Jinno H, Tanaka-Kagawa T, Ohno A, Makino Y, Matsushima E, Hanioka N, Ando M. Functional characterization of cytochrome P450 2B6 allelic variants. Drug Metab Dispos 2003; 31: 398–403
Giorgianni F, Bridson PK, Sorrentino BP, Pohl J, Blakley RL. Inactivation of aldophosphamide by human aldehyde dehydrogenase isozyme 3. Biochem Pharmacol 2000; 60: 325–338
Low SK, Kiyotani K, Mushiroda T, Daigo Y, Nakamura Y, Zembutsu H. Association study of genetic polymorphism in ABCC4 with cyclophosphamide-induced adverse drug reactions in breast cancer patients. J Hum Genet 2009; 54: 564–571
Montgomery JA, Hewson K. Nucleosides of 2-fluoroadenine. J Med Chem 1969; 12: 498–504
Molina-Arcas M, Bellosillo B, Casado FJ, Montserrat E, Gil J, Colomer D, Pastor-Anglada M. Fludarabine uptake mechanisms in B-cell chronic lymphocytic leukemia. Blood 2003; 101: 2328–2334
Gandhi V, Plunkett W. Cellular and clinical pharmacology of fludarabine. Clin Pharmacokinet 2002; 41: 93–103
Illei GG, Yarboro CH, Kuroiwa T, Schlimgen R, Austin HA, Tisdale JF, Chitkara P, Fleisher T, Klippel JH, Balow JE, Boumpas DT. Long-term effects of combination treatment with fludarabine and low-dose pulse cyclophosphamide in patients with lupus nephritis. Rheumatology 2007; 46: 952–956
Takada K, Danning CL, Kuroiwa T, Schlimgen R, Tassiulas IO, Davis JC Jr, Yarboro CH, Fleisher TA, Boumpas DT, Illei GG. Lymphocyte depletion with fludarabine in patients with psoriatic arthritis: clinical and immunological effects. Ann Rheum Dis 2003; 62: 1112–1115
Branagan TH. Current treatments of chronic immunemediated demyelinating polyneuropathies. Muscle Nerve 2009; 39: 563–578
Davis JC Jr, Fessler BJ, Tassiulas IO, McInnes IB, Yarboro CH, Pillemer S, Wilder R, Fleisher TA, Klippel JH, Boumpas DT. High dose versus low dose fludarabine in the treatment of patients with severe refractory rheumatoid arthritis. J Rheumatol 1998; 25: 1694–1704
Adams EM, Pucino F, Yarboro C, Hicks JE, Thornton B, McGarvey C, Sonies BC, Bartlett ML, Villalba ML, Fleisher T, Plotz PH. A pilot study: use of fludarabine for refractory dermatomyositis and polymyositis, and examination of endpoint measures. J Rheumatol 1999; 26: 352–360
Biasi D, Caramaschi P, Carletto A, Bambara LM. Unsuccessful treatment with fludarabine in four cases of refractory rheumatoid arthritis. Clin Rheumatol 2000; 19: 442–444
Bashey A. Immunosuppression with limited toxicity: the characteristics of nucleoside analogs and antilymphocyte antibodies used in non-myeloablative haematopoietic cell transplantation. Cancer Treat Res 2002; 110: 39–49
Hoffman PC. Immune hemolytic anemia – selected topics. Hematol Am Soc Hematol Educ Program 2009: 80–86
Serra M, Reverter-Branchat G, Maurici D, Benini S, Shen JN, Chano T, Hattinger CM, Manara MC, Pasello M, Scotlandi K, Picci P. Analysis of dihydrofolate reductase and reduced folate carrier gene status in relation to methotrexate resistance in osteosarcoma cells. Ann Oncol 2004; 15: 151–160
Fraser AG. Methotrexate: first-line or second-line immunomodulator? Eur J Gastroenterol Hepatol 2003; 15: 225–231
Grim J, Chládek J, Martínková J. Pharmacokinetics and pharmacodynamics of methotrexate in non-neoplastic diseases. Clin Pharmacokinet 2003; 42: 139–151
Zhao R, Goldman ID. Resistance to antifolates. Oncogene 2003; 22: 7431–7457
van Aubel RA, Smeets PH, Peters JG, Bindels RJ, Russel FG. The MRP4/ABCC4 gene encodes a novel apical organic anion transporter in human kidney proximal tubules: putative efflux pump for urinary cAMP and cGMP. J Am Soc Nephrol 2002; 13: 595–603
Warren RB, Chalmers RJ, Griffiths CE, Menter A. Methotrexate for psoriasis in the era of biological therapy. Clin Exp Dermatol 2008; 33: 551–554
Smolen JS, Landewé R, Breedveld FC, Dougados M, Emery P, Gaujoux-Viala C, Gorter S, Knevel R, Nam J, Schoels M, Aletaha D, Buch M, Gossec L, Huizinga T, Bijlsma JW, Burmester G, Combe B,Cutolo M, Gabay C, Gomez-Reino J, Kouloumas M, Kvien TK, Martin-Mola E, McInnes I, Pavelka K, van Riel P, Scholte M, Scott DL, Sokka T, Valesini G, van Vollenhoven R, Winthrop KL, Wong J, Zink A, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010; 69: 964–975
Kahn P. Juvenile idiopathic arthritis – current and future therapies. Bull NYU Hosp Jt Dis 2009; 67: 291–302
Lee YH, Song GG. Associations between the C677T and A1298C polymorphisms of MTHFR and the efficacy and toxicity of methotrexate in rheumatoid arthritis: a meta-analysis. Clin Drug Investig 2010; 30: 101–108
Borchers AT, Keen CL, Cheema GS, Gershwin ME. The use of methotrexate in rheumatoid arthritis. Semin Arthritis Rheum 2004; 34: 465–483
Ruperto N, Murray KJ, Gerloni V, Wulffraat N, de Oliveira SK, Falcini F, Dolezalova P, Alessio M, Burgos-Vargas R, Corona F, Vesely R, Foster H, Davidson J, Zulian F, Asplin L, Baildam E, Consuegra JG,Ozdogan H, Saurenmann R, Joos R, Pistorio A, Woo P, Martini A. A randomized trial of parenteral methotrexate comparing an intermediate dose with a higher dose in children with juvenile idiopathic arthritis who failed to respond to standard doses of methotrexate. Arthritis Rheum 2004; 50: 2191–2201
Smak Gregoor PJ, van Gelder T, Weimar W. Mycophenolate mofetil, Cellcept, a new immunosuppressive drug with great potential in internal medicine. Neth J Med 2000; 57: 233–246
Gabardi S, Tran JL, Clarkson MR. Enteric-coated mycophenolate sodium. Ann Pharmacother 2003; 37: 1685–1693
Srinivas TR, Kaplan B, Meier-Kriesche HU. Mycophenolate mofetil in solid-organ transplantation. Expert Opin Pharmacother 2003; 4: 2325–2345
Villarroel MC, Hidalgo M, Jimeno A. Mycophenolate mofetil: An update. Drugs Today 2009; 45: 521–532
Lui SL, Chan LY, Zhang XH, Zhu W, Chan TM, Fung PC, Lai KN. Effect of mycophenolate mofetil on nitric oxide production and inducible nitric oxide synthase gene expression during renal ischaemia-reperfusion injury. Nephrol Dial Transplant 2001; 16: 1577–1582
Kelly P, Kahan BD. Review: metabolism of immunosuppressant drugs. Curr Drug Metab 2002; 3: 275–287
Del Tacca M. Prospects for personalized immunosuppression: pharmacologic tools – a review. Transplant Proc 2004; 36: 687–689
Holt DW. Monitoring mycophenolic acid. Ann Clin Biochem 2002; 39: 173–183
Hale MD, Nicholls AJ, Bullingham RE, Hene R, Hoitsma A, Squifflet JP, Weimar W, Vanrenterghem Y, Van de Woude FJ, Verpooten GA. The pharmacokineticpharmacodynamic relationship for mycophenolate mofetil in renal transplantation. Clin Pharmacol Ther 1998; 64: 672–683
Mackenzie PI. Identification of uridine diphosphate glucuronosyl-transferases involved in the metabolism and clearance of mycophenolic acid. Ther Drug Monit 2000; 22: 10–13
Mele TS, Halloran PF. The use of mycophenolate mofetil in transplant recipients. Immunopharmacology 2000; 47: 215–245
Giessing M, Fuller TF, Tuellmann M, Slowinski T, Budde K, Liefeldt L. Steroid- and calcineurin inhibitor free immunosuppression in kidney transplantation: state of the art and future developments.World J Urol 2007; 25: 325–332
Koukoulaki M, Goumenos DS. The accumulated experience with the use of mycophenolate mofetil in primary glomerulonephritis. Expert Opin Investig Drugs 2010; 19: 673–687
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Birkhäuser Basel
About this chapter
Cite this chapter
Danesi, R., Bocci, G., Di Paolo, A., Parnham, M.J., Tacca, M.D. (2011). C11 Cytotoxic drugs. In: Nijkamp, F., Parnham, M. (eds) Principles of Immunopharmacology. Birkhäuser Basel. https://doi.org/10.1007/978-3-0346-0136-8_26
Download citation
DOI: https://doi.org/10.1007/978-3-0346-0136-8_26
Published:
Publisher Name: Birkhäuser Basel
Print ISBN: 978-3-0346-0135-1
Online ISBN: 978-3-0346-0136-8
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)