title: A tacrolimus-related immunosuppressant with reduced toxicity.
abstract: BACKGROUND
  Tacrolimus (FK506) has potent immunosuppressive properties reflecting its ability to block the transcription of lymphokine genes in activated T cells through formation of a complex with FK506 binding protein-12, which inhibits the phosphatase activity of calcineurin. The clinical usefulness of tacrolimus is limited, however, by severe adverse effects, including neurotoxicity and nephrotoxicity. Although this toxicity, like immunosuppression, appears mechanistically related to the calcineurin inhibitory action of the drug, a large chemistry effort has been devoted to search for tacrolimus analogs with reduced toxicity but preserved immunosuppressive activity that might have enhanced therapeutic utility.
  
  
  METHODS
  Here, we report on the identification of such an analog, which was synthetically derived from ascomycin (ASC), the C21 ethyl analog of tacrolimus, by introducing an indole group at the C32 position. The profile of biological activity of indolyl-ASC was characterized in rodent models of immunosuppression and toxicity.
  
  
  RESULTS
  Indolyl-ASC was found to exhibit an immunosuppressive potency equivalent to that of tacrolimus in T-cell activation in vitro and in murine transplant models, even though indolyl-ASC bound about 10 times less to intracellular FK506 binding protein-12 than tacrolimus or ASC. Further evaluation of indolyl-ASC revealed that it is threefold less potent than tacrolimus in inducing hypothermia, a response that may reflect neurotoxicity, and in causing gastrointestinal transit alterations in mice. Moreover, indolyl-ASC was at least twofold less nephrotoxic than tacrolimus upon 3-week oral treatment in rats.
  
  
  CONCLUSIONS
  Altogether, these data indicate a modest but definite improvement in the therapeutic index for indolyl-ASC compared with tacrolimus in rodent models.
authors.affiliation: Department of Immunology Research, Merck Research Laboratories, Rahway, New Jersey 07065, USA. francis_dumont@merck.com
authors.forename: F J
authors.initials: FJ
authors.lastname: Dumont
authors.forename: S
authors.initials: S
authors.lastname: Koprak
authors.forename: M J
authors.initials: MJ
authors.lastname: Staruch
authors.forename: A
authors.initials: A
authors.lastname: Talento
authors.forename: G
authors.initials: G
authors.lastname: Koo
authors.forename: C
authors.initials: C
authors.lastname: DaSilva
authors.forename: P J
authors.initials: PJ
authors.lastname: Sinclair
authors.forename: F
authors.initials: F
authors.lastname: Wong
authors.forename: J
authors.initials: J
authors.lastname: Woods
authors.forename: J
authors.initials: J
authors.lastname: Barker
authors.forename: J
authors.initials: J
authors.lastname: Pivnichny
authors.forename: I
authors.initials: I
authors.lastname: Singer
authors.forename: N H
authors.initials: NH
authors.lastname: Sigal
authors.forename: A R
authors.initials: AR
authors.lastname: Williamson
authors.forename: W H
authors.initials: WH
authors.lastname: Parsons
authors.forename: M
authors.initials: M
authors.lastname: Wyvratt
mesh_terms: D000818:Animals; D001806:Blood Urea Nitrogen; D001831:Body Temperature / Q000187:drug effects; D002455:Cell Division / Q000187:drug effects; D005260:Female; D007166:Immunosuppressive Agents / Q000494:pharmacology* / Q000633:toxicity; D015759:Ionomycin / Q000494:pharmacology; D007668:Kidney / Q000187:drug effects / Q000473:pathology; D008297:Male; D051379:Mice; D008807:Mice, Inbred BALB C; D008810:Mice, Inbred C57BL; D051381:Rats; D011918:Rats, Inbred SHR; D017207:Rats, Sprague-Dawley; D016559:Tacrolimus / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000633:toxicity; D013961:Thyroid Gland / Q000637:transplantation
chemical_list: D007166:Immunosuppressive Agents; D015759:Ionomycin; C110188:32-O-(1-hydroxyethylindol-5-yl)ascomycin; D016559:Tacrolimus