title: Mycophenolate mofetil combined with a cyclooxygenase-2 inhibitor ameliorates murine lupus nephritis.
abstract: BACKGROUND
  Approaches to the treatment of lupus nephritis include immunosuppressants associated with anti-inflammatory drugs, mainly steroids, which, however, cause major side effects. Mycophenolate mofetil (MMF) has been described as being less toxic than conventional immunosuppressants, and it was effective in preventing progressive nephritis in lupus mice. Our study evaluated the therapeutic effect of MMF in NZB/W F1 hybrid mice with established disease. We also examined the combination of MMF with a selective cyclooxygenase-2 (COX-2) inhibitor, DFU, based on previous findings of excessive renal production of COX-2-derived thromboxane A2 (TXA2) in lupus nephritis.
  
  
  METHODS
  Four groups of NZB/W mice (N = 30 each group), starting at five months of age, were given daily by gavage the following: vehicle, MMF 60 mg/kg, DFU 3 mg/kg, or MMF + DFU. Fifteen mice for each group were used for the survival studies, and the remaining mice were sacrificed at nine months.
  
  
  RESULTS
  MMF or DFU alone partially delayed the onset of proteinuria compared with vehicle. Combined therapy was significantly (P < 0.05) more effective than single drugs. Animal survival was partially ameliorated by MMF and significantly improved by the drug combination in comparison with the vehicle (P = 0.005) and DFU alone (P < 0.03). At nine months, serum blood urea nitrogen (BUN) levels were lower in all of the treated groups than in the vehicle group. Renal damage was also limited, but to a greater extent in mice given the combined therapy. In untreated mice, renal COX-2 mRNA expression was up-regulated, and generation of TXB(2), the stable breakdown product of TXA(2), increased. DFU prevented the abnormal renal TXB(2) production, confirming the COX-2 origin of this eicosanoid, whereas renal 6-keto-PGF(1 alpha) and prostaglandin E(2) (PGE(2)) were not affected substantially.
  
  
  CONCLUSIONS
  These results offer a strong case for exploring the possibility that in humans MMF combined with COX-2 inhibitors has a role in the treatment options for lupus nephritis. This combined drug therapy may be at least as effective as steroids but without the obvious nephrotoxicity of the latter.
authors.affiliation: Mario Negri Institute for Pharmacological Research, Bergamo, Italy. zoja@marionegri.it
authors.forename: C
authors.initials: C
authors.lastname: Zoja
authors.forename: A
authors.initials: A
authors.lastname: Benigni
authors.forename: M
authors.initials: M
authors.lastname: Noris
authors.forename: D
authors.initials: D
authors.lastname: Corna
authors.forename: F
authors.initials: F
authors.lastname: Casiraghi
authors.forename: M
authors.initials: M
authors.lastname: Pagnoncelli
authors.forename: D
authors.initials: D
authors.lastname: Rottoli
authors.forename: M
authors.initials: M
authors.lastname: Abbate
authors.forename: G
authors.initials: G
authors.lastname: Remuzzi
mesh_terms: D015121:6-Ketoprostaglandin F1 alpha / Q000652:urine; D000818:Animals; D000974:Antibodies, Antinuclear / Q000097:blood; D001806:Blood Urea Nitrogen; D051545:Cyclooxygenase 1; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000494:pharmacology*; D004195:Disease Models, Animal; D004359:Drug Therapy, Combination; D005260:Female; D005663:Furans / Q000494:pharmacology*; D015971:Gene Expression Regulation, Enzymologic / Q000502:physiology; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D007527:Isoenzymes / Q000037:antagonists & inhibitors / Q000235:genetics; D007668:Kidney / Q000502:physiology; D008181:Lupus Nephritis / Q000188:drug therapy* / Q000401:mortality; D018655:Lymphocyte Count; D016131:Lymphocyte Subsets; D008565:Membrane Proteins; D051379:Mice; D008814:Mice, Inbred NZB; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000494:pharmacology*; D011451:Prostaglandin-Endoperoxide Synthases / Q000235:genetics; D011507:Proteinuria / Q000188:drug therapy / Q000401:mortality; D013154:Spleen / Q000166:cytology; D015996:Survival Rate; D013929:Thromboxane B2 / Q000652:urine
chemical_list: C106876:5,5-dimethyl-3-(3-fluorophenyl)-4-(4-methylsulfonyl)phenyl-2(5H)-furanone; D000974:Antibodies, Antinuclear; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D005663:Furans; D007166:Immunosuppressive Agents; D007527:Isoenzymes; D008565:Membrane Proteins; D013929:Thromboxane B2; D015121:6-Ketoprostaglandin F1 alpha; D051545:Cyclooxygenase 1; D051546:Cyclooxygenase 2; D011451:Prostaglandin-Endoperoxide Synthases; C496512:Ptgs1 protein, mouse; D009173:Mycophenolic Acid