title: Influence of mycophenolic acid and tacrolimus on homocysteine metabolism.
abstract: BACKGROUND
  The effect of mycophenolate mofetil (MMF) on homocysteine (Hcy) metabolism is unknown.
  
  
  METHODS
  This in vitro study examined whether mycophenolic acid or tacrolimus influences the formation of Hcy as determined by measuring the total Hcy (tHcy) concentrations in supernatants of human renal proximal tubule epithelial cells. Cells were incubated with and without vitamins (folate, vitamin B6 and B12) in the presence of low or high methionine concentrations at different mycophenolic acid (0, or 5, or 20 microg/mL) or tacrolimus (0, or 10, or 25 ng/mL) concentrations for 24, 48 or 72 hours. The concentration of tHcy in culture supernatants was measured by a fluorescence polarization immunoassay. The effect of MMF on tHcy plasma levels was also examined in 454 kidney graft recipients.
  
  
  RESULTS
  Comparisons of tHcy levels in culture supernatants over time by four way ANOVA showed that methionine concentration (P < 0.00001), time (P < 0.00001), vitamins (P = 0.002728), and mycophenolic acid concentration (P = 0.000095) were all significant predictors of tHcy concentrations. This was due to significantly lower tHcy levels with using mycophenolic acid at a high concentration versus control at the 48- and 72-hour time points. By contrast, tacrolimus showed no effect in vitro. Among the kidney graft recipients, male patients on MMF therapy showed lower plasma tHcy concentrations as compared to those on azathioprine (P = 0.03).
  
  
  CONCLUSIONS
  Our study suggests a tHcy lowering effect of MMF in male transplant recipients, which improves the cardiovascular disease risk profile, whereas tacrolimus showed no effect.
authors.affiliation: Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Wien, Austria. michaela.ignatescu@nephro.imed3.akh-wien.ac.at
authors.forename: Mihaela C
authors.initials: MC
authors.lastname: Ignatescu
authors.forename: Josef
authors.initials: J
authors.lastname: Kletzmayr
authors.forename: Manuela
authors.initials: M
authors.lastname: Födinger
authors.forename: Christian
authors.initials: C
authors.lastname: Bieglmayer
authors.forename: Walter H
authors.initials: WH
authors.lastname: Hörl
authors.forename: Gere
authors.initials: G
authors.lastname: Sunder-Plassmann
mesh_terms: D000328:Adult; D002478:Cells, Cultured; D004791:Enzyme Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy / Q000378:metabolism; D006710:Homocysteine / Q000378:metabolism*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000188:drug therapy / Q000378:metabolism; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016030:Kidney Transplantation; D007687:Kidney Tubules, Proximal / Q000166:cytology / Q000187:drug effects* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000494:pharmacology*; D016559:Tacrolimus / Q000008:administration & dosage / Q000494:pharmacology*
chemical_list: D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D006710:Homocysteine; D009173:Mycophenolic Acid; D016559:Tacrolimus