title: Assessment of immunosuppressive drug interactions: inhibition of lymphocyte function in peripheral human blood.
abstract: Cyclosporin (CsA) or tacrolimus (TRL) is routinely combined with either sirolimus (SRL) or mycophenolate mofetil (MMF) in immunosuppressive regimes in organ transplantation. The aim of our study was to establish a specific human blood assay of lymphocyte function in order to assess interactions of these drug combinations. Different concentrations (10(6)-10(9) nM) of CsA, TRL, SRL or mycophenolic acid (MPA, the active metabolite of MMF) was added to whole blood of five human volunteers. Drug combinations were studied by adding 250, 500 or 1000 nM of MPA to different concentrations of CsA, TRL, or SRL or by adding 1, 10 or 25 nM of SRL to different concentrations of CsA or TRL. After concanavalin-A stimulation, whole blood cultures were analyzed by flow cytometry detecting lymphocyte proliferation and activation by bivariate expression of proliferating cell nuclear antigen (PCNA)/DNA content and T cell-surface activation antigens (e.g. CD25, CD95, and CD154). We found an order of potency inhibiting lymphocyte function with SRL>TRL>CsA>MPA. In addition, we observed enhanced inhibition of PCNA, CD25, CD95 or CD154, if either CsA or TRL was combined with low concentrations of MPA, or SRL alone or if SRL was combined with low concentrations of MPA. Data analysis revealed an independent functional synergism or partial agonism in most combinations. This human blood assay is able to assess lymphocyte function and to monitor immunosuppressive therapy. The assay also permits pharmacological analysis of drug interactions, which will lead to improved safety and therapeutic efficacy in transplanted patients.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany. bartenm@medizin.uni-leipzig.de
authors.forename: Markus J
authors.initials: MJ
authors.lastname: Barten
authors.forename: Stefan
authors.initials: S
authors.lastname: Dhein
authors.forename: Hubert
authors.initials: H
authors.lastname: Chang
authors.forename: Hartmuth B
authors.initials: HB
authors.lastname: Bittner
authors.forename: Attila
authors.initials: A
authors.lastname: Tarnok
authors.forename: Axel
authors.initials: A
authors.lastname: Rahmel
authors.forename: Friederich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Jan F
authors.initials: JF
authors.lastname: Gummert
mesh_terms: D016572:Cyclosporine / Q000494:pharmacology; D004338:Drug Combinations; D004347:Drug Interactions; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D008213:Lymphocyte Activation / Q000187:drug effects; D008214:Lymphocytes / Q000187:drug effects* / Q000502:physiology; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D020123:Sirolimus / Q000494:pharmacology; D016559:Tacrolimus / Q000494:pharmacology
chemical_list: D004338:Drug Combinations; D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus