In Vivo Higher Glucuronidation of Mycophenolic Acid in Male Than in Female Recipients of a Cadaveric Kidney Allograft and Under Immunosuppressive Therapy With Mycophenolate Mofetil

2001 ◽  
Vol 23 (5) ◽  
pp. 520-525 ◽  
Author(s):  
Pierre Morissette ◽  
Caroline Albert ◽  
Stephan Busque ◽  
Gilles St-Louis ◽  
Bernard Vinet
2000 ◽  
Vol 46 (3) ◽  
pp. 365-372 ◽  
Author(s):  
Maria Shipkova ◽  
Ekkehard Schütz ◽  
Victor William Armstrong ◽  
Paul Dieter Niedmann ◽  
Michael Oellerich ◽  
...  

Abstract Background: The acyl glucuronide (AcMPAG) of mycophenolic acid (MPA) has been found to possess pharmacologic and potentially proinflammatory activity in vitro. To establish its pharmacologic and toxicologic relevance in vivo, a reversed-phase HPLC method was modified to simultaneously determine MPA, the phenolic MPA-glucuronide (7-O-MPAG), and AcMPAG. In addition, cross-reactivity of AcMPAG in the Emit assay for MPA was investigated. Methods: The procedure used simple sample preparation, separation with a Zorbax Eclipse-XDB-C8 column, and gradient elution. AcMPAG was quantified as 7-O-MPAG-equivalents. Results: The assay was linear up to 50 mg/L for MPA, 250 mg/L for 7-O-MPAG, and 10 mg/L for AcMPAG (r >0.999). Detection limits were 0.01, 0.03, and 0.04 mg/L for MPA, 7-O-MPAG, and AcMPAG, respectively. The recoveries were 99–103% for MPA, 95–103% for 7-O-MPAG, and 104–107% for AcMPAG. The within-day imprecision was <5.0% for MPA (0.2–25 mg/L), <4.4% for 7-O-MPAG (10–250 mg/L), and ≤14% for AcMPAG (0.1–5 mg/L). The between-day imprecision was <6.2%, <4.5%, and ≤14% for MPA, 7-O-MPAG, and AcMPAG, respectively. When isolated from microsomes, purified AcMPAG (1–10 mg/L) revealed a concentration-dependent cross-reactivity in an Emit assay for the determination of MPA ranging from 135% to 185%. This is in accordance with the bias between HPLC and Emit calculated in 270 samples from kidney transplant recipients receiving mycophenolate mofetil therapy, which was greater (median, 151.2%) than the respective AcMPAG concentrations determined by HPLC. AcMPAG was found to undergo hydrolysis when samples were stored up to 24 h at room temperature or up to 30 days at 4 °C or −20 °C. Acidified samples (pH 2.5) were stable up to 30 days at −20 °C. Conclusions: The HPLC and Emit methods for AcMPAG described here may allow investigation of its relevance for the immunosuppression and side effects associated with mycophenolate mofetil therapy.


2017 ◽  
Vol 3 (3) ◽  
pp. 00016-2017 ◽  
Author(s):  
Ayodeji Adegunsoye ◽  
Justin M. Oldham ◽  
Evans R. Fernández Pérez ◽  
Mark Hamblin ◽  
Nina Patel ◽  
...  

In chronic hypersensitivity pneumonitis (CHP), lack of improvement or declining lung function may prompt use of immunosuppressive therapy. We hypothesised that use of azathioprine or mycophenolate mofetil with prednisone reduces adverse events and lung function decline, and improves transplant-free survival.Patients with CHP were identified. Demographic features, pulmonary function tests, incidence of treatment-emergent adverse events (TEAEs) and transplant-free survival were characterised, compared and analysed between patients stratified by immunosuppressive therapy. A multicentre comparison was performed across four independent tertiary medical centres.Among 131 CHP patients at the University of Chicago medical centre (Chicago, IL, USA), 93 (71%) received immunosuppressive therapy, and had worse baseline forced vital capacity (FVC) and diffusing capacity, and increased mortality compared with those who did not. Compared to patients treated with prednisone alone, TEAEs were 54% less frequent with azathioprine therapy (p=0.04) and 66% less frequent with mycophenolate mofetil (p=0.002). FVC decline and survival were similar between treatment groups. Analyses of datasets from four external tertiary medical centres confirmed these findings.CHP patients who did not receive immunosuppressive therapy had better survival than those who did. Use of mycophenolate mofetil or azathioprine was associated with a decreased incidence of TEAEs, and no difference in lung function decline or survival when compared with prednisone alone. Early transition to mycophenolate mofetil or azathioprine may be an appropriate therapeutic approach in CHP, but more studies are needed.


The Lancet ◽  
1985 ◽  
Vol 325 (8436) ◽  
pp. 999-1002 ◽  
Author(s):  
Y Vanrenterghem ◽  
T Lerut ◽  
L Roels ◽  
J Gruwez ◽  
P Michielsen ◽  
...  

2010 ◽  
Vol 32 (1) ◽  
pp. 79-85 ◽  
Author(s):  
Maria Shipkova ◽  
Ekkehard Schütz ◽  
Ingo Besenthal ◽  
Peter Fraunberger ◽  
Eberhard Wieland

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