Mecanismos de acción de los fármacos inmunosupresores / Mechanisms of action of immunosuppressive drugs

Durante los últimos 50 años, muchos fármacos inmunosupresores han sido descritos, y sus mecanismos de acción se pueden dividir en: Reguladores de la expresión génica; Agentes alquilantes; Inhibidores de novo de la síntesis de purinas y pirimidinas, e Inhibidores de quinasas y fosfatasas. Los glucocorticoides ejercen su acción inmunosupresora y antiinflamatoria principalmente mediante la inhibición de la expresión de los genes de interleuquina-2 (IL-2) y otros mediadores. Los metabolitos derivados de Ciclofosfamida alquilanizan las bases de ADN y suprimen preferentemente la respuesta inmune (RI) mediada por linfocitos B (LB). Por su parte, el Metotrexato reprime las respuestas inflamatorias liberando adenosina; ésta induce la apoptosis de LT activos e inhibe la síntesis de purinas y pirimidinas. La Azatioprina inhibe varias enzimas implicadas en la síntesis de purinas, mientras que el Ácido micofenólico inhibe la inosina-monofosfato deshidrogenasa, con lo que agota los nucleótidos derivados de guanosina, induciendo la apoptosis de LT activados. Un metabolito de la Leflunomida suprime la dihidro-orotatedeshidrogenada y, consecuentemente, la síntesis de nucleótidos pirimidínicos. La Ciclosporina y el Tacrolimus inhiben la actividad de la Calcineurina, con lo que se suprime la producción de IL-2 y de otras citoquinas. Además, estos compuestos han demostrado bloquear las vías de señalización JNK y p38, activadas por el reconocimiento de antígenos en LT. Por el contrario, la Rapamicina inhibe quinasas celulares necesarias para el ciclo celular y las respuestas a IL-2; también induce la apoptosis de LT activos. Un futuro promisorio es derivado de la aplicación de fármacos inmunosupresores biológicos. El papel y mecanismos de acción de ellos serán discutidos aquí.

During the past 50 years, many immunosuppressive drugs have been described and their mechanisms of action can be organized in: Regulators of gene expression; Alkylating agents; Inhibitors of the novo purine and pyrimidine synthesis, and Inhibitors of kinases and phosphatases. Glucocorticoids exert immunosuppressive and anti-inflammatory activity mainly by inhibiting the expression of interleukin-2 (IL-2) genes and other mediators. Cyclophosphamide metabolites alkylate DNA bases and preferentially suppress immune responses mediated by B-lymphocytes. Methotrexate suppresses inflammatory responses through the release of adenosine; they suppress immune responses by inducing the apoptosis of activated T-lymphocytes and inhibit the synthesis of both purines and pyrimidines. Azathioprine metabolites inhibit several enzymes of purine synthesis. Mycophenolic acid inhibits inosine monophosphate dehydrogenase, thereby depleting guanosine nucleotides, inducing the apoptosis of activated T-lymphocytes. A Leflunomide metabolite inhibits dihydroorotate dehydrogenase, thereby suppressing pyrimidine nucleotide synthesis. Cyclosporine and Tacrolimus inhibit the phosphatase activity of Calcineurin, thereby suppressing the production of IL-2 and other cytokines. In addition, these compounds have recently been found to block the JNK and p38 signaling pathways triggered by antigen recognition in T-cells. In contrast, Rapamycin inhibits both kinases required for cell cycling and responses to IL-2; it also induces apoptosis of activated T-lymphocytes.A promising future is the application of biologic immunosuppressive drugs. We review their role and action mechanisms.

Lesch-Nyhan syndrome and purine and pyrimidine metabolism didorders / 한양의대학술지

Purine & pyrimidine nucleotides are basic constituents of cellular DNA and RNA polynucleotides. Their function includes regulation of cell metabolism and function, energy conservation and transport and formation of coenzymes and active intermediates of phospholipids and carbohydrate metabolism. The origin of cellular purines and pyrimidines is almost exclusively endogenous source, and the dietary purines play only a minor role. Diagnostic and clinical markers of purine and pyrimidine nucleotide disorders are the level of uric acid, xanthine, hypoxanthine, orotic acid, uracil, thymine, dihydrouracil, dihydrothymine, and succinyladenosine. Clinical manifestations of purine and pyrimidine metabolic disorders are crystalluria and acute renal failure, infections, failure to thrive, and anemia. One of purine metabolic disorders, Lesch-Nyhan disease, is X-linked recessive disorder, presenting motor delay, cerebral palsy, involuntary movements, self-injurious behavior, hyperurcemia, uricosuria, urinary calculi and gouty arthritis. Hypoxanthine-guanine phosphoribosyl transferase(HPRT) is deficient.