Calcineurin inhibitors (CNI), including oral cyclosporin A and tacrolimus, are intensive immunosuppressants that are extensively used in the treatment of rheumatic and immunologic diseases in China. CNI selectively inhibit the activation and proliferation of T lymphocytes and the transcription of cytokines [such as tumor necrosis factor-α, interleukin (IL)-6, and IL-17] through inhibiting the activation of calcineurin in cells and reducing the release of IL-2. To standardize the use of CNI in the field of rheumatic and immunologic diseases, this consensus statement was developed by the National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), in conjunction with the Chinese Association of Rheumatology and Immunology Physicians, the Chinese Research Hospital Association, the Rheumatology and Immunology Professional Committee, and the Chinese Association of Rehabilitation Medicine. The 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence was used to rate the quality of the evidence and the strength of the recommendations, and the RIGHT (Reporting Items for practice Guidelines in HealThcare) checklist was followed to report the consensus. The consensus offers recommendations addressing nine clinical challenges to Chinese clinicians. The primary objective of this consensus is to deliver scientific and detailed guidance on CNI for Chinese clinicians, and to improve the quality of patient-centered medical services.
Humans ; Calcineurin Inhibitors/pharmacology* ; Immunosuppressive Agents/therapeutic use* ; Tacrolimus/pharmacology* ; T-Lymphocytes ; Immune System Diseases ; Rheumatic Diseases/drug therapy*

Two intracellular signal pathways mediated by cAMP and protein kinase C (PKC) were involved in the regulation of FN gene expression (Lee et al., Exp. Mol. Med. 30: 240, 1998). In this study, a possible involvement of protein phosphatase-dependent pathways in the regulation of FN gene expression was investigated by using protein phosphatase type 2B (PP2B) inhibitors, cyclosporin A and ascomycin. Both cyclosporin A and ascomycin increased the levels of FN mRNA in WI-38 human lung fibroblasts and the SV40-transformed WI-38 cells but not in MC3T3-E1 osteoblasts. The expression of FN appears to increase from six hours up to 48 hours after treatment suggesting that it is not an immediate effect. In addition, this effect required a new protein synthesis. Neither cyclosporin A nor ascomycin affects the phorbol myristate acetate (PMA)-induced stimulation of FN gene expression and the same result occurred in vice versa suggesting the mechanism of PMA and cyclosporin A/ascomycin in the regulation of FN gene expression may share a common downstream pathway. Taken together, this study suggests that PP2B is involved in the regulation of FN gene expression in normal and transformed fibroblasts but not in osteoblasts.
Animal ; Calcineurin/antagonists & inhibitors* ; Cell Line, Transformed ; Cell Transformation, Viral ; Cyclosporine/pharmacology* ; Enzyme Inhibitors/pharmacology ; Fibroblasts ; Fibronectins/metabolism ; Fibronectins/genetics* ; Gene Expression Regulation* ; Human ; Lung/cytology ; Mice ; Osteoblasts ; Tacrolimus/pharmacology ; Tacrolimus/analogs & derivatives*

Calcineurin inhibitors, tacrolimus and cyclosporine, characterized by a narrow therapeutic index and a high variability in pharmacokinetic behaviors, are 2 basic immunosuppressive drugs widely used in solid organ transplantation. Tailoring of immunosuppressive drug therapy to the specific requirements of individual patients to optimize the efficacy and minimize the toxicity remains one of the biggest challenges for doctors in solid organ transplantation. Pharmacogenetic and pharmacogenomic researches, studying the effect of genetic polymorphism encoding drug metabolizing enzymes, drug transporters and pharmacological target molecules on drug disposition and action, hold promise to produce useful clinical tools for individualizing immunosuppressive therapy.
Animals ; Calcineurin Inhibitors ; Cyclosporine ; pharmacokinetics ; pharmacology ; Cytochrome P-450 CYP3A ; genetics ; Humans ; Immunosuppressive Agents ; pharmacokinetics ; pharmacology ; Organ Transplantation ; Polymorphism, Genetic ; Tacrolimus ; pharmacokinetics ; pharmacology

OBJECTIVEImmunosuppressant tacrolimus (FK506) has shown neuroprotective effects on hypoxic-ischemic brain damage (HIBD) in the adult animal model. This study investigated whether FK506 has a protection against HIBD in neonatal rats by examining growthjassociated protein-43 (GAP-43) expression in the hippocampus.

METHODSNinety-six seven-day-old Sprague-Dawley rats were randomly divided into three groups: sham-operation, HIBD and FK506 intervention group. HIBD was induced in the later two groups. The FK506 intervention group was intraperitoneally injected with FK506 immediately after HIBD, at a dosage of 1 mg/kg daily, for three days. The HIBD group was injected with normal saline. Immunohistochemical technical was applied to examine GAP-43 expression in the hippocampus 24 and 72 hrs and 7 and 14 days after HIBD.

RESULTSCompared with the HIBD group, hematoxylin-eosin staining showed attenuated neuronal necrosis in the FK506 intervention group. In the HIBD group, the expression of GAP-43 increased significantly 72 hrs, and 7 and 14 days after HIBD compared with that in the sham-operation group. The GAP-43 expression in the FK506 intervention group was significantly higher than that in the HIBD group 72 hrs and 7 days after HIBD.

CONCLUSIONSFK506 might have neuroprotective effects against HIBD in neonatal rats.

Animals ; Animals, Newborn ; GAP-43 Protein ; analysis ; Hippocampus ; chemistry ; drug effects ; Hypoxia-Ischemia, Brain ; drug therapy ; metabolism ; pathology ; Immunosuppressive Agents ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Tacrolimus ; pharmacology

OBJECTIVETo explore the neuroprotective effect of FK506 on acute spinal cord injury in dogs.

METHODSAcute spinal cord injury model was made with the Allen technique. Animals were randomly divided into 3 groups. Group A (n = 8) was the control group and received operation but no therapy, while group B and C (n = 8) received a single dose of FK506 (0.18 mg/kg and 0.3 mg/kg, respectively) administered with an arterial duct 2 h after spinal cord injury (SCI). Spine MRI, neurological function, histopathological examination of injured spinal cord and immunohistochemical examination of expression of NF(200) in neurons and GFAP in astrocytes were assessed at certain time after injury.

RESULTSNeurological function score of group C and B was better than that of group A (P < 0.05), with significance between group C and A, while no significance between group B and A statistically. The signal scope of spinal cord injury on MRI in group C was the smallest among all the groups, and the signal scope in group B was smaller than that in group A, which was directively associated with the neurological outcome. The expression of NF and GFAP was significantly higher in group C than in group A (P < 0.05), but without statistical significance between group B and A.

CONCLUSIONLocal administration of FK506 (0.3 mg/kg) possesses neuroprotective effect on acute spinal cord injury, which can improve neurological function recovery and attenuate secondary spinal cord injury. Local administration of FK506 possesses a dosage-effect relation.

Acute Disease ; Animals ; Disease Models, Animal ; Dogs ; Female ; Male ; Neuroprotective Agents ; pharmacology ; therapeutic use ; Random Allocation ; Spinal Cord Injuries ; drug therapy ; Tacrolimus ; pharmacology ; therapeutic use

OBJECTIVETo explore the effect of tacrolimus on murine hair follicle cycle.

METHODHematoxylin-eosin dyeing and reverse transcription-polymerase chain raction techniques were used.

RESULTSFive days after depilation, the hair follicles in both the tacrolimus group and the minoxidil group was in anagen V, while that in the vaseline group was in anagen III. vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) were detected in back skin in both the tacrolimus group and the minoxidil group, but not in the vaseline group.

CONCLUSIONTacrolimus can promote the growth of hair by stimulating the hair follicle to enter anagen V in mice, which may be explained by the effects of VEGF and HGF.

Animals ; Hair Follicle ; drug effects ; physiology ; Hepatocyte Growth Factor ; metabolism ; Mice ; Mice, Inbred C57BL ; Minoxidil ; pharmacology ; Skin ; drug effects ; metabolism ; Tacrolimus ; pharmacology ; Vascular Endothelial Growth Factor A ; metabolism

OBJECTIVETo observe the change of Th immunological gene in renal transplant recipients after the treatment of cyclosporine (CsA) and tacrolimus (FK506).

METHODSThe peripheral blood lymphacytes just before and 24 hours after CsA and FK506 treatment were isolated. The total RNA of them were reverse-transcripted and examined by real-time quantity PCR array. The results were analyzed by bioinformatic methods.

RESULTSThe TLR4, CEBPB, IL4R, IL1R1,IL18R1,and IL1R2 genes were remarkably upregulated, whereas IL-2, CCL5, CD27, CCR5, CCR4, CD4, RPL13A, TGFB3, CD86, CCR3, STAT1, NFATC2IP, IL23A, IL15, IRF4, and TFCP2 were downregulated 24 hours after CsA treatment. The IL18, IL7, PTPRC, TNFSF4, SPP1, GFI1, TLR4, IL13RA1, TNF, INHBA, LAG3, IL13, IL1R1, SOCS5, IL10, YY1, TBX21, FASLG, IL18R1, and IL1R2 genes were remarkably upregulated, whereas IL-2, IL-3, IL-4, IL-6,CCR5, CD4, CD27, CD40LG, IL15, CCR3, CD86, CCR4, and IRF4 were obviously downregulated 24 hours after FK506 treatment.

CONCLUSIONCsA and FK506 exert their therapeutic effectiveness by regulating the expressions of a series of target genes.

Cyclosporine ; pharmacology ; Cytokines ; genetics ; metabolism ; Gene Expression Regulation ; Humans ; Kidney ; drug effects ; metabolism ; Kidney Transplantation ; Oligonucleotide Array Sequence Analysis ; T-Lymphocytes, Helper-Inducer ; drug effects ; metabolism ; Tacrolimus ; pharmacology

OBJECTIVETo study the effects of different immunodepressants on the sperm parameters of kidney transplant recipients.

METHODSIn 15 healthy fertile men and 37 kidney transplant recipients, ejaculates were aseptically obtained by masturbation. Thirty-seven patients were divided into two groups, 20 patients were treated with Prograf (FK506) combination with mycophenolate mofetil (MMF) and prednisone; 17 patients were treated with cyclosporine (CsA) combination with azathioprine with prednisone. The sperm viability, mobility parameters such as prorsad percentage motility, straight line velocity (VSL), curve line velocity (VCL), velocity of average path (VAP) and morph were estimated with a computer-assisted sperm analyzer (CASA) provided with a multiple-exposure photography system.

RESULTSThere were no significant difference in sperm viability rate [(81.7 +/- 5.7)%, (79.4 +/- 6.8)% and (83.8 +/- 6.0)%], VCL [(24.1 +/- 8.6)%, (23.9 +/- 4.4)%, (24.8 +/- 4.2)% ] and VAP [(19.7 +/- 6.6)%, (18.6 +/- 2.9)%, (21.0 +/- 4.0)%] among groups of FK506, CsA and control, respectively (P > 0.05). The rate of anomaly [(67.8 +/- 5.7)%], the prorsad percentage motility [(46.4 +/- 8.1)%] and VSL [(15.4 +/- 4.6)%] in the group of FK506 were respectively significantly lower and higher than those in the group of CsA [(80.1 +/- 5.6%, (33.3 +/- 6.4)%, (10.2 +/- 2.4)%] (P < 0.05).

CONCLUSIONThe application of FK506 combined with MMF could help recover the mobility and morphology of the sperm in kidney transplantation recipients.

Adolescent ; Adult ; Case-Control Studies ; Cyclosporine ; pharmacology ; Drug Therapy, Combination ; Humans ; Immunosuppressive Agents ; pharmacology ; Kidney Transplantation ; Male ; Mycophenolic Acid ; analogs & derivatives ; pharmacology ; Prednisone ; pharmacology ; Sperm Motility ; drug effects ; Tacrolimus ; pharmacology

OBJECTIVE: To investigate the effects of inflammation cytokines, (FK506) and cyclosporine (CSA) on albumin secretion, and the effects of FK506 and CSA on the IL-6 induced suppression of albumin synthesis in cultured human hepatocytes. METHODS: Human hepatoma cell lines (HepG2 cells) were separately cultured with IL-6, IL-2 and IL-10 (0 approximately 10 microg/L) and FK506, CSA (0 approximately 100 microg/L) for 48 h. In another experiment, HepG2 cells were stimulated with different doses of FK506 and CSA (0 approximately 10 microg/L) in the presence of IL-6 (5 microg/L) for 48 h. Albumin levels in the supernatant of all groups were measured by radioimmunoassay (RIA). The concentration of LDH secreted by cells stimulated with FK506 and CSA were detected with spectrophotometry. RESULTS: For cultured HepG2 cells, IL-6 significantly decreased albumin levels in a dose-dependent manner (P <0.01), and the maximal inhibition occurred at 5 microg/L. CSA mildly decreased albumin levels and a significant reduction in albumin production was first visible at 10 microg/ L (P <0.05). In contrast, IL-2, IL-10 and FK506 did not significantly influence albumin pro- duction (P > 0.05). FK506 obviously decreased LDH levels in the supernatant (P < 0.05) and attenuated IL-6 induced suppression of albumin synthesis (P < 0.01). But CSA slightly increased LDH concentration and could not block the IL-6 induced decrease of albumin synthesis (P > 0.05). CONCLUSION IL-6 but not IL-2 and IL-10 suppressed the production of hepatic albumin in vitro. FK506 protected against the suppression of hepatic albumin synthesis caused by IL-6, suggesting its potential role in improving hypoalbuminaemia in immune glomerulonephritis.
Albumins ; metabolism ; Carcinoma, Hepatocellular ; metabolism ; pathology ; Cyclosporine ; pharmacology ; Hepatocytes ; physiology ; Humans ; Interleukin-10 ; pharmacology ; Interleukin-2 ; pharmacology ; Interleukin-6 ; pharmacology ; Liver Neoplasms ; metabolism ; pathology ; Tacrolimus ; pharmacology ; Tumor Cells, Cultured

OBJECTIVETo investigate the stimulating effect of recombinant human hepatocyte growth factor (rhHGF) on the expression of matrix metalloproteinase-9 (MMP-9) in ECV304 cells and the suppression effect of FK506.

METHODSThe growth curve of ECV304 cells was drawn and the valid concentration of rhHGF and FK506 were determined. The expression levels of MMP-9 were analyzed by flow cytometry (FCM).

RESULTS(1) The optimal growth concentration of ECV304 cell was 1.0E+4/ml and logarithm growth time was 3-5 days. The valid concentration of rhHGF was 8 ng/ml and IC50 was 8.27 ng/ml. The valid concentration of FK506 was 50 ng/ml and IC50 was 51.63 ng/ml. (2) The expression level of MMP-9 was 39.74% in controls. Cell livability was 1.388169 +/-0.102033 (P<0.01) when 8 ng/ml rhHGF was added to culture medium, and the expression level of MMP-9 was 40.32%. Cell livability was 0.398764 +/-0.092476 (P<0.01) when 50 ng/ml FK506 was added to culture medium, and the expression level of MMP-9 was 14.61%. Cell livability was 0.767203 +/-0.02639 (P<0.01) when 8 ng/ml rhHGF was added 15 minutes after 50 ng/ml FK506 was added to culture medium, and the expression level of MMP-9 was 35.08%.

CONCLUSIONrhHGF can stimulate the proliferation of ECV304 cells and increase the protein expression level of MMP-9. FK506 can suppress the proliferation of ECV304 cells and decrease the expression level of MMP-9. FK506 can inhibit the proliferation of ECV304 cells induced by rhHGF and decrease MMP-9 protein level.

Cell Division ; drug effects ; Cell Line ; Endothelial Cells ; cytology ; metabolism ; Flow Cytometry ; Hepatocyte Growth Factor ; pharmacology ; Humans ; Immunosuppressive Agents ; pharmacology ; Matrix Metalloproteinase 9 ; biosynthesis ; Recombinant Proteins ; pharmacology ; Skin ; metabolism ; Tacrolimus ; pharmacology