Mycophenolate mofetil: therapeutic applications in kidney transplantation and immune-mediated renal disease

The immunosuppressant mycophenolate mofetil (MMF) inhibits the enzyme inosi ne-5' monophosphate dehydrogenase and thus interferes with cellular GTP syn thesis. MMF suppresses the cellular and humoral immune response and has ant iproliferative effects on vascular smooth muscle and mesangial cells in vit ro and in vivo. In large multicenter trials with almost 1500 patients MMF h as been proven highly efficacious for transplant rejection prophylaxis with the main side-effects of gastrointestinal disorders and a slightly increas ed incidence of viral infections, Recent investigations suggest MMF as an a lternative immunosuppressant in cyclosporin A nephrotoxicity. Preliminary o bservations show promising results for MMF in the treatment of autoimmune-m ediated renal disease. The rationale for its use in this patient group and evidence from experimental studies are discussed. As current therapy of thi s disease entity is still unsatisfactory, future clinical trials are necess ary to investigate the efficacy and safety of MMF for this new indication. Curr Opin Nephrol Hypertens 8:1-6, (C) 1999 Lippincott Williams & Wilkins.