Measurement of mycophenolate mofetil effect in transplant recipients

Background. Immunosuppression involves the nature of the immunosuppressive agents and individual differences in patient factors. We investigated wheth er the effect of mycophenolate mofetil (MMF) is measurable using an in vitr o measure of immunocompetence and related its effects to cyclosporine (CsA) in vitro. Methods. Liver or kidney transplant recipients receiving prednisone; CsA or tacrolimus; and MMF, azathioprine (AZA), or neither, were studied. Immunoc ompetence was assessed by one-way mixed lymphocyte culture using patients' peripheral blood leukocytes (PBL) and three validated stimulators. The effe ct of immunosuppressive agents added in vitro on normal PBL stimulation by Staphylococcus enterotoxin B was determined by the carboxyfluorescein diace tate succinimidyl ester measurement of division. Results. Patients receiving MMF had an average immunocompetence level of 12 +/- 23, compared with 39.7 +/- 65 and 25.5 +/- 42 for those receiving AZA or neither AZA nor MMF, respectively. Thus, there was an approximately 80% suppression of the response in the MMF group. Assessment of normal cell div ision revealed that CsA allowed multiple cell generations but suppressed th e numbers of cells in each, whereas MMF blocked proliferation into subseque nt generations. Addition of clinically relevant levels of mycophenolic acid , the active agent for MMF, added to more moderate levels of CsA, was requi red to achieve greater than 80% suppression, consistent with the degree of immunocompetence depression measured in patients. Conclusions. These data provide the novel finding that the effect of MMF tr eatment on patients is measurable in their PBL as decreased immunocompetenc e in vitro. The effect of MMF on normal PBL approximates the 80% inhibition that we found in patients. Moreover, the effect of MW on cell division pro vides a rationale for the superior effectiveness of regimens including MMF.