guanosine-triphosphate and Kidney-Failure--Chronic

MMF (mycophenolate mofetil) has been proven to provide an effective immunosuppression by non-competitive selective reversible inhibition of IMPDH (inosine monophosphate dehydrogenase), the enzyme playing a crucial role in GTP biosynthesis. However, the exact metabolic changes induced by inhibition of IMPDH in target cells of the immune system have been the subject of recent debate. The aim of the present study was to evaluate whether MMF treatment produced sustained changes in the guanosine nucleotide pool of MNLs (mononuclear leucocytes) in vivo. Sixty-two renal failure patients were divided into three groups: chronic renal failure patients undergoing haemodialysis (CRF-HD; n=20) and two groups of patients after renal transplantation, the first on AZA (azathioprine; TN-AZA; n=23) and the second treated with MMF (TN-MMF; n=19). In addition, MNLs from 25 healthy subjects were analysed as controls. Anion-exchange HPLC was used to quantify purine and pyrimidine nucleotides in MNLs. We report a significant decrease in GTP and the total MNL guanine nucleotide pool in the TN-MMF group (P<0.05) compared with control, CRF-HD and TN-AZA groups, although no significant differences were found between any of the other groups. Adenine nucleotide concentrations in MNLs were decreased in the TN-AZA group, but not in the TN-MMF group compared with the CRF-HD group and controls. There were no differences in CTP concentrations, but UTP concentrations were decreased in the CRF-HD, TN-AZA and TN-MMF groups compared with controls. MMF caused a significant and sustained decrease in the guanine nucleotide pool in MNLs from renal transplant recipients. This decrease contrasts with the elevation in GTP reported in erythrocytes of MMF-treated patients.

Topics: Adolescent; Adult; Aged; Azathioprine; Child; Drug Administration Schedule; Enzyme Inhibitors; Female; Guanosine Triphosphate; Humans; Immunosuppressive Agents; IMP Dehydrogenase; Kidney Failure, Chronic; Kidney Transplantation; Leukocytes, Mononuclear; Male; Middle Aged; Mycophenolic Acid; Postoperative Period; Purine Nucleotides; Pyrimidine Nucleotides

Therapy of renal anaemia in haemodialysis patients with chronic renal failure by application of recombinant human erythropoietin leads to an increase of the haematocrit. Rejuvenation of the erythrocyte population results in a decrease of the median density (D50), an increase of cell age-dependent enzyme activities, such as aspartate aminotransferase, and elevated concentrations of purine nucleotides in the erythrocytes. After density gradient separation of erythrocyte populations into cell age-dependent fractions, the concentrations of adenosine-5'-triphosphate, guanosine-5'-triphosphate and guanosine-5'-diphosphate were be found to be elevated by 25-100% in all cell fractions from haemodialysis patients, compared with a healthy control group. Therapy of haemodialysis patients with recombinant human erythropoietin leads to further increase (65%) of ATP in the younger (low density) cells, but not in the older (high density) cells. The elevated concentrations of ATP and total adenine nucleotides during recombinant human erythropoietin therapy possibly result in improved deformability of erythrocytes. The data point to an enhancement of the proportion of younger erythrocytes, but not to an improvement of the reduced life span of erythrocytes of haemodialysis patients during therapy with recombinant human erythropoietin.

Topics: Adenosine Diphosphate; Adenosine Monophosphate; Adenosine Triphosphate; Adult; Aged; Aspartate Aminotransferases; Erythrocytes; Erythropoietin; Female; Guanosine Diphosphate; Guanosine Triphosphate; Humans; Kidney Failure, Chronic; Male; Middle Aged; Purine Nucleotides; Renal Dialysis

Topics: Adenylyl Cyclases; Animals; Biological Assay; Dogs; Guanosine Triphosphate; Guanylyl Imidodiphosphate; Humans; Hyperparathyroidism, Secondary; Kidney; Kidney Failure, Chronic; Parathyroid Hormone; Radioimmunoassay