Mycophenolic acid is a drug that belongs to the immunosuppressant class of drugs. It was the first characteristic antibiotic to be researched in its mode of action on cell growth and division. It has been considered a reliable drug for about 85 years and is now frequently prescribed in the field of organ transplantation.
What is mycophenolic acid?
Mycophenolic acid is one of the immunosuppressants and is commonly prescribed in the field of organ transplantation. Mycophenolic acid, also known by its Latin name Acidum mycophenolicum, was first isolated in 1893 by Italian physician and microbiologist Bartolomeo Gosio. During his scientific research, Gosio observed that mycophenolic acid significantly reduced the growth of anthrax pathogens. It was only after Alexander Flemming researched the antibiotic effect of penicillin in 1928 and presented and released it for medical use in 1929 that the spectrum of medical care with antibiotics was expanded. Thus, a co-discoverer of penicillin came across the research results of Bertolomeo Gosio. He completed the observations and mode of action of selective, non-competitive and reversible inhibition of mycophenolic acid. The drug is a white crystalline powder, which is also known by the molecular formula C17H20O6. It is almost insoluble in cold water, sparingly soluble in toluene and moderately soluble diethyl ether and chloroform. Only with the addition of ethanol is the white powder slightly soluble.
Pharmacological action
Today, mycophenolic acid is used as an immunosuppressant for prophylactic treatment and aggressive diseases. The pharmacologic target is based on selective, noncompetitive, and reversible inhibition of an enzyme important for the biosynthesis of guanosine. The enzyme is known as inosine monophosphate dehydrogenase. By inhibiting the enzyme, the proliferation of B and T lymphocytes and DNA synthesis is blocked. While these cells are blocked, the other cells can seek another biosynthetic pathway. The difference of mycophenolic acid from other immunosuppressants is that this one does not attach directly to DNA.
Medical application and use
The medical treatment by mycophenolic acid is in the form of tablets. As an indication, the focus is on prophylactic treatment in organ transplantation, in combination with another immunosuppressant to prevent rejection symptoms. Furthermore, the drug can be prescribed if there is a severe rheumatic disease affecting the internal organs. If the organs are not yet affected, the drug can be taken prophylactically to prevent this. If possible, therapy with this immunosuppressive drug should only be administered by physicians with experience in the fields of organ transplantation. The dosage is individually adjusted to each patient, usually oriented around 720mg, twice daily in adults. The creeping of mycophenolic acid should be fully documented by regular laboratory testing of the blood to avoid overdose. The drug should not be taken during pregnancy and lactation. If allergies to the individual components of mycophenolic acid are known, it should also be avoided and, if necessary, an alternative to this drug should be prescribed. Whether treatment with mycophenolic acid is successful usually only becomes apparent 3 months after starting to take the drug. Patients often notice symptom relief after a treatment period of 4-8 weeks. The effect is shown by a decrease in pain and less water retention in the tissues. The inflammation values in the blood count improve, morning stiffness and fatigue decrease, and the ability to work under pressure increases. In order to bring about a continuous improvement, it is necessary to take the medication on a long-term basis. It must be taken regularly, even if the patient’s general condition has improved.
Risks and side effects
As with any pharmaceutical treatment, adverse side effects may occur. Basically, it should always be kept in mind that immunosuppressants weaken the immune system. The body cannot provide a strong defense, thus the general risk of infection increases. The infections can occur in the form of bacteria, viruses or fungi.Other side effects of mycophenolic acid often include gastrointestinal complaints (nausea, vomiting, stomach pain), flu-like infections, blood count changes, respiratory tract infection (bronchitis), and kidney and liver dysfunction. Rarely, on the other hand, tachycardia (increased pulse rate), tremors, hair loss, or the formation of malignant or benign tumors occur. No vaccinations should be given while taking the immunosuppressant. UV radiation should also be avoided as it may cause skin irritation. The physician should perform regular checks of laboratory values and of the skin and mucous membranes while the patient is taking mycophenolic acid.
