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Cyclosporine
C62H111N11O12
cyclo-(L-Alanyl-D-alanyl- N-methyl-L-leucyl-N-methyl-L-
leucyl-N-methyl-L-valyl-3-
hydroxy-N,4-dimethyl-L-2-amino- 6-octenoyl-L-a-amino-butyryl
-N-methylglycyl-N-
methyl-L- leucyl-L-valyl-N-methyl-L-leucyl)
Thea Lotz
Corinna Martin
Markus Müller
Martin Müller
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2 DaMocles – WS 09/10 Cyclosporine
Structure:
Cyclosporine is a cyclic peptide, made of eleven
amino acids. It doesn't have any C- or N
terminus.
In particular, the peptide has two unusual
amino acids: (4R)-4-[(E)-but-2-enyle]-4-
methyle-L-threonine (Bmt), that is synthesized
intracellular in an enzyme catalyzed reaction,
and (L)-α-amino-butyric acid (Abu). Both of
them are found in nearly no other organisms.
The circle also contains a D-alanine, made of L-
alanine by a racemase that is normally found
only in bacteria cells.
For the immune suppressive functionality, the relevant parts are
the long chain of Bmt and its
surrounding amino acids.
Historical facts about Cyclosporine:
Cyclosporine is extracted from the sac fungi Tolypocladium
inflatum and Cylindrocarpon
lucidum. Tolypocladium inflatum was discovered in Obergurgl in
Tirol in 1957 and tested by the
company Sandoz (today Novartis) in Basel on antibiotic or
inhibition effects in 1971.
Tolypocladium inflatum constrains other fungi in their growth
and causes a specific aborization
in their growing.
After many years of research they found amongst thousands of
substances of the raw material
only few specimens of the effective combination:
Cyclosporine.
They chemically analyzed Cyclosporine, but didn´t find any
antibiotic effect. In 1975 its structure
was cleared up with chemical and radiographic additives.
Some years later it was discovered by accident that Cyclosporine
has an immunosuppressive
effect while they tested the substance on mice that had had
kidney transplantations. They
showed a increased rate of living after the addition of
Cyclosporine.
Both Dr. Jean-Francois Borel and Dr. Hartmann Staehlin were
included in the discovery of
Cyclosporine. Dr. Jean-Francois Borel said about the unique
property which hampers only cells
of the immune defense mechanism:
„When you compare the immune answer with biting dogs, then
Cyclosporine is the muzzle who
hinders special cells of the immune defense system to bite
without killing them.“
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3 DaMocles – WS 09/10 Cyclosporine
In 1976 the biological characteristics of Cyclosporine were
published for the first time and more analyses at the
Cambridge University of Great Britain conducted by Roy
Calne followed.
At first Cyclosporine was given oral in capsules. It didn’t
work, since the blood was not receptive of the substance.
Giving a solution consisting of Cyclosporine and olive oil
solved the problem. Firstly there were made tests on dogs
with transplanted kidneys and it was again noticed an
increased number of living patients. In 1978 Cyclosporine was
given to a human for the first
time. In 1982 it was licensed as ‘Sandimmun’. Until today the
doctors succeeded in transplanting
more than 500.000 kidneys, using Cyclosporine as an immune
suppressive.
Since 1994 Cyclosporine is given in a homogenous solution which
makes the reception faster
and more efficient.
It hasn´t been discovered yet, what exactly Cyclosporine does in
the metabolic system of the
fungus Tolypocladium inflatum.
Synthesis:
The fungus is cultivated via fermentation until today. Complete
or part synthesis have proven too
expensive. The enzyme catalyzing the synthesis is
‘Cyclosporine-Synthase’. The starting amino acid
for the circle building is D-Ala; the amino groups are
methylised in the end.
Mechanism:
The active agent cyclosporine inhibits blood cells, the
so-called T helper cells which are part of
the immune defense. The T helper cells recognize exogenous
substances caring for their removal
from the organism. It is important to control them in
transplantation medicine to prevent
rejection of a transplanted organ. Administration of
cyclosporine inhibits the body’s defense
reaction.
The mechanism of action of cyclosporine can be described roughly
as an inhibition of the DNA-
transcription factor, which would cause an activation of T
helper cells.
If a T helper cell comes upon an exogenous substance, a cascade
of reactions is triggered
activating the T helper cells.
In the cytoplasm the enzyme calcineurin binds to the
gene-transcription factor NF-AT
dephosphorylating it. Thus the transcription factor can get into
the nucleus. There it specifically
activates the transcription of diverse cytokines (proteins which
initiate or adjust cell growth and
cellular differentiation) and cell-surface-receptors (especially
Interleukin-2).
If these gene-sections are expressed, the resulting activation
of T helper cells starts removal of
the exogenous substances.
Tolypocladium inflatum
http://dict.leo.org/ende?lp=ende&p=Ci4HO3kMAA&search=synthesis&trestr=0x8001
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4 DaMocles – WS 09/10 Cyclosporine
Cyclosporine comes into action directly in the first step of the
chain reaction: it ties down to
calcineurin so that the dephosphorylation cannot take place.
Like this the genes that are
necessary for the immune reaction cannot be realized.
However cyclosporine inhibits only inactive T helper cells. Once
a T helper cell is activated,
cyclosporine can barely influence it.
Through the inhibition of the T helper cells indirectly also
B-Lymphocytes and T killer cells are
inhibited, since they can only be activated by the T helper
cells. Though, cyclosporine does not
have an impact on Macrophages and other cells in the human body.
This implies an increased
specificity simplifying the dosage scheme.
The inhibition of calcineurin is reversible; as soon as the
concentration of cyclosporine in the
cells decreases, the immune defense can proceed normally
again.
Areas of application:
Primary Cyclosporine is used after organ transplants to prevent
the rejection of the foreign
tissue.
Cyclosporine is also used to fight off inflammations, which are
caused by the immune system,
like Uveitis, Neurodermatitis or Rheumatoid Arthritis.
In that case Cyclosporine is only used when all other
medications show no effect.
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5 DaMocles – WS 09/10 Cyclosporine
Another unproven area of application is the usage of
Cyclosporine for type 1 Diabetes, which is
also caused by the immune system.
Side effects:
The major side effect of Cyclosporine is the arterial
hypertension which is closely linked to a
kidney failure. This effect occurs at 80 percent of the patients
and is known as nephrotoxicity.
The main reason for the nephrotoxicity is the retention of the
Na+-level which causes an
increased water-resorption so that the volume blood plasma
rises. Studies have shown that a
low sodium diet can help to improve the arterial
hypertension.
Other side effects are hyperlipidemia, tremor and headache which
occurred at 10% of the
patients.
Much rarer side effects are cramps, gastrointestinal problems,
tiredness and liver damages
(about 1% of the patients).
At less than 0,1% of the patients caused the taking of
Cyclosporine states of confusion, visual
disorders and comatose states.
Conclusion:
Cyclosporine has long been irreplaceable concerning
transplantations. But by now, there are
some other agents, which have a similar efficiency rate but
fewer side effects.
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6 DaMocles – WS 09/10 Cyclosporine
Sources:
“Synthese von Cyclosporin und Analoga: Zusammenhang zwischen
Struktur und immunsuppressiver Aktivität”: Dr. Roland Maurice
Wenger, Angewandte Chemie, 2006
“Biosynthesis of the unusual amino acid
(4R)-4-[(E)-2-butenyl]-4-methyl-L-threonine of cyclosporin A.
Identification of 3(R)-hydroxy-4(R)-methyl-6(E)-octenoic acid as a
key intermediate by enzymatic in vitro synthesis and by in vivo
labeling techniques.” : M. Offenzeller, 1993, The Journal of
Biological Chemistry
http://www.wikipedia.org/wiki/Ciclosporin
F. Schröder / S. Herzig: Ciclosporin, 1998, DMW
http://www3.interscience.wiley.com/journal/112279523/abstract?SRETRY...Y=0
http://www.elfenbeinturm.net/archiv/2000/bot2.html
http://www.chemie-im-alltag.com/articles/0104/
http://www.rheuma-online.de/medikamente/ciclosporin-immunosporin/im-detail/wirkmechanismus.html
http://www.novartistransplantation.de/transplantation/geschichte/geschichte_csa.shtmlhttp://www.transplant.at
http://www.jbc.org/content/269/4/2841.abstract
http://www.freidok.uni-freiburg.de/volltexte/402/pdf/diss.pdf
http://www.medizinfo.de/rheuma/medikamente/cyclosporin.shtml
http://www.vetpharm.uzh.ch/reloader.htm?wir/00005986/5133_02.htm?wir/00005986/5133_00.htm
http://epub.uni-regensburg.de/9912/
http://www.biology.ru/course/content/chapter3/section2/paragraph1/images/03020103.jpg
Medizinische Wochenzeitschrift 123 (1998), Abb.1, Seite
121-122
by Thea Lotz, Corinna Martin,
Markus Müller, Martin Müller
TU Darmstadt
Bc. of Science Biomolecular Engineering
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