= Cyclosporin A
Cyclic polypeptide systhesised by Tolypocladium inflatum
or Cyclindrocarpon lucidum.
Transplant, RhA, recalcitrant psoriasis.
Binds calcineurin, and hence reduces IL2 synthesis, resulting in
inhibition of T-cells in G0 or G1 of the cell cycle.
No myelosuppressive effect.
Dose-dependent nephrotoxicity. Hypertension, hirsutism, gingival hyperplasia.
In renal transplant, it can be difficult to differentiate between
graft rejection and cyclosporine nephrotoxicity. Toxicity
is suggested by:
Diagnosis may only be confirmed by biopsy.
- absence of fever
- no graft tenderness
- no graft enlargement