Mycophenolate mofetil: therapeutic applications in kidney transplantation and immune-mediated renal disease

The immunosuppressant mycophenolate mofetil (MMF) inhibits the enzyme inosine-5' monophosphate dehydrogenase and thus interferes with cellular GTP synthesis. MMF suppresses the cellular and humoral immune response and has antiproliferative effects on vascular smooth muscle and mesangial cells in vitro and in vivo. In large multicenter trials with almost 1500 patients MMF has been proven highly efficacious for transplant rejection prophylaxis with the main side-effects of gastrointestinal disorders and a slightly increased incidence of viral infections. Recent investigations suggest MMF as an alternative immunosuppressant in cyclosporin A nephrotoxicity. Preliminary observations show promising results for MMF in the treatment of autoimmune-mediated renal disease. The rationale for its use in this patient group and evidence from experimental studies are discussed. As current therapy of this disease entity is still unsatisfactory, future clinical trials are necessary to investigate the efficacy and safety of MMF for this new indication.