A possible mechanism of gastrointestinal toxicity posed by mycophenolic acid

Neerman, Michael F.

doi:10.1016/s1043-6618(03)00055-0

Cited by 24 publications

(14 citation statements)

References 15 publications

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“…Although the mechanisms relating IMPDH1 genetic polymorphisms and GI side effects are not fully understood, Neerman et al suggested that MPA inhibition of IMPDH enzymes within the rapidly dividing GI tract lining may promote cytotoxicity even in the presence of the purine salvage pathway. 37 Thus, an IMPDH variant resistant to MPA inhibition could be expected to exhibit less GI cytotoxicity and resultant GI intolerance to MMF. Wang et al reported significantly increased incidence of acute rejection in the first year posttransplantation in a population of kidney recipients treated with MMF and homozygous GG at IMPDH1 rs2278294.…”

Section: Discussionmentioning

confidence: 99%

Genetic polymorphisms influence mycophenolate mofetil–related adverse events in pediatric heart transplant patients

Ohmann

Burckart

Brooks

et al. 2010

The Journal of Heart and Lung Transplantation

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Section: Discussionmentioning

confidence: 99%

Genetic polymorphisms influence mycophenolate mofetil–related adverse events in pediatric heart transplant patients

Ohmann

Burckart

Brooks

et al. 2010

The Journal of Heart and Lung Transplantation

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“…The impact of multiple concomitant medications, which is unavoidable in the post‐transplant period, should be considered (14). Mycophenolate mofetil has been more commonly associated with diarrhea in comparison with other immunosuppressant drugs by several authors (14–18). In the present study, among the diarrhea episodes in the SOT group, 5 of 43 (11.6%) were found to be mycophenolate mofetil‐associated.…”

Section: Discussionmentioning

confidence: 99%

Etiologic agents of diarrhea in solid organ recipients

Arslan

Inci

Azap

et al. 2007

Transplant Infectious Dis

117

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: After transplantation, diarrhea may be caused by infectious agents, drug‐specific effects, metabolic conditions, or mechanical complications of surgery. Determining the cause helps to determine whether to initiate antimicrobial therapy and the duration of treatment. In this study we aimed to determine the causes of diarrhea in kidney or liver recipients. Fifty‐two diarrhea episodes among 43 solid organ recipients were evaluated. The cause of diarrhea was detected in 43 patients (82.6%). Infectious etiologies accounted for 33 out of the 43 episodes (76.7%) in which a specific cause was determined: Giardia lamblia in 9, Cryptosporidium parvum in 7, cytomegalovirus (CMV) in 6, Clostridium difficile in 3, Campylobacter jejuni in 2, Shigella sonnei in 2, Salmonella enteritidis in 1, rotavirus in 1, Entamoeba histolytica in 1, and Blastocystis hominis in 1. Non‐infectious etiologies were found for 10 episodes (23.3%): mycophenolate mofetil‐associated diarrhea in 5, antibiotic‐associated diarrhea in 2, colchicine‐associated diarrhea in 2, and laxative drug‐associated in 1. Non‐infectious etiologies seem to be relatively common causes of diarrhea among transplant recipients. Therapy was adjusted in 5 patients because of mycophenolate mofetil‐associated diarrhea. CMV and C. parvum, which are seldom seen in the normal population, were frequent causes of diarrhea in this group. Evaluating the transplant recipients for non‐infectious causes of diarrhea is important in prompt diagnosis and treatment.

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“…From a pathophysiologic point of view, it is not illogical that an increased enterohepatic recirculation of MPAG leads to diarrhea (53). Also the acyl glucuronide of MPA (AcMPAG), involved in the pathogenesis of MMF-associated diarrhea (54,55), could have played a role in the diarrhea observed in carriers of the MRP2 C-24T SNP, because also this glucuronide is excreted via MRP2 (56).…”

Section: Discussionmentioning

confidence: 99%