The cyclosporin family of secondary metabolites isolated from the fungus
Tolypocladium inflatum
is characterised by a cyclopeptide structure consisting of an 11‐membered amino acid ring, containing
N
‐methylated peptide bonds. Parent cyclosporin A (CsA) is a drug widely used to prevent and treat rejection episodes after organ transplantation and can be used in autoimmune diseases. It is immunosuppressive, anti‐inflammatory, antichemotactic and antiviral but CsA‐induced immunosuppression and nephrotoxicity cause limitations in its general use in clinical practice. In lymphoid cells, after binding to its receptor cyclophilin A (CypA), CsA acts via gain‐of‐function inhibiting the protein phosphatase calcineurin and thus the transcription of several cytokines. Nonimmunosuppressive CsA derivatives lacking gain‐of‐function in the cell result from semisynthetic procedures mostly modifying its MeLeu‐4 side chain. These derivatives strongly inhibit the prolyl
cis
/
trans
isomerase activity of CypA, which, in turn, is a host cell factor for viral infections and other pathophysiological states in human diseases.
Key Concepts:
Beside its use in transplantation medicine, treatment of other human disorders with CsA has some limitations due to immunosuppression and toxicity.
Immunosuppressive activity can be successfully removed from the cyclosporine molecule using a variety of Leu‐4 substituted CsA derivatives.
Nonimmunosuppressive CsA derivatives can retain the high potency of CsA in inhibiting the prolyl
cis/trans
isomerase activity of the CsA receptor CypA.
Nonimmunsuppressive CsA derivatives have been utilised to launch clinical phase studies for the treatment of hepatitis C virus infections.
A broad antiviral activity of nonimmunosuppressive CsA derivatives in addition to the anti‐HCV profile has been suggested.
CsA derivatives have been designed to target cyclophilins in specific tissues and organelles.
Extracellularly restricted CsA derivatives are potent drug candidates to combat chronic inflammations.