Perspectives on Mycophenolate Mofetil in the Management of Autoimmunity

Bhat, R. G.; Tonutti, Antonio; Timilsina, Suraj; Selmi, Carlo; Gershwin, M. Eric

doi:10.1007/s12016-023-08963-3

Cited by 9 publications

(3 citation statements)

References 175 publications

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“…Although there are many clinical reports of congenital microtia in newborns caused by MMF, there are few studies on the pathogenesis of these effects. MMF can cause renal ectopia, cardiac ectopia, umbilical hernia and diaphragmatic hernia in rabbits, and hydrocephalus, eyelessness and jaw absence in rats (Bhat et al, 2023). Jiang et al (2016) studied the direct effect of MPA exposure on zebrafish embryos and found that morphological defects such as tail curvature and severe pericardial edema of zebrafish embryos caused by MPA.…”

Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil exposure on embryonic and fetal ear development in rats during pregnancy

Chen,

Zhang,

Luo

et al. 2023

Birth Defects Research

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BackgroundTo explore the pathogenesis of microtia, in this study, the different concentrations of mycophenolate mofetil (MMF) exposure on the development of rat embryonic and fetal ears, in order to establish a drug‐induced microtia model, and provide a basis for further exploring the pathogenesis of microtia.MethodsThe pregnant rat model was established in this study, 56 pregnant SD rats were randomly divided into 4 groups: control group and MMF (50, 100, and 200 mg/kg) group. Solutions were administered to the rats by oral gavage at gestation day (GD) 9 and GD 10 8:00 a.m, once a day. On GD 10.5 and GD 14.5, embryos were evaluated for neural crest development. On GD 20.5, fetuses were evaluated for overall survival and development with particular focus on ear development via morphologic, skeletal, and histologic investigation. Some animals were allowed to deliver their litters and offspring were evaluated on postnatal day 18 for ear development.ResultsA total of 56 pregnant rats, 14 in each group, were included in the study. As a result, depending on MMF dose increase, in experimental groups, it was determined that the statistically significant the development of the first and second branchial arches and derived tissues of the embryo, overall survival, ear development, and length and weight of fetuses. Imaging of MMF groups revealed statistically significant differences in the development of the skull and auditory vesicles of MMF treated fetuses. Histologically, MMF affected the proliferation and differentiation of chondrocytes and the expression of type II collagen.ConclusionsMycophenolate mofetil can lead to the hypoplasia of rat embryos, fetuses, and auricle in a dose‐dependent. MMF may affect the migration and proliferation of cranial neural crest cells, and then lead to microtia. MMF may induce the establishment of an animal model of microtia.

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Section: Discussionmentioning

confidence: 99%

Mycophenolate mofetil exposure on embryonic and fetal ear development in rats during pregnancy

Chen,

Zhang,

Luo

et al. 2023

Birth Defects Research

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“…The more intense and T cell involving immunosuppression in patients with organ transplantation may suppress inflammatory processes, which can lead to evolvement of fibrotic changes. Anti-fibrotic effects have for instance been discussed for mycophenolate mofetil [ 33 ]. This would suggest that at least a relevant part of the observed lung changes is linked to immunological effects, not viral replication itself, as seen for COVID-19 in immunocompetent patients [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era

Götz,

Mathé,

Agarwal

et al. 2023

Infection

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Purpose This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication. Methods We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included. Results 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17). Conclusion Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days. Trial registration number DRKS 00027299.

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“…Hydroxychloroquine was employed as a disease-modifying antirheumatic medication (DMARD), to manage systemic lupus activity [8]. Mycophenolate mofetil was introduced as an immunosuppressive drug to prevent further autoimmune exacerbations, although specific dosing details were not provided [9].…”

Section: Blood Investigationsmentioning

confidence: 99%

Tolosa-Hunt Syndrome as the Initial Presentation of Systemic Lupus Erythematosus

Nilofar,

Mohanasundaram,

Kumar

et al. 2024

Cureus

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Perspectives on Mycophenolate Mofetil in the Management of Autoimmunity

Cited by 9 publications

References 175 publications

Mycophenolate mofetil exposure on embryonic and fetal ear development in rats during pregnancy

Mycophenolate mofetil exposure on embryonic and fetal ear development in rats during pregnancy

Clinical phenotype and outcome of persistent SARS-CoV-2 replication in immunocompromised hosts: a retrospective observational study in the Omicron era

Tolosa-Hunt Syndrome as the Initial Presentation of Systemic Lupus Erythematosus

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