Dear Sir,In a previous report, 1 we showed that mycophenolic acid (MPA), at concentrations readily attainable during immunosuppressive therapy (0.1-10 M), using its mycophenolate mofetil prodrug, causes a decrease of intracellular levels of guanine nucleotides, G 1 arrest and time-and dose-dependent death by apoptosis. The first effect appears to be the consequence of inosine monophosphate dehydrogenase (IMPDH) inhibition and to trigger the other effects through p53-mediated pathways.MPA fails to achieve high concentrations following in vivo administration because of rapid glucuronidation, which inactivates the drug. 2 The morpholinoethyl ester of MPA (mycophenolate mofetil; CellCept, Roche, Milan, Italy) has improved bioavailability and is used as an immunosuppressant following solid-organ transplants. 2 Mycophenolate mofetil is rapidly absorbed following oral administration and almost completely hydrolyzed to the active metabolite MPA, which is extensively and tightly bound to human albumin. [2][3][4] Free MPA in most patients accounts for about 2% of the mean plasma drug level, which is usually maintained around 3 g/ml. 4 We previously reported apoptotic effects on human neuroblastoma cell lines obtained at MPA concentrations corresponding to the total plasma drug levels during immunosuppressive CellCept therapy. 1 In the present study, we investigated the effects of this drug on human neuroblastoma cell lines at lower concentrations, corresponding to those of the active free drug readily attainable during therapy with mycophenolate mofetil.Three established human neuroblastoma cell lines (LAN5, IMR32 and SK-N-SH) were utilized in the current study. Exponentially growing cells were cultured at 37°C in a humidified atmosphere with 5% CO 2 in RPMI-1640 supplemented with 10% FBS, 100 units/ml penicillin, 100 g/ml streptomycin and 2 mM glutamine. Cells were treated with 50 nM MPA or not in the presence or absence of 0.1 mM guanosine for 3 and 6 days. Incubation media were changed every 3 days. Addition of 50 nM MPA led to a decrease of intracellular guanine nucleotide levels with respect to control cells cultured in the absence of drug after 3 or 6 days of incubation. In LAN5 cells, nucleotide extraction and chromatographic analysis performed as described 1 evidenced a guanine nucleotide depletion (87% of GTP, 77% of GDP control values) after 3 days of incubation in the presence of drug. This effect was reversed, at least in part, by 0.1 mM guanosine, added simultaneously with the IMPDH inhibitor: after 6 days of incubation in the presence of guanosine, the reduction of guanine nucleotide levels with respect to control cells was less evident (GTP 92%, GDP 83% of control values).After 6 days of incubation in the presence of 50 nM MPA, neuroblastoma cells differentiated toward the neuronal phenotype with outgrowth of neurite-like processes. In IMR32 cells, the morphologic changes were less evident. Immunofluorescence or immunoperoxidase analysis using anti-NF200 (intermediate filaments), anti-GAP43 (growth-associat...