II. Indications
- See Antimetabolite Chemotherapy for Purine Analog related indications in cancer
- Solid Organ Transplant Immunosuppression (maintenance prevention of rejection)
- Autoimmune Conditions (e.g. IgA nephropathy, lupus erythematosus, Nephrotic Syndrome, Crohns Disease)
III. Medications: Inosine monophosphate dehydrogenase (IMPDH) Inhibitors
- Mechanism
- Inosine monophosphate dehydrogenase (IMPDH)
- IMPDH is key to conversion of inosine monophosphate (IMP) to guanosine monophosphate (GMP)
- Guanosine monophosphate (GMP) is in turn converted to the guanine purine Nucleotides (GDP, GTP, and dGTP)
- Guanine purine Nucleotide is key to DNA and RNA synthesis, as well as Energy Metabolism (GTP)
- IMPDH Inhibitors decrease DNA and RNA synthesis
- IMPDH effects de novo Purine synthesis but not the salvage pathway Purine synthesis
- Lymphocytes are selectively affected, as they rely on de novo Purine synthesis of guanine
- Inosine monophosphate dehydrogenase (IMPDH)
- Inosine monophosphate dehydrogenase (IMPDH) Inhibitors
- Mycophenolate (Cellcept)
- Mizoribine (MZ)
IV. Medications: Analog Purine Synthesis Inhibitors
- See Antimetabolite Chemotherapy
- Mechanism
- Purine Analogs, resembling adenine or guanine, and incorporate into DNA
- Result in DNA cross-linking and inhibition of synthesis and repair of DNA
- Purine Analogs