TY - JOUR
T1 - Mycophenolate mofetil combined with a cyclooxygenase-2 inhibitor ameliorates murine lupus nephritis
AU - Zoja, C.
AU - Benigni, A.
AU - Noris, M.
AU - Corna, D.
AU - Casiraghi, F.
AU - Pagnoncelli, M.
AU - Rottoli, D.
AU - Abbate, M.
AU - Remuzzi, G.
PY - 2001
Y1 - 2001
N2 - Background. Approaches to the treatment of lupus nephritis include immunosuppressants associated with anti-inflammatory drugs, mainly steroids, which, however, cause major side effects. Mycophenolate mofetil (MMF) has been described as being less toxic than conventional immunosuppressants, and it was effective in preventing progressive nephritis in lupus mice. Our study evaluated the therapeutic effect of MMF in NZB/W F1 hybrid mice with established disease. We also examined the combination of MMF with a selective cyclooxygenase-2 (COX-2) inhibitor, DFU, based on previous findings of excessive renal production of COX-2-derived thromboxane A2 (TXA2) in lupus nephritis. Methods. Four groups of NZB/W mice (N = 30 each group), starting at five months of age, were given daily by gavage the following: vehicle, MMF 60 mg/kg, DFU 3 mg/kg, or MMF + DFU. Fifteen mice for each group were used for the survival studies, and the remaining mice were sacrificed at nine months. Results. MMF or DFU alone partially delayed the onset of proteinuria compared with vehicle. Combined therapy was significantly (P <0.05) more effective than single drugs. Animal survival was partially ameliorated by MMF and significantly improved by the drug combination in comparison with the vehicle (P = 0.005) and DFU alone (P <0.03). At nine months, serum blood urea nitrogen (BUN) levels were lower in all of the treated groups than in the vehicle group. Renal damage was also limited, but to a greater extent in mice given the combined therapy. In untreated mice, renal COX-2 mRNA expression was up-regulated, and generation of TXB2, the stable breakdown product of TXA2, increased. DFU prevented the abnormal renal TXB2 production, confirming the COX-2 origin of this eicosanoid, whereas renal 6-keto-PGF1α and prostaglandin E2 (PGE2) were not affected substantially. Conclusions. These results offer a strong case for exploring the possibility that in humans MMF combined with COX-2 inhibitors has a role in the treatment options for lupus nephritis. This combined drug therapy may be at least as effective as steroids but without the obvious nephrotoxicity of the latter.
AB - Background. Approaches to the treatment of lupus nephritis include immunosuppressants associated with anti-inflammatory drugs, mainly steroids, which, however, cause major side effects. Mycophenolate mofetil (MMF) has been described as being less toxic than conventional immunosuppressants, and it was effective in preventing progressive nephritis in lupus mice. Our study evaluated the therapeutic effect of MMF in NZB/W F1 hybrid mice with established disease. We also examined the combination of MMF with a selective cyclooxygenase-2 (COX-2) inhibitor, DFU, based on previous findings of excessive renal production of COX-2-derived thromboxane A2 (TXA2) in lupus nephritis. Methods. Four groups of NZB/W mice (N = 30 each group), starting at five months of age, were given daily by gavage the following: vehicle, MMF 60 mg/kg, DFU 3 mg/kg, or MMF + DFU. Fifteen mice for each group were used for the survival studies, and the remaining mice were sacrificed at nine months. Results. MMF or DFU alone partially delayed the onset of proteinuria compared with vehicle. Combined therapy was significantly (P <0.05) more effective than single drugs. Animal survival was partially ameliorated by MMF and significantly improved by the drug combination in comparison with the vehicle (P = 0.005) and DFU alone (P <0.03). At nine months, serum blood urea nitrogen (BUN) levels were lower in all of the treated groups than in the vehicle group. Renal damage was also limited, but to a greater extent in mice given the combined therapy. In untreated mice, renal COX-2 mRNA expression was up-regulated, and generation of TXB2, the stable breakdown product of TXA2, increased. DFU prevented the abnormal renal TXB2 production, confirming the COX-2 origin of this eicosanoid, whereas renal 6-keto-PGF1α and prostaglandin E2 (PGE2) were not affected substantially. Conclusions. These results offer a strong case for exploring the possibility that in humans MMF combined with COX-2 inhibitors has a role in the treatment options for lupus nephritis. This combined drug therapy may be at least as effective as steroids but without the obvious nephrotoxicity of the latter.
KW - Anti-inflammatory
KW - Autoimmune disease
KW - DFU
KW - Immunosuppression
KW - Inflammation
KW - Nephrotoxicity
KW - Progressive nephritis
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U2 - 10.1046/j.1523-1755.2001.060002653.x
DO - 10.1046/j.1523-1755.2001.060002653.x
M3 - Article
C2 - 11473648
AN - SCOPUS:0034927121
VL - 60
SP - 653
EP - 663
JO - Kidney International
JF - Kidney International
SN - 0085-2538
IS - 2
ER -