Ciclosporin

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Ciclosporin (INN, pronounced /ˌsaɪklɵˈspɔərɨn/), cyclosporine (USAN), cyclosporin (former BAN) or cyclosporin A, is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the patient's immune system, and therefore the risk of organ rejection. It has been studied in transplants of skin, heart, kidney, liver, lung, pancreas, bone marrow, and small intestine. Initially isolated from the fungus Tolypocladium inflatum isolated from a soil sample obtained by Sandoz scientists at Hardangervidda, Norway in 1969,[1] ciclosporin is a cyclic nonribosomal peptide of 11 amino acids and contains a single D-amino acid, which are rarely encountered in nature.[2]

Contents

Indications

The immuno-suppressive effect of ciclosporin was discovered on 31 January 1972 by employees of Sandoz (now Novartis) in Basel, Switzerland, in a screening test on immune-suppression designed and implemented by Hartmann F. Stähelin, M.D. The success of ciclosporin in preventing organ rejection was shown in kidney transplants by Calne and colleagues at the University of Cambridge,[3] and in liver transplants performed by Dr. Thomas Starzl at the University of Pittsburgh Hospital. The first patient, on March 9, 1980, was a 28-year-old woman.[4] Ciclosporin was subsequently approved for use in 1983.

Apart from in transplant medicine, ciclosporin is also used in psoriasis, severe atopic dermatitis, pyoderma gangrenosum, chronic autoimmune urticaria, and, infrequently, in rheumatoid arthritis and related diseases, although it is only used in severe cases. It is commonly prescribed in the US as an ophthalmic eyedrop for the treatment of dry eyes. It has been investigated for use in many other autoimmune disorders, and is sometimes prescribed in veterinary cases, particularly in extreme cases of immune-mediated hemolytic anemia. Inhaled ciclosporin has been investigated to treat asthma and is being studied as a preventative therapy for chronic rejection of the lungs. Ciclosporin has also been used to help treat patients with ulcerative colitis that do not respond to treatment with steroids.[5] This drug is also used as a treatment of posterior or intermediate uveitis with non-infective etiology.

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