Cyclosporine Research & Studies

Cholinergic itch is part of symptom complex that also includes cholinergic erythema and cholinergic urticaria. It mostly occurs during the winters among young adults. It is characterized by onset of severe itching or burning sensation all over body, mostly, on exposure to sunlight, warm atmosphere and in some cases after hot and spicy food intake. In most of the cases, it is poorly responsive to antihistamine therapy.

Cyclosporine, a member of the calcineurin inhibitor family, has immunomodulatory effects on T cells. It blocks the earliest stages of the immune response by binding to cyclophilin, thus inhibiting calcineurin. It was initially used for transplant patients to prevent transplant rejections. The main indication for cyclosporine in dermatology is severe psoriasis. Other dermatologic indications for the use of cyclosporine include atopic dermatitis, chronic idiopathic urticaria, pyoderma gangrenosum, and Behçet's disease.

We describe a 34-year-old kidney transplant patient who developed a distinct cutaneous side-effect to cyclosporine manifested as an infiltrated appearance to the skin with abundant flesh-colored, follicular papules predominantly affecting the ears, nose, and surrounding areas of the face, but also the trunk and extremities. The clinical and histologic findings in this case closely match those presented in 2 previous case reports, in which immunosuppressive doses of cyclosporine appeared to be causative. We present a detailed report of the clinical and histologic findings that are unique to these 3 cases and we introduce a theory, based on the recent in vitro studies involving cyclosporine, to help explain the pathogenic events induced by cyclosporine in these patients. We propose the term "cyclosporine induced folliculodystrophy" or CIF as an appropriate name for this distinct clinicohistopathologic entity. Finally, we set forth 3 clinical and 4 histopathologic criteria upon which the diagnosis of CIF can be made.

The polypeptide immunosuppressant cyclosporine is a prodrug that binds an intracellular immunophilin. The complex cyclosporine-cyclophilin binds and inhibits the phosphatase activity of calcineurin interfering with the dephosphorilation of members of the nuclear factor of activated T cells, which is involved in the regulation of genes encoding many cytokines. However, calcineurin is not exclusive from T cells; it is also present in many organs, such as the kidney, and their inhibition accounts for both the immunosuppressive and the nephrotoxic effects of cyclosporine. In renal transplantation, it was shown that graft survival improved progressively between 1998 to 1996, mainly due to reduction of acute rejection episodes. There is no doubt that cyclosporine contributed to that success. After 20 years, cyclosporine targets for maintenance immunosuppression have not been defined and the magnitude of chronic cyclosporine nephrotoxicity in renal allografts is not known, in part by the limitations of histologic classification of chronic allograft nephropathy. In the future, the new technology based on DNA microarrays can be a valuable tool to separate chronic drug toxicity from other causes of graft deterioration. On the other hand, in the cyclosporine era, chronic renal failure has emerged as a frequent adverse event after transplantation of nonrenal organs and it is associated with increased risk of death. Although there is not yet enough evidence to support a generalization of calcineurin-free immunosuppression, we should open our minds to the upcoming new concepts on immunosuppression.

To describe a case of an anaphylactic reaction after first ingestion of oral cyclosporine capsules (Neoral).

To report a possible interaction between cyclosporine (CsA) and amiodarone in a kidney transplant recipient.