环孢菌素又称环孢霉素、环孢菌素A或山地明。这种由某些丝孢纲真菌,如光泽柱孢菌和膨大弯颈霉产生的疏水性多肽药物,是一种强力的T细胞免疫抑制剂。它能够选择性地抑制辅助性T细胞,从而抑制细胞免疫反应和体液免疫反应。辅助性T细胞负责传递抗原信息给B细胞,并诱导其产生抗体;同时还能协助杀伤性T细胞及巨噬细胞发挥免疫作用。
环孢素(英语:Cyclosporine A,简称CsA),于1969年首次从土壤样本中的多孔木霉中分离出来,并在1972年被发现具有免疫抑制功能。此后陆续证实其可用于肾脏移植、肝脏移植的免疫抑制治疗。第一个商品药Sandimmune于1983年在瑞士上市,开始正式用于临床。
药理作用环孢菌素是一种新型T淋巴细胞调节剂,主要通过选择性地作用于辅助性T淋巴细胞(TH),阻断抗原或有丝分裂原刺激的淋巴增生、分化和成熟过程。它还能减少白细胞介素-2等淋巴因子的产生,并能阻滞细胞周期G0/G1早期相中休止的淋巴细胞,从而抑制体内抗移植物抗体的产生。
药代动力学环孢菌素口服吸收不规则且差异大,生物利用度为30%,但可随治疗时间延长和剂量增大而增加。肝移植后、肝病或胃肠功能混乱患者可能吸收减少。本品与血浆蛋白结合率高达约90%,主要与脂蛋白结合。口服达峰时间为3~4小时,全血浓度可为血浆的2~9倍。成人的血浆T1/2为19(10~27)小时,儿童仅为7(7~19)小时。
适应证环孢菌素适用于预防同种异体肝、肾、肺、骨髓、心脏等器官或组织移植所发生的排斥反应,也可用于预防及治疗骨髓移植时发生的移植物抗宿主反应。常与肾上腺皮质激素等免疫制剂联合应用以提高疗效。
用途山地明环孢灵被认为是一种免疫抑制剂,能够与T淋巴细胞中的亲环素结合。
不良反应环孢菌素的毒性比其他免疫抑制剂低,但可引起肝、肾损害、高血压及中枢神经症状;易引发继发感染;大剂量快速静脉注射(约6.25mg/kg)可导致震颤、抽搐和癫痫样症状。不良反应还包括多毛症、牙龈肿胀和胃肠不适。
生物活性环孢菌素通过与亲环素形成复合物,抑制钙调磷酸酶的磷酸酶活性,并调节核转运及随后NFAT转录因子的活化。它也能阻断抗原识别引起的JNK 和p38激活,成为T细胞活化的特异性抑制剂。
体内研究环孢菌素可增强免疫缺陷的SCID浅褐色小鼠体内的肿瘤生长,并在小鼠体内抑制诱发型创伤后肌肉再生。在血液、脾脏和肾脏中1小时内达到最高浓度,且脾脏和肾脏中的浓度高于血液中的浓度。
中文名称 | 英文名称 | CAS号 | 化学式 | 分子量 |
---|---|---|---|---|
—— | cyclosporin A | 59865-13-3 | C62H111N11O12 | 1202.63 |
环孢菌素 H | cyclo-[MeBmt-Abu-Sar-MeLeu-Val-MeLeu-Ala-D-Ala-MeLeu-MeLeu-DMeVal] | 83602-39-5 | C62H111N11O12 | 1202.63 |
中文名称 | 英文名称 | CAS号 | 化学式 | 分子量 |
---|---|---|---|---|
—— | [(R)-2-methyl-Sar]-3-cyclosporin | —— | C63H113N11O12 | 1216.66 |
—— | [L-MeSar]3-CsA | —— | C63H113N11O12 | 1216.66 |
环孢菌素 H | cyclo-[MeBmt-Abu-Sar-MeLeu-Val-MeLeu-Ala-D-Ala-MeLeu-MeLeu-DMeVal] | 83602-39-5 | C62H111N11O12 | 1202.63 |
—— | [(R)-α-hydroxymethyl-sar]-3-cyclosporin | 108466-69-9 | C63H113N11O13 | 1232.66 |
环孢菌素 C | cyclosporin C | 59787-61-0 | C62H111N11O13 | 1218.63 |
伏环孢素 | Voclosporin | 515814-01-4 | C63H111N11O12 | 1214.64 |
—— | (5R,6R,E)-6-((2S,5S,11S,14S,17S,20S,23R,26S,29S,32S)-5-ethyl-11,17,26,29-tetraisobutyl-14,32-diisopropyl-1,7,10,16,20,23,25,28,31-nonamethyl-3,6,9,12,15,18,21,24,27,30,33-undecaoxo-1,4,7,10,13,16,19,22,25,28,31-undecaazacyclotritriacontan-2-yl)-6-hydroxy-5-methylhex-2-enoic acid | 100364-58-7 | C62H109N11O14 | 1232.61 |
SCY-635前体 | [(γ-hydroxy)-N-MeLeu]-4-cyclosporin | 107335-26-2 | C62H111N11O13 | 1218.63 |
—— | [(R)-α-hydroxymethyl-Sar]-3-[(γ-hydroxy)-NMeLeu]-4-cyclosporin | —— | C63H113N11O14 | 1248.66 |
—— | [(3R,4R)-3-hydroxy-4-methyl-6-(2-hydroxyethyl)-N-MeNle]-1-cyclosporin | —— | C62H113N11O13 | 1220.65 |
—— | [(R)-(2-formylethoxy)methyl-Sar]-3-cyclosporin | —— | C66H117N11O14 | 1288.72 |
—— | [(R)-(tert-butoxycarbonylmethoxy)methyl-Sar]-3-cyclosporin | —— | C69H123N11O15 | 1346.8 |
—— | Cyclosporin 4,7-bis(thioamide) | 139050-41-2 | C62H111N11O10S2 | 1234.76 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,30S,33S)-30-ethyl-6,9,18,24-tetraisobutyl-3,21-diisopropyl-33-((2R,3R)-5-isopropyl-3-methyltetrahydrofuran-2-yl)-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecaazacyclotritriacontan-2,5,8,11,14,17,20,23,26,29,32-undecaone | —— | C63H113N11O12 | 1216.66 |
—— | ((R)-methylthio-Sar)3-(4'-hydroxy-MeLeu)4 cyclosporin A | —— | C63H113N11O13S | 1264.72 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-27-(2-dimethylaminoethylsulfanyl)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C66H120N12O12S | 1305.82 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-6,9,18,24-tetraisobutyl-3,21-diisopropyl-27-[2-[isopropyl(methyl)amino]ethylsulfanyl]-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C68H124N12O12S | 1333.87 |
—— | [(R)-2-(N-diethylamino)ethylthio-Sar]-3-cyclosporin | —— | C68H124N12O12S | 1333.87 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-27-(2-hydroxyethylsulfanyl)-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | 108466-76-8 | C64H115N11O13S | 1278.75 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-27-[2-[tert-butyl(methyl)amino]ethylsulfanyl]-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C69H126N12O12S | 1347.9 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-27-[2-(1-piperidyl)ethylsulfanyl]-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C69H124N12O12S | 1345.88 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,30S,33S)-33-((2R,3R)-5-acetyl-3-methyltetrahydrofuran-2-yl)-30-ethyl-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecaazacyclotritriacontan-2,5,8,11,14,17,20,23,26,29,32-undecaone | —— | C62H109N11O13 | 1216.61 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-27-(2-morpholinoethylsulfanyl)-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C68H122N12O13S | 1347.86 |
—— | SCY-635 | 210759-10-7 | C66H120N12O13S | 1321.82 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-27-(2-diethylaminoethylsulfanyl)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-24-(2-hydroxy-2-methyl-propyl)-6,9,18-triisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C68H124N12O13S | 1349.87 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-27-(2-hydroxyethylsulfanyl)-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-24-(2-hydroxy-2-methyl-propyl)-6,9,18-triisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C64H115N11O14S | 1294.75 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-27-[2-[tert-butyl(methyl)amino]ethylsulfanyl]-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-24-(2-hydroxy-2-methyl-propyl)-6,9,18-triisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C69H126N12O13S | 1363.9 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-24-(2-hydroxy-2-methyl-propyl)-6,9,18-triisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-27-[2-(1-piperidyl)ethylsulfanyl]-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C69H124N12O13S | 1361.88 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,27R,30S,33S)-30-ethyl-33-[(E,1R,2R)-1-hydroxy-2-methyl-hex-4-enyl]-27-(2-imidazol-1-ylethylsulfanyl)-6,9,18,24-tetraisobutyl-3,21-diisopropyl-1,4,7,10,12,15,19,25,28-nonamethyl-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | —— | C67H117N13O12S | 1328.81 |
—— | [(2S,3R,4R)-1-(1H-benzimidazol-2-yl)-3-hydroxy-4-methyl-2-(methylamino)pentanoic acid]1cyclosporin A | 1454574-20-9 | C66H111N13O12 | 1278.69 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,30S,33S)-33-[(1R,2R)-3-(1,4-dihydroquinazolin-2-yl)-1-hydroxy-2-methylpropyl]-30-ethyl-1,4,7,10,12,15,19,25,28-nonamethyl-6,9,18,24-tetrakis(2-methylpropyl)-3,21-di(propan-2-yl)-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | 1454574-25-4 | C67H113N13O12 | 1292.71 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,30S,33S)-30-ethyl-33-[(1R,2R)-1-hydroxy-2-methyl-3-(6-methyl-1H-benzimidazol-2-yl)propyl]-1,4,7,10,12,15,19,25,28-nonamethyl-6,9,18,24-tetrakis(2-methylpropyl)-3,21-di(propan-2-yl)-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | 1454574-21-0 | C67H113N13O12 | 1292.71 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,30S,33S)-30-ethyl-33-[(1R,2R)-1-hydroxy-2-methyl-3-(4-oxo-3H-quinazolin-2-yl)propyl]-1,4,7,10,12,15,19,25,28-nonamethyl-6,9,18,24-tetrakis(2-methylpropyl)-3,21-di(propan-2-yl)-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | 1454574-24-3 | C67H111N13O13 | 1306.7 |
—— | (3S,6S,9S,12R,15S,18S,21S,24S,30S,33S)-33-[(1R,2R)-3-(1,3-benzothiazol-2-yl)-1-hydroxy-2-methylpropyl]-30-ethyl-1,4,7,10,12,15,19,25,28-nonamethyl-6,9,18,24-tetrakis(2-methylpropyl)-3,21-di(propan-2-yl)-1,4,7,10,13,16,19,22,25,28,31-undecazacyclotritriacontane-2,5,8,11,14,17,20,23,26,29,32-undecone | 1454574-23-2 | C66H110N12O12S | 1295.74 |