The temporal profile of calcineurin inhibition by cyclosporine in vivo.

Background. Cyclosporine (CsA) acts by inhibiting the phosphatase calcineurin (CN), but the time course and extent of inhibition in vivo are unknown. We examined the effect of single oral CsA doses on CN activity in humans and mice in vivo. Methods. In humans, blood CsA levels were determined and CN activity was measured in whole blood and in blood leukocytes of patients up to 12 hr after CsA dosing (just before the second dose). Samples were collected from patients receiving a first single dose (2.5 mg/kg), and up to 14 days later after repeated dosing. In mice, after CsA dosing (12.5‐200 mg/kg) by oral gavage, CsA levels in blood and tissue (spleen, kidney) were determined and CN activity was measured in spleen and kidney. Results. In humans, peak CsA levels of 800-2285 mg/L at 1‐2 hr produced 70 ‐96% CN inhibition. Inhibition correlated closely with the rise and fall of CsA levels with no observable lag at the times sampled. Repeated doses showed similar CN inhibition to first dose, with no significant adaptation. In mice, CsA peaked at 1 hr in blood, spleen, and kidney, with higher concentrations in spleen and kidney than in blood. CN inhibition closely followed CsA concentrations/doses, and was greater in kidney than spleen. Conclusion. Thus CsA induces partial CN inhibition that varies directly with the blood and tissue levels, and may be greater in some tissues due to higher drug accumulation. The high CsA concentrations and CN inhibition in kidney may be relevant to nephrotoxicity. Calcineurin (CN*) activity is a rate-limiting step in the activation of primary human T lymphocytes (1, 2) and is the target of two important immunosuppressive drugs, cyclosporine (CsA) and tacrolimus. CN is a serine-threonine phosphatase comprised of a catalytic A subunit and a regulatory B subunit. It is usually inactive because its autoinhibitory domain blocks the active site. A rise in cytosolic Ca 11 alters