Question

Non-transplant indications of CNI (Calcineurin Inhibitors).

Hint:

While effective for autoimmune diseases, CNIs should be used cautiously due to their potential nephrotoxic and neurotoxic effects.

Answer 1

Calcineurin inhibitors (CNIs), such as tacrolimus and cyclosporine, are primarily used in organ transplantation to prevent graft rejection. However, they also have non-transplant indications due to their immunosuppressive properties.
Step 1: Non-transplant Indications:
1. Autoimmune Diseases: CNIs are used in the treatment of various autoimmune disorders, including systemic lupus erythematosus (SLE) and rheumatoid arthritis, to suppress immune system activity and reduce inflammation.
2. Nephrotic Syndrome: CNIs can be used in steroid-resistant nephrotic syndrome, especially in children, to reduce proteinuria and improve kidney function.
3. Dermatologic Conditions: Tacrolimus is commonly used in the form of topical ointments for atopic dermatitis and psoriasis to reduce inflammation and control symptoms.
Step 2: Mechanism of Action:
CNIs inhibit calcineurin, a protein phosphatase that activates T-cells by dephosphorylating nuclear factors. This suppression of T-cell activation decreases the production of cytokines, leading to reduced inflammation.