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Pathway Description
Mercaptopurine Action Pathway (New)
Homo sapiens
Drug Action Pathway
Mercaptopurine is an antimetabolic antineoplastic agent used in the treatment and maintenance therapy of acute lymphatic leukemia (ALL), acute promyelocytic leukemia, autoimmune hepatitis, Crohn's disease (CD), lymphoblastic lymphoma, and ulcerative colitis. This drug is a purine analogue, so it acts by interfering with the nucleic acid biosynthesis in cells. More specifically, this molecule is an analogue of the adenine and hypoxanthine bases. By being an analogue of those, mercaptopurine competes with them for the hypoxanthine-guanine phosphoribosyltransferase (HGPRTase) enzyme and is itself converted to thioinosinic acid (TIMP). It is this metabolite that inhibits many reactions: among others, the conversion of inosinic acid to xanthylic acid and the conversion of IMP to adenylic acid (via the adenylosuccinate). There are 3 ways that this drug causes immunosuppression 1) One of the metabolites (thiodeoxyguanosine-5'-triphosphate) can be incorporated into DNA creating false information that cannot be used for replication or RNA transcription and translation, 2) Thioguanosine 5'-triphosphate (not deoxy form metabolite) causes inhibition of ras-related c3 botulinum toxin substrate 1, a small GTPase protein on the cell membranes. This protein regulates many events like replication, cell-to-cell adhesion, epithelial differentiation, apoptosis, and more. Most importantly, it helps the regulation of the apoptosis of T and B lymphocytes so when this substrate is inhibited, T and B cells undergo apoptosis since there is no regulation lowering the immune system. 3) the 6-methyl thiopurine 5'-monophosphate ribonucleotide/6-methylthioisonate, a mercaptopurine metabolite, inhibits amidophosphoribosyltransferase (glutamine-5-phosphoribosylpyrophosphate aminotransferase) which is a key enzyme in the purine de novo synthesis pathway. Amidophosphoribosyltransferase catalyzes the conversion of phosphoribosyl pyrophosphate into 5-phosphoribosylamine, the first committed step to the biosynthesis of purines. By inhibiting this step, adenine, adenosine, guanine, and guanosine cannot be produced. Because T and B lymphocytes are reliant on the purine de novo pathway to obtain purines, inhibition causes them to die since they cannot proliferate quickly. Other cells can obtain purines from other sources, but T and B cells cannot. An overdose of this drug would result in anorexia, nausea, vomiting, myelosuppression, liver dysfunction, and gastroenteritis. Mercaptopurine is administered as an oral suspension or tablet.
References
Mercaptopurine Pathway (New) References
Wishart DS, Feunang YD, Guo AC, Lo EJ, Marcu A, Grant JR, Sajed T, Johnson D, Li C, Sayeeda Z, Assempour N, Iynkkaran I, Liu Y, Maciejewski A, Gale N, Wilson A, Chin L, Cummings R, Le D, Pon A, Knox C, Wilson M: DrugBank 5.0: a major update to the DrugBank database for 2018. Nucleic Acids Res. 2018 Jan 4;46(D1):D1074-D1082. doi: 10.1093/nar/gkx1037.
Pubmed: 29126136
Dubinsky MC: Azathioprine, 6-mercaptopurine in inflammatory bowel disease: pharmacology, efficacy, and safety. Clin Gastroenterol Hepatol. 2004 Sep;2(9):731-43. doi: 10.1016/s1542-3565(04)00344-1.
Pubmed: 15354273
Sahasranaman S, Howard D, Roy S: Clinical pharmacology and pharmacogenetics of thiopurines. Eur J Clin Pharmacol. 2008 Aug;64(8):753-67. doi: 10.1007/s00228-008-0478-6. Epub 2008 May 28.
Pubmed: 18506437
Ohtsuki S, Asaba H, Takanaga H, Deguchi T, Hosoya K, Otagiri M, Terasaki T: Role of blood-brain barrier organic anion transporter 3 (OAT3) in the efflux of indoxyl sulfate, a uremic toxin: its involvement in neurotransmitter metabolite clearance from the brain. J Neurochem. 2002 Oct;83(1):57-66. doi: 10.1046/j.1471-4159.2002.01108.x.
Pubmed: 12358729
Fernandez-Ramos AA, Marchetti-Laurent C, Poindessous V, Antonio S, Laurent-Puig P, Bortoli S, Loriot MA, Pallet N: 6-mercaptopurine promotes energetic failure in proliferating T cells. Oncotarget. 2017 Jun 27;8(26):43048-43060. doi: 10.18632/oncotarget.17889.
Pubmed: 28574837
BENNETT, L., BROCKMAN, R., SCHNEBLI, P. et al. Activity and Mechanism of Action of 6-Methylthiopurine Ribonucleoside in Cancer Cells Resistant to 6-Mercaptopurine. Nature 205, 1276–1279 (1965).
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