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Inosine-5'-
monophosphate
dehydrogenase 1
Mycophenolic
Acid
Transporter
ADP-sugar
pyrophosphatase
Ribose-
phosphate
pyrophosphokinase
3
Amidophosphoribosyltransferase
Trifunctional
purine
biosynthetic
protein
adenosine-3
Trifunctional
purine
biosynthetic
protein
adenosine-3
Phosphoribosylformylglycinamidine
synthase
Trifunctional
purine
biosynthetic
protein
adenosine-3
Multifunctional
protein ADE2
Multifunctional
protein ADE2
Adenylosuccinate
lyase
Adenine
phosphoribosyltransferase
Bifunctional
purine
biosynthesis
protein PURH
Bifunctional
purine
biosynthesis
protein PURH
Ectonucleoside
triphosphate
diphosphohydrolase
8
Ectonucleoside
triphosphate
diphosphohydrolase
8
Nucleoside
diphosphate
kinase 6
GMP synthase
[glutamine-
hydrolyzing]
Cytosolic
purine
5'-nucleotidase
Purine
nucleoside
phosphorylase
Mycophenolic acid
Inosinic acid
Guanosine
Guanine
Mycophenolic
acid
Adenosine
diphosphate
ribose
H
2
O
AMP
D-Ribose
5-phosphate
ATP
Phosphoribosyl
pyrophosphate
AMP
5-
Phosphoribosylamine
PP
i
L-Glutamic acid
L-Glutamine
H
2
O
ATP
Glycine
ADP
P
i
Glycineamideribotide
10-
Formyltetrahydrofolate
Tetrahydrofolic
acid
5'-
Phosphoribosyl-
N-
formylglycinamide
ATP
L-Glutamine
H
2
O
ADP
Phosphoric acid
Phosphoribosylformylglycineamidine
L-Glutamic acid
ATP
ADP
P
i
5-
Aminoimidazole
ribonucleotide
5-amino-1-(5-
phospho-D-
ribosyl)imidazole-
4-carboxylate
CO
2
ATP
L-Aspartic acid
ADP
Phosphoric acid
SAICAR
Fumaric acid
AICAR
PP
i
5-
Aminoimidazole-
4-carboxamide
Phosphoribosyl
pyrophosphate
10-
Formyltetrahydrofolate
Tetrahydrofolic
acid
Phosphoribosyl
formamidocarboxamide
H
2
O
IDP
H
2
O
P
i
Inosine
triphosphate
H
2
O
P
i
ATP
ADP
NAD
H
2
O
Xanthylic acid
NADH
ATP
NH
3
AMP
PP
i
Guanosine
monophosphate
H
2
O
Phosphoric acid
P
i
Ribose
1-phosphate
Calcium
Adenine and
Adenosine
Synthesis
DNA and RNA
Synthesis
DNA and RNA
Synthesis
Potassium
Magnesium
Magnesium
4Fe-4S
Calcium
Magnesium
Magnesium
Cytosol
Mycophenolic acid is
absorbed in the GI tract and
delivered through the blood
to the site of action. The
plasma protein albumin is
important for the movement
of the drug as mycophenolic
acid binds to albumin.
Mycophenolic acid inhibits
inosine-5'-monophosphate
dehydrogenase from
converting inosinic acid
into xanthylic acid. This
reaction is the first
commited step the purine de
novo synthesis pathway to
create guanine.
Due to the inhibition, low
levels or guanine and
guanosine are produced
halting DNA and RNA
synthesis as guanine and
gunaosine are important as
they are nucleobase and
nucleoside respectively.
T and B lymphocytes require
purines being produced
through the purine de novo
pathway in order to
proliferate and create
antibodies. Unlike other
cells who can obtain DNA/RNA
building blocks through
other means, T and B
lymphocytes are reliant on
this pathway. Mycophenolic
acid has potent cytostatic
effects causing the immune
system to weaken.
Lymphocyte