Cardiac allograft vasculopathy is a leading cause of death in patients undergoing cardiac transplantation. This disease of coronary arteries in characterized by diffuse intimal thickening and narrowing of the vessel lumen. Mycophenolate mofetil (MMF) is a prodrug that is efficiently metabolized to mycophenolic acid (MPA) and which is an effective suppressor of T and B lymphocyte proliferation. MMF also leads to inhibition of lymphocyte adhesion and migration, smooth muscle proliferation. these mechanisms lead to decreased cellular rejection and in a controlled clinical trial MMF, compared to azathioprine, has been demonstrated to improve patient survival, in part by diminishing deaths due to cardiovascular causes. MMF has also been demonstrated to reduce titres of anti-vimentin antibodies, which have been shown to be a marker for increased risk of coronary vascular disease. Data from intravascular ultrasound, angiography and autopsies suggest that MMF by diminish the development of cardiac allograft vasculopathy, which may explain the improvement in survival observed after MMF therapy.
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