Synergistic effect of rapamycin and cyclosporin A in the treatment of experimental autoimmune uveoretinitis

J Immunol. 1995 Jan 15;154(2):922-7.

Abstract

Immunosuppressive drugs currently available for the treatment of autoimmune diseases display a narrow therapeutic window between efficacy and toxic side effects. The use of combinations of drugs that have a synergistic effect may expand this window and reduce the risk of toxicity. We evaluated the combination effect of rapamycin (Rapa) and cyclosporin A (CsA) in an autoimmune disease model of the eye. The dose-effect relationship of Rapa with CsA was measured in vitro on the inhibition of proliferation of retinal S-Ag-primed lymphocytes. A median effect analysis was performed and a combination index (CI) calculated for 50% inhibition of proliferation. Rapa and CsA were markedly synergistic over a wide dose range (lowest CI = 0.31). Calculated dose reduction factors indicated that Rapa could be reduced nine-fold and CsA reduced five-fold when these drugs were used in combination. These reduced doses were tested in vivo for the treatment of experimental autoimmune uveoretinitis (EAU). Twelve of 15 rats treated with CsA, 2 mg/kg/day, developed EAU with a median severity of 2.5. Fourteen of 15 rats treated with Rapa, 0.01 mg/kg/day, developed EAU with a median severity of 3.25. Complete inhibition of EAU was achieved in all 15 animals treated with the combination of Rapa and CsA (combined vs CsA alone, p < 0.0002; combined vs Rapa alone, p < 0.00001). The demonstrated synergistic relationship between Rapa and CsA will allow the use of reduced doses of each drug to achieve a therapeutic effect. The use of lower doses may reduce the toxicity of these drugs for the treatment of autoimmune uveitis.

MeSH terms

  • Animals
  • Antigens / immunology
  • Arrestin
  • Autoimmune Diseases / drug therapy*
  • Cyclosporine / therapeutic use*
  • Drug Synergism
  • Eye Proteins / immunology
  • Immunosuppressive Agents / therapeutic use*
  • Lymph Nodes / cytology
  • Lymphocyte Activation / drug effects*
  • Male
  • Polyenes / therapeutic use*
  • Rats
  • Rats, Inbred Lew
  • Retinitis / drug therapy*
  • Retinitis / immunology
  • Sirolimus
  • Uveitis / drug therapy*
  • Uveitis / immunology

Substances

  • Antigens
  • Arrestin
  • Eye Proteins
  • Immunosuppressive Agents
  • Polyenes
  • Cyclosporine
  • Sirolimus