Rapamune (Sirolimus, rapamycin): an overview and mechanism of action.

Rapamycin (Sirolimus, Rapamune), a potent immunosuppressive agent, has been demonstrated to have remarkable activity in inhibiting allograft rejection in animal models of transplantation. It is currently in phase II clinical trials. Rapamycin belongs to the class of macrocyclic immunosuppressive drugs that are bioactive only when bound to immunophilins. Cyclosporin A and FK506, two other members of this class, selectively block the transcriptional activation of several cytokine genes, thereby inhibiting cytokine production. Although rapamycin and its structural analog FK506 bind to the same immunophilin (FKBP), rapamycin acts at a later stage in T-cell cycle progression by blocking cytokine-mediated signal transduction pathways. This inhibition is the consequence of modulation of activity of a target protein by the rapamycin: FKBP complex [sirolimus effector protein (SEP)]. Although the identification of SEP has recently been reported, its function in cell-cycle progression is not known. The biochemical events that rapamycin has been shown to inhibit are (a) activation of p70S6 kinase, (b) activation of cdk2/cyclin E complex, (c) phosphorylation of retinoblastoma protein, and (d) suppression of cdc2 and cyclin A transcription.