Thus, infections caused by S epidermidis biofilms are particular

Thus, infections caused by S. epidermidis biofilms are particularly hard to eradicate. Biofilm formation by S. epidermidis is a multistep process and involves (1) attachment of the bacterial cells to a polymer surface or to the host-derived matrix that has previously coated the polymeric device and (2) accumulation to form multilayered cell clusters with cell-to-cell

adherence mediated by the production of a slimy extracellular matrix (Vadyvaloo & Otto, 2005). Several genes have been identified to play important roles in the biofilm formation of S. epidermidis (Mack et al., 2007). The atlE gene encodes autolysin AtlE, which mediates the initial attachment of S. epidermidis to a polymer surface (Heilmann et al., 1997), and the ica gene locus (icaADBC) encodes the biosynthesis

of polysaccharide intercellular adhesion (PIA), which is essential in the accumulation process (Heilmann et al., 1996). A few regulatory Sirolimus genes of biofilm formation were also identified (Mack et al., 2007). For example, the icaR gene affects the ability of biofilm formation by repressing the icaADBC operon (Conlon et al., 2002). The sarA gene encodes an activator of the icaADBC operon and positively regulates the biofilm formation of S. epidermidis (Tormo et al., 2005). The rsbU gene, a positive regulator of the alternative sigma factor, σB, positively regulates the biofilm formation of S. epidermidis by repressing icaR (Knobloch

et al., BMS-907351 nmr 2004). Besides, LuxS (Xu et al., 2006) and Agr (Kong et al., 2006), a quorum-sensing system, also mediate biofilm formation in S. epidermidis. Recent work indicates that the regulation of biofilm formation in S. epidermidis is a complex networking and may involve mechanisms other than the ica system. The sarZ gene encodes a regulator that activates the transcription of the icaADBC operon in an icaR-independent manner and positively regulates the biofilm formation of S. epidermidis (Wang et al., 2008) Additionally, it is not uncommon to find clinical isolates that accumulate biofilm in an ica-independent mode (Ruzicka et al., 2004; Hennig et al., 2007; Qin et al., 2007), which indicates that there may be other mechanisms mediating biofilm formation. Protein degradation is essential for cell viability and homeostasis, and this process is commonly Chlormezanone mediated by ATP-dependent proteases. One notable case is ClpXP proteases, which function in degrading SsrA-tagged misfolded proteins (Gottesman et al., 1998), controlling the RpoS concentration in Escherichia coli (Gottesman et al., 1998) and regulating bacterial adaptation to stress (Porankiewicz et al., 1999). ClpXP proteases also play a crucial role in the biofilm formation of Pseudomonas fluorescens (O’Toole & Kolter, 1998), Streptococcus mutans (Lemos & Burne, 2002), Staphylococcus aureus (Frees et al., 2004) and S. epidermidis (Wang et al., 2007).

The modalities of this tolerance induction might be considered as

The modalities of this tolerance induction might be considered as mirroring innate immunity and so be described as ‘innate tolerance’. CD1d-restricted immune responses should also be considered within such a group of tolerance effectors. CD1d is a non-classical major histocompatibility class 1-like molecule that primarily presents either buy Dinaciclib microbial or endogenous glycolipid antigens to T cells involved in innate immunity. CD1d-restricted T cells comprise NKT cells and a subpopulation of γδ T cells expressing the Vγ4 T-cell receptor. In particular, activated NKT cells secrete large quantities

of cytokines that both help control infection and modulate the developing adaptive immune response. However, NKT cells can also promote Treg-cell activation[75] and the chronic in vivo stimulation of NKT often leads to a Th2 bias in the immune response and promotes the generation of tolerogenic dendritic cells. CB-839 supplier Furthermore, with similar modalities to MSC and macrophages, reagents have been identified that, by interacting with CD1d, differently bias Th-cell

responses.[76] One of the best examples in which effectors of such ‘innate tolerance’ are actively recruited is cancer. Tumour cells evade immune system recognition not only by mutating antigenic epitopes initially recognized by host immune surveillance, but also and especially by creating an environment that is extremely potent at inhibiting immune responses in a non-specific fashion. Fibroblasts[77] and immunosuppressive myelomonocytic cells[78] heavily infiltrate the tumour process and facilitate the activation of ‘adaptive tolerance’ effectors like Treg cells.[45] Within this context, it is plausible to surmise a major role of MSC because of their

ability to polarize and activate Adenosine triphosphate immunosuppressive networks as summarized in this review. This hypothesis gains support also by a recent set of data elegantly generated using a transgenic mouse in which stromal cells could be depleted. The depletion of cells expressing fibroblast activation protein-α caused rapid hypoxic necrosis of both cancer and stromal cells in immunogenic tumours by a process involving IFN-γ and TNF-α.[79] Mesenchymal stromal cells can also contribute to the tumour-related immune impairment because they produce TGF-β, which can suppress or alter the activation, maturation and differentiation of both innate and adaptive immune cells.[80] In addition, TGF-β has an important role in the differentiation and induction of Treg cells. Furthermore, in the presence of IL-6, also produced by MSC, TGF-β induces the differentiation of IL-17-producing CD4+ Th17 cells, which may have tumour-promoting activities.[81] An interesting proposal for a ‘tissue-based’ approach to the regulation of the immune response has been recently put forward by Matzinger and Kamala.

1) IKK-β leads to nuclear exclusion and protein degradation of F

1). IKK-β leads to nuclear exclusion and protein degradation of FOXO3 [[16]]. To determine if IKK-ε promotes the same phenomenon, FLAG-tagged expression constructs encoding IKK-β and IKK-ε, as well as their dominant

negative forms, were expressed in the 293-TLR4 cells. As expected, IKK-β expression was associated with reduced FOXO3 nuclear localization, while expression of its dominant negative mutant (IKK-β-KA) had no effect (Fig. 1B). Decreased levels of FOXO3 were also observed in nuclear fraction of the IKK-ε- but not IKK-ε-KA-expressing selleck kinase inhibitor cells, suggesting that similarly to IKK-β, IKK-ε induces nuclear exclusion. In addition, a slow migrating band (indicated by an arrow) detected in cells expressing IKK-ε (Fig. 1B), consistent with direct or indirect IKK-ε-mediated posttranslational modifications of FOXO3, for example Navitoclax phosphorylation. Next, we examined whether IKK-ε can physically interact with FOXO3. HA-tagged FOXO3 protein (HA-FOXO3) was expressed in the 293-TLR4 cells together with FLAG-tagged IKK-β, IKK-ε, or bacterial alkaline phosphatase (BAP) as a negative control, and immunoprecipitated (IP) (Fig. 2A). Consistent with previous findings [[16]], FOXO3 interacted with IKK-β. It also formed complexes with IKK-ε, but not with BAP (Fig. 2A).

To examine if this association was inducible upon TLR4 stimulation, 293-TLR4 cells, which stably express TLR4/MD2-CD14 receptors, were treated with lipopolysaccharide (LPS). IKK-ε/FOXO3 interaction was slightly enhanced by LPS treatment (Fig. 2A), suggesting that FOXO3 recruitment by IKK-ε is potentiated by LPS stimulation. This observation was confirmed in a time course experiment which demonstrates that IKK-ε-FOXO3 complex formation increased as early as 5 min, reached its maximum at 30 min, and returned to the basal level after 120 min post LPS stimulation

(Supporting Information Alectinib mouse Fig. 2A). The rapid and transient kinetics of IKK-ε-FOXO3 complex formation suggests that IKK-ε may signal to FOXO3 in response to TLR4 activation. Next, we examined whether an interaction between the endogenous IKK-ε and FOXO3 could be detected in human monocyte-derived DCs (MDDCs) and if this interaction may be induced by LPS stimulation. FOXO3 was IP and western blot (WB) analysis for IKK-ε revealed a specific interaction with FOXO3, which was induced after LPS stimulation (Fig. 2B). Further mapping of the interaction interface using deletion mutants of HA-FOXO3 revealed that C-terminus of FOXO3 protein is critical for IKK-ε-FOXO3 interaction (Fig. 2C). To determine if slow migrating bands observed in protein extracts of the cells expressing IKK-ε (Fig. 1B, 2A and C), correspond to phosphorylated forms of FOXO3, the extracts were treated with lambda-phosphatase to remove all phosphate groups. After phosphatase treatment, only one band of the right size was detected (Supporting Information Fig. 2B), demonstrating that IKK-ε induces FOXO3 phosphorylation.

To this purpose, innovative automated genome-based research techn

To this purpose, innovative automated genome-based research technologies derived from recent knowledge of the human genome project may represent a valuable tool to weight the genetic/genomic influence on pharmacological outcomes, to assist clinicians to optimize daily therapeutic strategies (Fig. 1) and to identify more selective find more and more appropriate targets for pharmacological interventions. For many years, several studies have emerged indicating that a substantial portion of variability in drug response is determined genetically. Approximately 40 years ago, Kalow and Gunn [14] described, for the first time, that subjects homozygous for a gene encoding for an atypical form

of the enzyme butyrylcholinesterase (pseudocholinesterase) were predisposed to develop a delayed recovery from muscular paralysis and prolonged apnoea after administration of the neuromuscular blocker succinylcholine. At almost the same time, it was observed that a common genetic variation in a phase II pathway of drug metabolism (N-acetylation) could result in striking differences in the half-life and plasma

concentrations of drugs metabolized by N-acetyltransferase. Such drugs included the anti-tuberculosis agent isionazid [15], the anti-hypertensive agent hydralazine [16] and the anti-arrhythmic drug procainamide [17]. In all cases these variations learn more had clinical consequences [18]. These early examples of potential influence of inheritance on drug effects, followed by subsequent studies, gave rise

to the field of ‘pharmacogenetics’. However, the molecular genetic basis for such inherited traits began to be elucidated only in the late 1980s, with the initial cloning and characterization of polymorphic human genes encoding for drug-metabolizing enzymes [19,20]. The use of different combinations of powerful drugs [e.g. calcineurin inhibitors, mammalian target of rapamycin (mTOR) inhibitors, corticosteroids] leads to a significant improvement in the treatment of several renal disorders and in the short- and long-term pharmacological management of GNA12 renal transplantation recipients [1,21]. However, these drugs are hampered frequently by a narrow therapeutic index. Moreover, these agents are characterized by a high variability in pharmacokinetic behaviour and by a poor correlation between drug concentrations and pharmocodynamic effects [22–24]. ‘Tailoring’ the dose of such drugs to the specific requirements of the individual patient to minimize toxicity while maintaining efficacy is therefore a challenging goal in clinical nephrology. To achieve this objective, several research programmes have been undertaken analysing the genetic influence on the patient’s response to these conventional treatments. Considerable evidence in the literature has reported that genetic polymorphisms have a major impact on the metabolism of azathioprine (AZA), a purine anti-metabolite used widely in nephrology [25–27].

The expulsion of worms from the gut is still not well understood

The expulsion of worms from the gut is still not well understood in immunological terms and for some parasite species may be more difficult to manipulate with a vaccine. Although eosinophils are implicated as effectors in some murine models, there are clearly very capable alternative mechanisms available, and closer scrutiny of these is likely to teach us lessons more widely applicable in immunology. In a number of experimental models, we have yet to accurately track the migration of larvae and until this can be performed we will not be able to analyse the nature of immune responses the parasites encounter. An example of this is seen in N. brasiliensis check details infections, where resistance is most

potent in the pre-lung phase of infection and yet, larvae see more are virtually untraceable from the time they leave the skin 2 h pi., until the majority arrive in the lungs 24–48 h later. In this infection, larvae are being trapped both in and outside of subcutaneous tissues prior to the lung phase, but so far only the skin has been quantitatively surveyed with any degree accuracy. Eosinophils are quite numerous in the lamina propria

of the small intestine and increase in frequency after parasites localize to this compartment. Whilst eosinophils may make a contribution to expulsion of some species of worms, they are not essential and may offer little protection against other species. The role that eosinophils play in maintaining the integrity of the gut may turn out to be more important than

contributions made to worm expulsion. The complement system is another innate effector mechanism of importance in early resistance to nematode infection. Complement proteins can be involved in recruitment of leucocytes, attachment of effectors to larvae and at least to some degree, in retarding the migration of parasites. However, many parasitic helminths can upregulate mechanisms that interfere with the complement pathway. In addition, the absence of complement is compensated for in primary and secondary infections with pathogens that are at least partially sensitive to it. S. ratti and N. brasiliensis infections in mice may continue to prove useful in better understanding innate mechanisms Diflunisal that regulate the recruitment and behaviour of leucocytes soon after entry of the parasite and again, this is likely to have broader implications in immunology. Evidence of new or newly reconsidered innate effector mechanisms continue to emerge from murine models of nematode infections (23,24,71). We have yet to determine whether IL-4 and IL-13 are important in the pre-lung phase of infections with skin-invasive helminths other than N. brasiliensis. Nor do we understand how these cytokines function in N. brasiliensis infections, but they might have a combination of effects on leucocyte recruitment and function.

[21] However, cellular and molecular approaches are necessary to

[21] However, cellular and molecular approaches are necessary to directly investigate epileptogenic changes in neural circuits; these

approaches cannot be adequately applied to resected and often fixed human tissues. For this purpose, an organotypic slice culture system that retains the characteristic anatomic organization of the tissue of origin suits well to these requirements. Further, in the slice cultures derived from neonatal brain tissues, several developmental changes of neural circuits 5-Fluoracil order take place, including neuronal migration, axonal and dendritic growth, and synaptogenesis. In a recent study,[4] we utilized organotypic slice cultures that were prepared from rat pups which experienced experimental febrile

seizures, to investigate the mechanisms underlying the emergence of ectopic granule cells, because the ectopic granule cells have been suggested to be abnormally incorporated into excitatory hippocampal networks and may be epileptogenic (the morphological and functional properties of ectopic granule Opaganib in vitro cells were excellently reviewed in Scharfman et al., Pierce et al. and Scharfman and Pierce).[22-24] The slice culture system allowed us to perform time-lapse imaging of the migrating granule cells, revealing that neonatally generated granule cells exhibit aberrant migration after febrile seizures, which results in granule cell ectopia. We further determined that the aberrant migration is mediated

by the excitatory action of GABA. In this article, I will introduce our study[4] mainly focusing on the use of hippocampal slice cultures. First, we examined whether complex febrile DCLK1 seizures affect the localization of neonatally generated granule cells using a rat model of febrile seizures. Experimental febrile seizures were induced by placing rats at post natal day 11 (P11) under hyperthermic conditions.[25] To examine the localization of neonatally generated granule cells, P5 rats were injected with the S-phase marker 5-bromo-2′-deoxyuridine (BrdU), and the localization of BrdU-labelled granule cells were examined at P60. Immunohistochemical analysis revealed that the number of BrdU-labelled ectopic granule cells which failed to migrate into the granule cell layer and remained in the dentate hilus was significantly higher in the rats that experienced febrile seizures compared to control rats. In the same experimental paradigm, except that a retrovirus that encodes membrane-targeted green fluorescent protein (GFP) instead of BrdU was injected into P5 rats, we found ectopic granule cells which had bipolar dendrites that extended into the hilus and axons that projected to the granule cell layer, as well as into the CA3 region in seizure animals at P60. These results suggested that febrile seizures attenuated the proper migration of neonatally generated granule cells, inducing granule cell ectopia that persists into adulthood.

Cells of the neurovascular unit can now be investigated in the in

Cells of the neurovascular unit can now be investigated in the intact brain through the combined use of high-resolution in vivo imaging and non-invasive molecular tools to observe and manipulate cell function. Mouse lines that target transgene expression to cells of the neurovascular unit will be of great value in future work. However, a detailed evaluation of target cell specificity and expression pattern within the brain is required for many existing lines. The purpose of this review is to catalog mouse lines selleck inhibitor available to cerebrovascular biologists and to discuss their utility and limitations in future

imaging studies. This article is protected by copyright. All rights reserved. “
“Please cite this paper as: Roy S, Sen CK. miRNA in wound inflammation and angiogenesis. Microcirculation19: 224–232, 2012. Chronic wounds represent a rising health and economic burden to our society. Emerging studies indicate that miRNAs play a key role in regulating several hubs that orchestrate the wound inflammation and angiogenesis processes. Of interest to wound inflammation Pictilisib are the regulatory loops where

inflammatory mediators elicited following injury are regulated by miRNAs, as well as regulate miRNA expression. Adequate angiogenesis is a key determinant of success in ischemic wound repair. Hypoxia and cellular redox state are among the key factors that drive wound angiogenesis. We provided first evidence demonstrating that

miRNAs regulate cellular redox environment via a NADPH oxidase-dependent mechanism in human microvascular endothelial cells (HMECs). We further demonstrated that hypoxia-sensitive miR-200b is involved in induction of angiogenesis by directly targeting Ets-1 in HMECs. These studies point toward a potential role of miRNA in wound angiogenesis. Non-specific serine/threonine protein kinase miRNA-based therapeutics represent one of the major commercial hot spots in today’s biotechnology market space. Understanding the significance of miRs in wound inflammation and angiogenesis may help design therapeutic strategies for management of chronic nonhealing wounds. “
“In pathological scenarios, such as tumor growth and diabetic retinopathy, blocking angiogenesis would be beneficial. In others, such as myocardial infarction and hypertension, promoting angiogenesis might be desirable. Due to their putative influence on endothelial cells, vascular pericytes have become a topic of growing interest and are increasingly being evaluated as a potential target for angioregulatory therapies. The strategy of manipulating pericyte recruitment to capillaries could result in anti- or proangiogenic effects. Our current understanding of pericytes, however, is limited by knowledge gaps regarding pericyte identity and lineage.

, 2011) The maximum killing effect of mucoid biofilms by imipene

, 2011). The maximum killing effect of mucoid biofilms by imipenem or colistin was obtained with higher dosages and longer treatment compared with non-mucoid biofilms (Fig. 2; Hengzhuang et al., 2011). Mature biofilms of both the nonmucoid and the mucoid strain showed increased tolerance compared with young biofilms. A high variation in biomass and morphology of biofilms formed by nonmucoid CF isolates was found by confocal laser scanning microscopy of flow-cell biofilms. Investigation of isolates collected from the early and late stages of the chronic infection showed a loss in in vitro biofilm formation capacity over time (Lee et al., 2005). The heterogeneity

of in vitro biofilm formation of nonmucoid

isolates correlated with significant changes in the gene expression profiles of nonmucoid isolates (Lee et al., 2011). In contrast, the clonally related paired click here mucoid isolates maintained unaltered biofilm formation capacity together with an unaltered transcriptomic profile (Lee et al., 2011). These in vitro data suggest that treatment of P. aeruginosa infection in CF patients requires the treatment of several structural and phenotypic types of biofilms located in the different compartments of the respiratory airways. Traditional antibiotic susceptibility determination of planktonic cultures reveals greater susceptibility to antibiotics of mucoid compared with nonmucoid CF Selleckchem Torin 1 isolates (Ciofu et al., 2001). In accordance, more recent colistin-resistant isolates belonging to two of the most common clones at the Copenhagen CF Centre were identified (Johansen et al., 2008) and all had a nonmucoid phenotype. However, biofilm susceptibility determination showed that mucoid biofilms are more tolerant to antibiotics than nonmucoid biofilms. As mucoidy is associated with poor lung function (Pedersen et al., 1992), it has been proposed that antimicrobial

treatment should be aimed at mucoid biofilms for a beneficial clinical outcome Reverse transcriptase (Ciofu & Høiby, 2007; Bjarnsholt et al., 2009). Mutator P. aeruginosa isolates are usually found at late stages of the chronic infection (Ciofu et al., 2005, 2010) and have been associated with antibiotic resistance (Macia et al., 2005). Evidence has been provided that the hypermutable phenotype of CF P. aeruginosa isolates is due to alterations in the genes of the DNA repair systems of either the mismatch repair system (MMR), which involves mutS, mutL and uvrD, or the DNA oxidative lesions repair system, which involves mutT, mutY and mutM (Oliver et al., 2000, 2002; Mandsberg et al., 2009). The PAO1 ∆mutS and ∆mutL strains both formed biofilms with significantly enhanced microcolony growth compared with both the wild-type and the respective complemented strains. Biofilms created by the hypermutator strains were significantly larger in total biovolume and maximum microcolony thickness (Conibear et al., 2009).

Natural Tregs (nTregs) develop in the thymus whereas induced regu

Natural Tregs (nTregs) develop in the thymus whereas induced regulatory T cells (iTregs) differentiate

in peripheral sites.1In vitro differentiation of iTregs is mediated by T-cell receptor (TCR) -mediated activation together with transforming growth factor-β (TGF-β) and interleukin-2 (IL-2).2 Both types of Tregs constitutively express Foxp3 [forkhead (FKH)-winged helix family protein of transcription regulators], which is the master gene mediating the immunosuppressive function of Tregs.3,4 It is likely that the induction of Foxp3 expression in Tregs p38 MAPK signaling with TGF-β is secondary to activation of the enhancer and promoter regions of the Foxp3 gene, as well as being secondary to regulation of histone

acetylation and DNA demethylation of the Foxp3 gene.5,6 The role of TGF-β in Treg induction in vivo is unclear because the optimal concentrations of TGF-β used to induce Foxp3 expression in vitro are unlikely to be present in vivo. Statins are widely used drugs for the treatment of hypercholesterolaemia. They function as competitive inhibitors of 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR), which is the rate-determining enzyme of the mevalonate pathway. More recent studies have also suggested that statins can mediate immunosuppressive functions and have proven effective in the treatment of autoimmune diseases or graft-versus-host disease in animal models.7–9 A number of mechanisms have been proposed to explain the immunosuppressive effects of the statins including inhibition of antigen presentation by inhibition of the induction of MHC class II expression, find more and blocking of T helper type 1 (Th1) cell differentiation by inhibiting

TCR-specific phosphorylation of Stat4 in Th1 differentiation.7,10 Suppression of Th1 differentiation Janus kinase (JAK) by statins in the experimental autoimmune encephalomyelitis mouse model was mediated by inhibition of protein geranylgeranylation, one of the main downstream metabolic branches of the mevalonate pathway.10 Statins may also interfere with the interaction between T cells and antigen-presenting cells by inhibiting the functions of the β-integrin, lymphocyte function-associated antigen 1 (CD11a/CD18).11 Although direct effects of statins on Treg function have not been reported, a number of studies have suggested that Tregs play an important role in the control of pathology in atherosclerosis and atherosclerotic plaques have been reported to contain a lower percentage of Foxp3+ Tregs compared with normal tissue.12,13 Recently, a study has reported that the number of Foxp3+ T cells is elevated in the peripheral blood mononuclear cellsof patients who take statins.14 However, it is still unclear if statins directly increase the number of Foxp3+ cells or indirectly modulate the trafficking of Tregs into blood or to sites of immunopathology.

In CIDP, such drugs either showed no significant benefit or there

In CIDP, such drugs either showed no significant benefit or there were no efficacy data available from randomized controlled clinical trials. Azathioprine is a purine MLN8237 ic50 analogue that is metabolized rapidly to the cytotoxic

and immunosuppressant derivatives 6-mercaptopurine and thioinosinic acid. The latter inhibits purine synthesis, impairs activation and proliferation and causes apoptosis of T cells and B cells due to their lack of metabolic pathways for nucleotide salvage (‘recycling’). Azathioprine is used widely in organ transplantation and in autoimmune disorders. Azathioprine has been the most widely used immunosuppressive treatment in MS prior to approval of immunomodulatory therapies. Preparations and administration: azathioprine is usually administered orally at a dose of 2−3 mg/kg/day in two to three single doses. Clinical trials: in a recent meta-analysis of five controlled, randomized clinical trials involving 698 patients Doxorubicin with RRMS, azathioprine at a dose of 2−3 mg/kg/day reduced the relapse rate compared with placebo during the first year of treatment [relative risk reduction (RRR) = 20%], at 2 years’ (RRR = 23%) and at 3 years’ (RRR = 18%) follow-up [39]. Moreover, in three small trials with a total of 87 patients, azathioprine reduced

the number of patients with disability progression (RRR = 42%) at 3 years’ follow-up compared to placebo [39]. Unfortunately, data on MRI paramenters of inflammation or degeneration were not available [39]. Rucaparib In CIDP, azathioprine showed no significant benefit on primary (clinical disability) or secondary (electrophysiological parameters, demand for corticosteroids and/or IVIG) outcomes measures

in a recent meta-analysis that included only one controlled, randomized clinical trial with 27 patients [25]. Due to the limited size of the study, uncertainty remains about the effects of azathioprine and its use in patients with CIDP, in whom disease activity cannot otherwise be controlled. Adverse effects, frequent: gastrointestinal disturbances, bone marrow suppression and hepatic toxicity are the most frequent side effects. Infrequent: data from clinical trials and from cohort and case–control studies did not show an increase in risk of malignancy from azathioprine. However, a possible long-term risk of cancer from azathioprine may occur with treatment duration longer than 10 years or cumulative doses above 600 g [39]. In RRMS and CIDP, other ‘classic’ non-selective oral immunosuppressive drugs such as methotrexate, mycophenolate mofetil, tacrolimus/sirolimus and cyclosporin A (as monotherapies) either showed no significant benefit or there are no data available from randomized, controlled clinical trials to support a clinical benefit [25, 40]. Due to the loss of patent protection of these drugs, it is unlikely that new studies will be performed to support their use as monotherapies in MS and CIDP.