**6.5 Antiproliferative agents**

Antiproliferative agents inhibit DNA replication and suppress B cells and T cells proliferation. Azathioprine and MMF are commonly used antiproliferative agents. MMF is an organic synthetic derivative of the natural fermentation product mycophenolic acid (MPA) that causes the noncompetitive reversible inhibition of inosine monophosphate dehydrogenase, which interferes with purine synthesis. Adverse effects of MMF include nausea, diarrhea, leukopenia, and thrombocytopenia. Invasive CMV infection has also been rarely associated with MMF. The introduction of MMF has been shown to be associated with improvement or stabilization of renal function, even several years after transplantation.

Other antiproliferative agents, such as cyclophosphamide and, more recently, leflunomide, have also been used.
