Suppression of the allogeneic response by the anti‐allergy drug N‐(3,4‐dimethoxycinnamonyl) anthranilic acid results from T‐cell cycle arrest

Previously we have shown that indoleamine 2,3‐dioxygenase (IDO) and the tryptophan metabolite, 3‐hydroxykynurenine (3HK) can prolong corneal allograft survival. IDO modulates the immune response by depletion of the essential amino acid tryptophan by breakdown to kynurenines, which themselves act directly on T lymphocytes. The tryptophan metabolite analogue N‐(3,4‐dimethoxycinnamonyl) anthranilic acid (DAA, ‘Tranilast’) shares the anthranilic acid core with 3HK. Systemic administration of DAA to mice receiving a fully MHC‐mismatched allograft of cornea or skin resulted in significant delay in rejection (median survival of controls 12 days, 13 days for cornea and skin grafts, respectively, and of treated mice 24 days (P < 0·0001) and 17 days (P < 0·03), respectively). We provide evidence that DAA‐induced suppression of the allogeneic response, in contrast to that induced by tryptophan metabolites, was a result of cell cycle arrest rather than T‐cell death. Cell cycle arrest was mediated by up‐regulation of the cell cycle‐specific inhibitors p21 and p15, and associated with a significant reduction in interleukin‐2 production, allowing us to characterize a novel mechanism for DAA‐induced T‐cell anergy. Currently licensed as an anti‐allergy drug, the oral bioavailability and safe therapeutic profile of DAA make it a candidate for the prevention of rejection of transplanted cornea and other tissues.