Apoptosis in endothelial cells by cyclosporine.

OBJECTIVES: The immunosuppressive drug cyclosporine (CsA) is a potent agent widely used after organ transplantations and to treat various autoimmune disorders. After using CsA, some patients suffer severe complications including renal and vascular toxicity, which are influenced by the degree of the endothelial damage. Several studies have demonstrated CsA treatment to directly induce apoptosis in several cell types. Thus, CsA may induce endothelial damage via activation of proapoptotic proteins. The present study was undertaken to investigate the effects of CsA on apoptosis of endothelial cells using human umbilical vein endothelial cells. METHODS: Proliferation was measured by using the Cell Counting Assay Kit after cells were exposed to CsA (0 L, 10 L, 30 L, 50 L or 100 µg/mL). Apoptotic cells were identified by fluorescence microscopy of 4', 6-diamidino-2-phenylidole-stained nuclei. Western blot analysis was done for poly(ADP-ribose) polymerase (PARP), p27, p53 and caspase. RESULTS: Cell viability decreased dependent on the CsA concentration. CsA treatment group showed chromatin condensation and nuclear fragmentation. CsA produced a dose-dependent induction of p27 and reduction of procasapase-3. CsA treatment induced the degradation of 116-kDa PARP into an 89-kDa fragment. CONCLUSIONS: CsA induced apoptosis of endothelial cells.

Effect of cyclosporine on apoptosis in bronchial epithelial cells.

OBJECTIVES: Among airway complications, posttransplantation infections are related to impaired mucociliary clearance, which may represent a toxicity of cyclosporine (CsA), a potent, widely used immunosuppressive drug after organ transplantations. Since several recent studies have demonstrated CsA treatment to directly induce apoptosis in several cell types, we investigated its effects on airway cells using the human bronchial epithelial cell line BEAS-2B. METHODS: Proliferation was measured by using a Cell Counting Assay Kit by exposing cells to CsA (0, 10, 30, 50, or 100 µg/mL). Apoptotic cells were identified using fluorescence microscopy after 4', 6-diamidino-2-phenylidole (DAPI) staining. Western blot analysis was performed to evaluate the contents of poly(adenosine diphosphate-ribose) polymerase (PARP), p27, Bcl-2, and caspase-3. RESULTS: Cell viability decreased dependent on the CsA concentration: 100.00 ± 0.01% with 0 µg CsA as control; 98.65 ± 0.02% with 10 µg (P < .05 vs control); 95.41 ± 0.05% with 30 µg (P < .05 vs control); 38.84 ± 0.04% (P < .001 vs control) with 50 µg; and 15.28 ± 0.05% with 100 µg (P < .001 vs control). Apoptotic cells detected with DAPI showed chromatin condensation and nuclear fragmentation. CsA induced p27 and p53, as well as degradation of 116-kd PARP into an 89-kd fragment. CONCLUSION: CsA induced apoptosis in human bronchial epithelial cells.

Effects of cyclosporine on oxidative stress in human bronchial epithelial cells.

OBJECTIVES: Some of the airway complications relate to the use of cyclosporine (CsA), a potent agent widely used after organ transplantations. Several recent studies have demonstrated CsA treatment to induce reactive oxygen species (ROS). The present study was undertaken to investigate effects of CsA on production of ROS and antoxidant defense of airway cells using the human bronchial epithelial cell line BEAS-2B. METHODS: We measured biological antioxidant potential (BAP), as well as ROS and malondialdehyde levels in BEAS-2B cells after CsA treatment, using Free Radical Analytical System 4 kits (Diacron, Grosseto, Italy). ROS production was expressed as Carr Units as established by the manufacturer and BAP as µmol/2 × 10(5) cells; malondialdehyde, by the thiobarbituric acid assay. RESULTS: ROS production was increased in the BEAS-2B cells after CsA treatment: 73.5 at 0 (controls); 82.5 at 10; 84.0 at 30; 86.0 at 50; and 93.0 Carr Unit/2 × 10(5) cells at 100 µg/mL of CsA. The levels of BAP were 1821 at 0 (controls), 1698 at 10; 1653 at 30; 1366 at 50 µg/mL; and 1391 at 100 µg/mL. The levels of malondialdehyde were increased: 3.8 at 0 (controls); 3.4 at 10; 4.4 at 30; 4.2 at 50: and 5.0 nmol/10(6) cells at 100 µg/mL. CONCLUSIONS: Increased production of ROS and decreased BAP by CsA in BEAS-2B cells may increase malondialdehyde levels by radical-induced damage.

Effects of cyclosporine on metalloproteinase in endothelial cells.

OBJECTIVES: Cyclosporine (CsA) is a potent agent widely used after organ transplantations and in treatment of various autoimmune disorders. Some patients suffer severe complications including renal and vascular toxicity that are influenced by the degree of endothelial damage. Dysregulation of metalloproteinase (MMP) activity is known to contribute to renal and vascular diseases. To investigate the possible mechanisms of posttransplantation complications in the kidney and vessels by CsA, we examined its effects on metalloproteinases in endothelial cells using human umbilical vein endothelial cells (HUVECs). METHODS: HUVECs isolated from umbilical cords by collagenase digestion were seeded in 6-well plates at a density of 1 × 10(5) cells/well before treatment with 2-250 µmol/L CsA and a 24-hour incubation. Thereafter we performed gelatin zymography of MMP-1, MMP-2, MMP-3, MMP-8, MMP-9, and MMp-13 to evaluate band density using a luminescent image analyzer system with controls calculated as 100%. RESULTS: MMP-1, MMP-3, MMP-8, MMP-9, and MMP-13 activities were increased after CsA treatment; MMP-1 = 121; MMP-3 = 164; MMP-8 = 133; MMP-9 = 124; and MMP-13 = 121. In contrast, MMP-2 activity was decreased after CsA treatment; MMP-2 = 79. CONCLUSIONS: This study showed CsA to activate most MMPs (except MMP-2) in endothelial cells. This result suggests that CsA may dysregulate MMPs in endothelial cells.

The production of reactive oxygen species in tacrolimus-treated glial cells.

OBJECTIVE: After organ transplantation, some patients suffer from mild neurological symptoms, such as tremor, to severe complications, including seizures and encephalopathy. These neurological side effects can be caused by immunosuppressants such as tacrolimus. However, the mechanism of encephalopathy by tacrolimus is not fully understood. METHODS: We measured the production of reactive oxygen species (ROS) in glioma cells after tacrolimus treatment. Tacrolimus added to glioma cells was incubated for 60 minutes at 37 degrees C. The production of ROS was evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2',7'-dichlorofluorescin using VICTOR3TM multilabel counter. RESULTS: Tacrolimus resulted in the production of the ROS in glioma cells. The production of the ROS was increased in time-dependent fashion. CONCLUSIONS: These findings indicated that the tacrolimus may contribute the neurological side effects by ROS production.

Cytokine array after cyclosporine treatment in rats.

OBJECTIVES: Long-term treatment with cyclosporine (CsA) results in chronic nephrotoxicity, which is known to be mediated by several cytokines including transforming growth factor-betal. Cytokines are known to play an important role in innate immunity, apoptosis, angiogenesis, cell growth, and differentiation. They are known to be involved in most disease processes, including cancer, cardiac disease, and nephrotoxicity. To evaluate changes of cytokines in a rat model of CsA-induced chronic nephrotoxicity, we performed a cytokine array. METHODS: Experiments were performed on two groups of rats; normal control group and CsA-treated group. Cytokine array in rat serum was performed using Cytokine Antibody Array I kit from RayBiotech. RESULTS: Serum creatinine, urine creatinine, and creatinine clearance increased in the CsA-treated group. Among the several cytokines, the expressions of the lipopolysaccharide-induced CXC chemokine (LIX), monocyte chemoattractant protein 1 (MCP-1), nerve growth factor (beta-NGF), and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the CsA-treated group were increased above that of cytokines in the control group. The density of the LIX in controls was 0.62, and in the CsA-treated group was 1.24. The density of the MCP-1 in controls was 0.68, and in CsA-treated, 1.43. The density of the beta-NGF in controls was 0.62, and that in CsA-treated, 1.24. The density of the TIMP-1 in controls 1.13, and in CsA-treated, 1.40. CONCLUSIONS: Our data suggested that among several cytokines elevated levels of the LIX, MCP-1, beta-NGF, and TIMP-1 are the contributing factors to CsA-induced nephropathy.

Effects of tacrolimus on antioxidant status and oxidative stress in glioma cells.

OBJECTIVES: After organ transplantation, some patients suffer from mild neurologic symptoms, ranging from tremor to severe complications, including seizures and encephalopathy. Among the immunosuppressants, tacrolimus can cause neurologic side effects. However, the mechanisms of encephalopathy by tacrolimus are not fully understood. We measured the antioxidant status, hydrogen peroxide level, and malondialdehyde level in glioma cells after tacrolimus treatment. METHODS: The production of hydrogen peroxide was determined by the modified xylenol orange method. The amount of malondialdehyde was measured by the thiobarbituric acid assay, which is based on malondialdehyde reaction with thiobarbituric acid to give a red species absorbing at 535 nm. Total antioxidant status (TAS) was measured using TAS kits (NX2332). RESULTS: Tacrolimus resulted in dose- and time-dependent increases in the production of hydrogen peroxide by glioma cells. The antioxidant status decreased in the glioma cells after tacrolimus treatment. Malondialdehyde level was unchanged in the glioma cells after tacrolimus treatment. CONCLUSIONS: Increased production of reactive oxygen species and decreased antioxidant status by tacrolimus in glioma cells may contribute to neurologic side effects.

Effects of cyclosporine on the production of the reactive oxygen species in the glial cells.

OBJECTIVES: After organ transplantation, some patients suffer mild neurological symptoms such as tremor to severe complications including seizures and encephalopathy. Among the immunosuppressants, cyclosporine (CsA) can induce neurological side effects. However, the mechanisms of encephalopathy by CsA are not fully understood. We measured the production of reactive oxygen species (ROS) in the glioma cells after CsA treatment. METHODS: CsA (2.5 mmol/L) added to glioma cells was incubated for 60 minutes at 37 degrees C. ROS production was evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2',7'-dichlorofluorescin using VICTOR3 multilabel counter. RESULTS: CsA resulted in ROS production by glioma cells. The ROS production increased with the time of exposure to CsA. CONCLUSIONS: These findings indicated that CsA may contribute to neurological side effects via ROS production.

Polyphenol (-)-epigallocatechin gallate protection from ischemia/reperfusion-induced renal injury in normotensive and hypertensive rats.

INTRODUCTION: The effect of epigallocatechin gallate (EGCG) in an in vivo renal model of ischemia with reperfusion (I/R) was compared between normotensive (WKR) and hypertensive (SHR) rats. METHODS: WKR (groups I, II, III) and SHR groups (groups IV, V, VI) were divided into three types. Groups I and IV were sham-operated animals; groups II and V were subjected to 45 minutes of renal I/R; and groups III and VI received 10 mg/kg EGCG intravenously at the time of reperfusion. Three days after renal I/R, we compared renal function markers, malondialdehyde (MDA), and histologic changes. RESULTS: Following renal I/R, levels of blood urea nitrogen (BUN) and serum creatinine (sCr) were increased and serum creatinine clearance (CrCl) decreased in group V compared to group II (P < .001). Those receiving EGCG treatment (groups III and VI) had decreased BUN and sCr compared to non-EGCG I/R groups (P < .001), but not surprisingly, higher than sham groups. CrCl was lowest in the SHR groups. The MDA was significantly decreased after EGCG treatment (P = .028 in group III, P = .002 in group VI). Following renal I/R, tissue necrosis was more severe among SHR (P < .001). However, the ratio of regeneration to damage significantly increased in SHR after EGCG treatment. CONCLUSIONS: The reperfusion injury was greater among SHR compared with WKR in terms of renal function, lipid peroxidation, and tissue damage. EGCG treatment significantly ameliorated renal impairment and promoted tissue regeneration following renal I/R.

Total antioxidant status and oxygen free radicals during hepatic regeneration.

OBJECTIVES: The damage induced by oxygen free radicals (OFRs) is caused by an imbalance of the production of versus the antioxidant defenses against OFRs. METHODS: To understand hepatic damage induced by oxygen free radicals after hepatectomy in rats, total antioxidant status and total production of oxygen free radicals were serially measured in regeneration liver. At 1, 2, 3, 7, and 10 days after hepatectomy of Sprague-Dawley rats, blood was obtained into a capillary tube from a tail vein. Total antioxidant status and total production of oxygen free radicals were measured using the Randox kit, a colorimetric method, and the Free Radical Analytical System. We also measured the amount of malonyldialdehyde, which provides an indirect index of oxidative injury. RESULTS: The level of malonyldialdehyde after hepatectomy was higher compared with that before hepatectomy. The level of total oxygen free radicals after hepatectomy was higher compared with that before hepatectomy. Total antioxidant status after hepatectomy was lower compared with that before hepatectomy. CONCLUSIONS: The results suggested that the damage by OFRs to the regenerating liver was caused by increased production of OFRs and decreased antioxidant defense against OFRs.

Effects of cyclosporine and tacrolimus on the oxidative stress in cultured mesangial cells.

OBJECTIVES: Cyclosporine (CsA) and tacrolimus (Tac) are two primary immunosuppressive agents used for the prevention of graft rejection. However, their use is associated with significant side effects, most notably nephrotoxicity. The mechanisms of this toxicity are not fully understood, but they seem to be associated with increases in the production of oxygen free radicals (OFRs). This present work examined the effect of CsA and Tac on the production of OFRs in cultured rat renal mesangial cells (RMCs). METHODS: Varying concentrations of CsA and Tac (0 to 40 micromol/L) were added to RMCs and incubated for 60 minutes at 37 degrees C. The production of OFRs was evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2', 7'-dichlorofluorescin. RESULTS: At 60 minutes, the relative fluorescence units (RFU) for OFRs production in RMCs exposure to CsA were increased by 2.5%, 11.5%, 22.5%, 57.2%, and 174% at 2.5, 5, 10, 20, and 40 micromol/L, respectively. Tac increased the RFU by 15.9%, 13.6%, 14.8%, 13.2%, 21.4%, 13.2%, and 28.1% at 0.1, 1, 2.5, 5, 10, 20, and 40 micromol/L, respectively. In RMCs, the RFU produced by CsA was higher than that by Tac. CONCLUSIONS: The results of this experiment suggest that CsA and Tac induced renal injury by OFRs.

Effect of tacrolimus on the production of oxygen free radicals in hepatic mitochondria.

OBJECTIVES: Cyclosporine (CsA) causes side effects that occur mainly in the kidney but also in the liver. Several reports have strongly suggested that the production of oxygen free radicals (OFRs) is a common mechanism of CsA toxicity. However, tacrolimus is believed to suppress the production of OFRs. METHODS: We obtained the mitochondrial fraction with 96% purity from rat liver using a sucrose density gradient solution. Zero to 100 micromol/L tacrolimus was incubated with the mitochondrial fraction for 6 hours at 37 degrees C. OFRs were evaluated by measuring the fluorescent product from the oxidation of an oxidant-sensitive 2,7-dichlorefluorescein using a VICTOR3 multilabel counter. RESULTS: The fluorescence units for OFR production were increased as the time of exposure to tacrolimus passed from 1 to 6 hours. The fluorescence units in 0.1 micromol/L tacrolimus were 6.0 x 10(5) at 1 hour, 7.8 x 10(5) at 2 hours, 9.0 x 10(5) at 3 hours, 10.0 x 10(5) at 4 hours, 11.1 x 10(5) at 5 hours, and 11.4 x 10(5) at 6 hours. However, the fluorescence units were similar although the tacrolimus concentration increases from 0.1 to 100 micromol/L. CONCLUSIONS: The results in this experiment suggested that tacrolimus induced the production of OFRs depending on the exposure time.

Apoptosis by cyclosporine in mesangial cells.

INTRODUCTION: The immunosuppressive agent cyclosporine (CsA) is widely used to treat allograft rejection and various autoimmune disorders. A major limiting factor in the use of CsA is chronic nephrotoxicity. The pathogenesis of CsA-induced nephrotoxicity is not fully understood. Several recent studies have suggested that CsA treatment directly induces apoptosis in several cell types. The present study was undertaken to investigate the effects of CsA on apoptosis of cultured rat mesangial cells (RMCs). METHODS: RMCs were treated with CsA at concentrations of 0.1 to 40 mumol/L. Cell viability was determined by MTT assay. Apoptotic protein expression was determined by Western blot analysis. RESULTS: Cell viability was decreased with increasing concentrations of CsA in dose-dependent manner. CsA produced dose-dependent induction of p53, caspase-6, and Bax protein expression. CsA treatment caused proteolytic cleavage of caspase-3 and induced the degradation of 116-kDa PARP into 89-kDa fragment. RMCs with CsA reduced Bcl-2 and cIAP expression. CONCLUSIONS: In this study, CsA induced apoptosis by up-regulating proapoptotic factors, caspase-3 and -6, p53, Bax, cleaving PARP, and down-regulating antiapoptotic factor, Bcl-2, and cIAP. These results suggested that the increased cell apoptosis exerted by CsA may be one of the mechanisms promoting CsA-induced nephrotoxicity.

Effects of epigallocatechin gallate on the hemolysis induced by cyclosporine.

INTRODUCTION: Hemolysis is one of the side effects of cyclosporine (CsA) therapy, in part due to, increased production of free radical species by CsA. Epigallocatechin gallate (EGCG), which acts as a highly efficient free radical scavenger, may have a protective effect on CsA-induced hemolysis. In this study, we measured the degree of hemolysis of as well as the amounts of hydrogen peroxide level and malondialdehyde produced by normal human erythrocytes (RBCs) incubated with CsA and with EGCG. METHODS: Human RBCs were incubated as follows. In group 1, 4.2 x 10(6)/mL RBCs were incubated with Cremophore EL. In group 2, the RBCs were incubated with only 167 microg/mL EGCG. In group 3, the RBCs were incubated with 1.67 mg/mL CsA. In group 4, the RBCs were incubated with CsA plus EGCG. RESULTS: The degree of hemolysis in group 2 (53.8 +/- 3.8) was significantly higher than that in group 1 (7.0 +/- 1.0). The degree of hemolysis in group 3 (86.2 +/- 2.2) was significantly higher than that in group 1 and group 2. The degree of hemolysis in group 4 (74.9 +/- 2.9) was significantly higher than in group 1 and in group 2, but lower than that in group 3. The hydrogen peroxide and malondialdehyde levels paralleled the degree of hemolysis. CONCLUSIONS: These results suggest that CsA can induce free radical-mediated hemolysis, which can be partially prevented with EGCG.

Effects of polyhemoglobin-antioxidant enzyme complex on ischemia-reperfusion in kidney.

INTRODUCTION: The kidney suffers ischemia-reperfusion (I/R) injury during transplantation. The purpose of the present study was to investigate the therapeutic effect of artificials cells on renal I/R injury through biochemical assays and histological examination. METHODS: We prepared artificial cells using cross-linked hemoglobin (Hb), superoxide dismutase (SOD), and catalase. Normal male Sprague-Dawley rats were divided into 6 groups: the sham-operated control group, the group treated with polyHb,and the group treated with polyHb-SOD-catalase (PSC) (per groups were subjected to ischemia for 1 hour or 2 hours). After reperfusion for 4 hours, kidney and blood samples were obtained. RESULTS: The levels of SOD and catalase in the PSC group were 15 and 50 times higher than those of the control group, respectively. In the polyHb group, the levels of blood urea nitrogen (BUN), serum creatinine, renal hydrogen peroxide, and renal malondialdehyde were increased. However, their levels were significantly decreased by PSC administration. Renal SOD activity did not show any significant changes in the polyHb group, but renal catalase activity was decreased by polyHb treatment in comparison with the control group. The activities of renal SOD and catalase were increased using PSC treatment. In the histological findings, the PSC group showed no evidence of acute tubular necrosis in proximal convoluted tubules; their microvilli and cytoplasmic microorganelles were relatively well preserved. CONCLUSIONS: These results show that PSC effectively reduces renal damage via diminished oxygen free radical-mediated injury after I/R.

Effect of artificial cells on hepatic function after ischemia-reperfusion injury in liver.

BACKGROUND: The liver suffers from ischemia/reperfusion injury during transplantation. Reactive oxygen species generated by xanthine oxidase during reperfusion of the ischemic liver may be partially responsible for the hepatic injury. Oxygen free radicals are removed by antioxidant enzymes such as superoxide dismutase (SOD), catalase, and glutathione peroxidase. Using glutaraldehyde and lysine we constructed crosslinked hemoglobin, containing SOD and catalase, and assessed its ability to protect against ischemia/reperfusion injury during transplantation. METHODS: In contrast to the sham-operated control groups, blood was exchanged using crosslinked hemoglobin (polyHb) a PolyHb-SOD-catalase (PSC) group. After ischemia/reperfusion injury, several parameters of hepatic damage and oxygen free radicals were measured as well as microscopic examination. RESULTS: Alanine aminotransferase, aspartate aminotransferase, superoxide production, hydrogen peroxide, and malondialdehyde levels were higher among the PolyHb group than sham-operated controls. The PolyHb group revealed a few apoptotic bodies, some acute inflammatory infiltrates in the sinusoids, nuclear fragmentations, cell shrinkage, and chromatin clumping with formation of apoptotic bodies in the apoptotic cells under microscopic examination. Alanine aminotransferase, aspartate aminotransferase, superoxide production, and hydrogen peroxide levels were lower in the PSC than the PolyHb group. Hepatic structures were well preserved in the PSC group. CONCLUSIONS: Reactive oxygen species contribute to hepatic dysfunction with morphologic changes. PSC is effective to reduce hepatic damage by lowering oxygen free radical-mediated injury after ischemia/reperfusion in the liver.

Effect of epigallocatechin gallate on renal function in cyclosporine-induced nephrotoxicity.

INTRODUCTION: Nephrotoxicity is a clinically important side effect of cyclosporine (CsA). CsA-induced nephrotoxicity results from increased production of free radical species in the kidney. Epigallocatechin gallate (EGCG) acts as an antioxidant, thus, EGCG may have a protective effect on the alteration of renal function resultant from oxygen free radicals. The purpose of the present study was to investigate the protective effect of EGCG in a rodent model. METHODS: Experiments were performed on 3 groups. The normal control group (group 1) received normal saline solution. The CsA-treated group (group 2; 15 mg/kg body weight/d for 14 days) received subcutaneous injections. The EGCG-treated group (group 3) in addition received 25 mg of EGCG/kg body weight by intraperitoneal injection. RESULTS: There were significant increases in levels of blood urea nitrogen (BUN)(42.8 +/- 8.2 mg/dL; P < .001), serum creatinine (1.18 +/- 0.60 mg/dL; P < .05), and serum malondialdehyde (3.09 +/- 0.20 nmol/mL; P < .001), and a significant decrease in CCr(0.07 +/- 0.02 mL/min; P < .001) in group 2 compared with group 1. Levels of BUN (30.2 +/- 0.7 mg/dL; P < .01)and CCr (0.12 +/- 0.08 mL/min) were lower in group 3 than in group 2. Serum creatinine (0.71 +/- 0.04 mg/dL) and serum malondialdehyde level (2.13 +/- 0.15; P < .001 nmol/mL) were lower in group 3 than in group 2. There was no significant difference in CsA levels between group 2 (6.86 +/- 1.48 mug/mL) and group 3 (6.69 +/- 0.62 mug/mL). CONCLUSIONS: EGCG treatment significantly protected renal function and free radical-mediated injury in the kidney from CsA-induced changes.

Effect of melatonin on the malondialdehyde level of neutrophils in cyclosporine-treated rats.

INTRODUCTION: Cyclosporine (CsA) may contribute to oxygen free radical metabolism in neutrophils, thus resulting in the damage to these cells. This damage may be mitigated by antioxidants such as melatonin. In this study, we measured the malondialdehyde level, which was used as a marker of free radical-induced tissue damage from neutrophils in rats treated with CsA and melatonin. METHODS: The experiments included the following: (1) normal controls (group 1) that received Cremophor EL and 0.5 mL of 5% ethanol-saline solution; (2) CsA alone-treated (group 2) rats that received 15 mg/kg of body weight per day for 14 days by subcutaneous injection; and (3) melatonin-treated (group 3) rats received CsA as for group 2 plus melatonin (715 mug). RESULTS: Malondialdehyde level was significantly higher among group 2 (13.34 +/- 7.54 nmol/10(7) neutrophils) than group 1 animals (7.33 +/- 2.63 nmol/10(7) neutrophils; P < .05). The level was significantly lower in group 3 (5.58 +/- 1.59 nmol/10(7) neutrophils) than group 2 (P < .01). CsA levels were not significantly different between group 2 (6.25 +/- 1.60 mug/mL) and group 3 (6.09 +/- 2.01 mug/mL). CONCLUSIONS: In this experiment, the malondialdehyde level in neutrophils was increased after CsA treatment, suggesting that damage resulted from oxygen free radicals by CsA. This damage was reduced by melatonin. Thus, CsA-induced neutrophils oxidative damage may be protected by melatonin in transplant recipients.