Which of the following statement (s) is/are true concerning currently approved immunosuppressant agents?

c. Cyclosporine blocks transcription of several early T-cell activation genes

e. The monoclonal antibody OKT3 interferes with T-cell antigen recognition function

The major principle of immunosuppression is to induce the patient with high doses of drugs at the time of allografting in order to prophylax rejection. The drugs are then reduced rapidly within a period of days to weeks to less toxic maintenance levels. The anti-metabolite azathioprine (Imuran) interferes with nucleic acid metabolism inhibiting proliferation and clonal expansion of activated lymphocytes, eliminating alloantigen specific immune responses. This agent is used during induction immunosuppression and for maintenance immunosuppression but has little role for treating an acute, ongoing rejection. Glucocorticoids are the mainstays of virtually all immunosuppressive regimens. All glucocorticoids have similar immunosuppressive actions and none is more effective than any other at equipotent doses. Complications and side effects are equivalent at all equipotent doses. Cyclosporine inhibits the rotamase activity of cyclophilin. Therefore the major immunosuppressive activity of cyclosporine is to block transcription of several early T-cell activation genes. The macrolide antibiotic, FK-506 is 10-100 times more potent than cyclosporine on a molar basis but it too is associated with a number of significant and similar toxicities. Antibodies are given for only short periods of time to prophylax rejection and to treat acute ongoing rejection. There are two major types of antibody preparations—polyclonal antibodies such as antilymphocyte (ALG) or antithymocyte globulin (ATG) or monoclonal antibodies. The only monoclonal antibody currently available is OKT3 which is the used for both induction and treatment of rejection and is the most efficacious agent currently available for the treatment of rejection.