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6-thioguanine (6-TGN)

6-thioguanine (6-TGN) along with 6-methylmercaptopurine (6-MMP) are metabolites of 6-MP and Azathioprine and the red blood cell concentration of 6-TGN is a potential guide to therapy with these medications. 6-TGN concentrations between 235-450 pmol/8 108 erythrocytes are shown to correlate with remission for patients with IBD as intracellular increases of 6-TGN are believed to be what inhibits T cell proliferation and DNA synthesis. This leads to the suppression of immune activity and the therapeutic affect of these medications. A 6-TGN level greater than 450 pmol/8 108 erythrocytes is shown to correlate with an increase in the chances for myelosuppression.[4]

Mesalamine, the active ingredient in such medications as Pentasa, Asacol, Lialda, and others is shown to increase levels of 6-TGN when used at the same time as Azathioprine or 6-MP. This may lead to increased chances for Leukopenia or potentially be used to help get 6-TGN levels in the therapeutic range.[1][2][3]

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