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Inosine-5'- monophosphate dehydrogenase 1 Mycophenolic Acid Transporter ADP-sugar pyrophosphatase Ribose- phosphate pyrophosphokinase 3 Amidophosphoribosyltransferase Trifunctional purine biosynthetic protein adenosine-3 Trifunctional purine biosynthetic protein adenosine-3 Phosphoribosylformylglycinamidine synthase Trifunctional purine biosynthetic protein adenosine-3 Multifunctional protein ADE2 Multifunctional protein ADE2 Adenylosuccinate lyase Adenine phosphoribosyltransferase Bifunctional purine biosynthesis protein PURH Bifunctional purine biosynthesis protein PURH Ectonucleoside triphosphate diphosphohydrolase 8 Ectonucleoside triphosphate diphosphohydrolase 8 Nucleoside diphosphate kinase 6 GMP synthase [glutamine- hydrolyzing] Cytosolic purine 5'-nucleotidase Purine nucleoside phosphorylase Mycophenolic acid Inosinic acid Guanosine Guanine Mycophenolic acid Adenosine diphosphate ribose H2O AMP D-Ribose 5-phosphate ATP Phosphoribosyl pyrophosphate AMP 5- Phosphoribosylamine PPi L-Glutamic acid L-Glutamine H2O ATP Glycine ADP Pi Glycineamideribotide 10- Formyltetrahydrofolate Tetrahydrofolic acid 5'- Phosphoribosyl- N- formylglycinamide ATP L-Glutamine H2O ADP Phosphoric acid Phosphoribosylformylglycineamidine L-Glutamic acid ATP ADP Pi 5- Aminoimidazole ribonucleotide 5-amino-1-(5- phospho-D- ribosyl)imidazole- 4-carboxylate CO2 ATP L-Aspartic acid ADP Phosphoric acid SAICAR Fumaric acid AICAR PPi 5- Aminoimidazole- 4-carboxamide Phosphoribosyl pyrophosphate 10- Formyltetrahydrofolate Tetrahydrofolic acid Phosphoribosyl formamidocarboxamide H2O IDP H2O Pi Inosine triphosphate H2O Pi ATP ADP NAD H2O Xanthylic acid NADH ATP NH3 AMP PPi Guanosine monophosphate H2O Phosphoric acid Pi Ribose 1-phosphate Calcium Adenine and Adenosine Synthesis DNA and RNA Synthesis DNA and RNA Synthesis Potassium Magnesium Magnesium 4Fe-4S Calcium Magnesium Magnesium Cytosol Mycophenolic acid is absorbed in the GI tract and delivered through the blood to the site of action. The plasma protein albumin is important for the movement of the drug as mycophenolic acid binds to albumin. Mycophenolic acid inhibits inosine-5'-monophosphate dehydrogenase from converting inosinic acid into xanthylic acid. This reaction is the first commited step the purine de novo synthesis pathway to create guanine. Due to the inhibition, low levels or guanine and guanosine are produced halting DNA and RNA synthesis as guanine and gunaosine are important as they are nucleobase and nucleoside respectively. T and B lymphocytes require purines being produced through the purine de novo pathway in order to proliferate and create antibodies. Unlike other cells who can obtain DNA/RNA building blocks through other means, T and B lymphocytes are reliant on this pathway. Mycophenolic acid has potent cytostatic effects causing the immune system to weaken. Lymphocyte