Cyclophilin inhibition as potential therapy for liver diseases

J Hepatol. 2014 Nov;61(5):1166-74. doi: 10.1016/j.jhep.2014.07.008. Epub 2014 Jul 15.


The cyclophilins are a group of proteins with peptidyl-prolyl isomerase enzymatic activity, localised in different cellular compartments and involved in a variety of functions related to cell metabolism and energy homeostasis, having enhanced expression in inflammation or malignancy. Cyclophilin A (CypA), the most abundantly expressed cyclophilin, is present mainly in the cytoplasm and is a host factor involved in the life cycle of multiple viruses. The extracellular fractions of CypA and CypB are potent pro-inflammatory mediators. CypD, located in mitochondria, is a key regulator of mitochondrial permeability transition pores, and is critical for necrotic cell death. Cyclosporines are the prototype cyclophilin inhibitors. Cyclic peptides, which bind and inhibit cyclophilins without having immunosuppressive properties, have been generated by chemical modifications of cyclosporin A. In addition, cyclophilin inhibitors that are structurally different from cyclosporines have been synthesized. The involvement of cyclophilins in the pathogenesis of different liver diseases has been established using both in vitro and in vivo investigations, thus indicating that cyclophilin inhibition may be of therapeutic benefit. This review summarises the evidence for potential therapeutic applications of non-immunosuppressive cyclophilin inhibitors, alone or in combination with other agents, in virus-induced liver diseases like hepatitis C, B or Delta, liver inflammation and fibrosis, acetaminophen-induced liver toxicity and hepatocellular carcinoma.

Keywords: Alisporivir; Cyclophilin A; Cyclophilin D; Cyclophilin inhibitors; SCY-635; Sanglifehrins.

Publication types

  • Review

MeSH terms

  • Acetaminophen / toxicity
  • Animals
  • Carcinoma, Hepatocellular / drug therapy
  • Chemical and Drug Induced Liver Injury / drug therapy
  • Cyclophilins / antagonists & inhibitors*
  • Cyclophilins / metabolism
  • Enzyme Inhibitors / chemistry
  • Enzyme Inhibitors / therapeutic use
  • Hepatitis B, Chronic / drug therapy
  • Hepatitis B, Chronic / metabolism
  • Hepatitis B, Chronic / virology
  • Hepatitis C, Chronic / drug therapy
  • Hepatitis C, Chronic / metabolism
  • Hepatitis C, Chronic / virology
  • Humans
  • Liver Cirrhosis / drug therapy
  • Liver Diseases / drug therapy*
  • Liver Diseases / metabolism
  • Liver Neoplasms / drug therapy
  • Liver Regeneration / drug effects
  • Mitochondria, Liver / drug effects
  • Mitochondria, Liver / metabolism
  • Non-alcoholic Fatty Liver Disease / drug therapy


  • Enzyme Inhibitors
  • Acetaminophen
  • Cyclophilins