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Figure 2. Simplified metabolic pathway of thiopurines.

Figure 2. Simplified metabolic pathway of thiopurines. Figure 2. Simplified metabolic pathway of thiopurines. Azathioprine (AZA) is converted into mercaptopurine (MP), which is converted through an extensive multistep metabolism in, among others, 6-methylmercaptopurine (6-MMP) and 6-thioguaninenucleotide (6-TGN). The therapeutic effect of thiopurines has been related to 6-TGN metabolites, whereas (hepatotoxic) adverse events were primarily associated with 6-MMP metabolites. Thioguanine (TG) is converted into 6-TGN in one step, without the formation of 6-MMP.
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