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First, 6-TGN can be converted into deoxy-6-thioguanosine, which causes cell apoptosis by incorporation into DNA and inhibition of DNA-processing enzymes such as topoisomerase and DNA ligase that maintain base-pair stability and DNA dynamics ( de novo purine synthesis ( The Role of TPMT Monitoring The American Gastroenterological Association recommends that TPMT activity should be tested prior to the start of thiopurines and the dose adjusted according to TPMT status ( Figure 1 ), TPMT influences the risk of severe and potentially fatal myelosuppression among patients receiving standard doses of azathioprine or 6-mercaptopurine