General characteristics of immunostimulants used in medicine. Immunomodulators: mechanism of action and clinical application. Features in purpose

Immunomodulator – a special drug of biological, plant or synthetic origin that affects the immune system. Drugs in this category can both stimulate it (immunostimulants) and suppress it (immunosuppressors). Taking them for a number of diseases can significantly speed up recovery and minimize adverse consequences.

Immunostimulants and immunomodulators: differences

Immunostimulants and immunomodulators- these are two groups of drugs that stimulate the immune system. In a broad sense, these drugs are identical, since they perform the same function, but still, they have differences from each other. In order to once and for all understand and remember what the differences are between immunostimulants and immunomodulators, you need to know what each of these terms means.

Immunomodulators- these are (conditionally) “weakly neutral” drugs that simply act on the body and force its own immunity to work more thoroughly under certain conditions (for example, during ARVI).

Immunostimulants- these are more “powerful” and “strong” drugs that are used only in cases where the human immune system suffers significantly, and one’s own immunity cannot cope with even minor diseases. In other words, these drugs are used mainly only for immunodeficiency conditions (for example, HIV).

Classification of immunomodulators

1. Thymic - increase the number of special cells (T cells), which largely determine the adequacy of the immune response. The latest generations of thymic drugs are synthetic analogues of thymus hormones, or the human thymus gland.

2. Bone marrow - they contain the so-called. myelopeptides, which have both a stimulating effect on T cells and an inhibitory effect on malignant tumor cells.<

3. Microbial. They combine two actions – vaccinating (specific) and non-specific.

4. Cytokines are endogenous immunoregulatory molecules, the deficiency of which does not allow the body to adequately respond to the viral threat.

5. Nucleic acids.

6. Chemically pure immunomodulators with a wide spectrum of action - immune stimulation, antioxidant, antitoxic. They are also capable of providing a membrane-protective effect.

Action and use of immunomodulators and immunostimulants

Such drugs are prescribed as part of complex therapy. This is due to the fact that they do not have a direct effect on the pathogen. The immunomodulator corrects and stimulates the body's defense reactions, allowing you to effectively fight infection. But in some cases, the immune system begins to fight against the body’s cells (autoimmune diseases) - in this case, immunosuppressants that suppress the immune system are indicated. Suppressors are also used in transplantology to prevent rejection of transplanted donor organs.

The use of immunocorrectors is indicated for a variety of infections (especially chronic, sexually transmitted infections), allergic diseases, neoplasms, and HIV. As a separate (independent) drug, they can be used as a prophylactic agent during epidemics (influenza, ARVI) - for this purpose, both herbal immunomodulators and synthetic complexes can be used. Among the modern and proven immunostimulants, it is worth noting “Timogen” - a unique drug that allows its use starting from 6 months of age. The dosage of the drug is prescribed by the doctor, in accordance with the age and severity of the condition.

Immunosuppressants. Classification. Characteristics and mechanism of action of drugs. Application. Side effects.

Drugs intended to artificially suppress human immunity are called immunosuppressants, another name for them is immunosuppressants. This group of drugs is usually used during organ transplant surgery.

Antitumor immunity is the main type of hereditary immunity that ensures the survival of multicellular animals, in the body of which, as calculations of somatic mutations show, about 1 million mutant cells appear within one day, a significant part of which undergoes tumor transformation. By quickly recognizing and destroying them, the immune system performs the function of homeostasis, which determines the normal development of organisms in the prenatal and postnatal periods.

Etiological basis for the occurrence of tumors. According to the now accepted views, cancerous degeneration of cells in animals is most often caused by integration DNA- and RNA-containing viruses. It usually does not occur immediately, since the genome of the integration virus in the host cell chromosome is repressed. Transformation of a cell into a malignant one occurs after derepression and reading of information from viral oncogenes. Provoking agents of oncogene derepression can be exogenous or endogenous factors of a wide variety of nature (see “Oncogenic viruses”).

Types and mechanisms of antitumor immunity. There are two systems of antitumor defense: 1) innate, universal antitumor reactivity of the body, independent of the specificity of cancer antigens; 2) specific, which is induced by antigens of emerging tumors, focused on the focus (blastoma).

Natural antitumor immunity is determined mainly by normal killer cells, which destroy malignant cells upon contact with them, and TNF. The phagocytic reaction in natural antitumor defense does not seem to be of great importance. Macrophages do not engulf living tumor cells, but, like normal killer cells, they can have a cytolysis mechanism.

Specific anti-blastoma immunity is provided mainly by CTLs, but their effectiveness is determined by the immunogenicity of membrane tumor-specific transplantation antigens (see “Oncogenic viruses”), the protective and adaptive mechanisms of malignant cells and their suppressive effect on the host immune system.

Mechanisms of protection of tumor cells from immune factors. There are two mechanisms for protecting malignant cells from immune surveillance. One of them is associated with a deficiency of recognition molecules on tumor cells, and the other is associated with masking (escape) of their antigens.

In particular, tumor cells are difficult to recognize by CTLs because they weakly or not at all express MHC class I molecules. In addition, tumor cells do not express CD80 and CD86 molecules, which react with the CD28 co-receptor, without a signal from which, instead of activation and differentiation CB8+ lymphocytes develop anergy, and often they are simply destroyed by the mechanism of apoptosis.

If a tumor antigen induces antibody formation, then specific immunoglobulins, reacting with it, instead of damaging tumor cells, often protect them from the action of cytotoxic T lymphocytes or even enhance malignant growth. This is explained by the fact that antibody blockade of tumor antigens on membranes hides the foreignness of cancer cells. What is not clear is why antitumor antibodies do not opsonize malignant cells, promoting their phagocytosis or killing by NK cells. It should be noted that the foreignness of tumor antigens is masked not only by antibodies, but also by mucopolyscharides, which always accumulate during the transformation of normal cells into malignant ones.

Tumor cells can also escape immune surveillance by internalizing (immersing) the immune complex of antibodies with membrane antigens inside the cell without subsequent resynthesis of surface antigens. It is possible that in some cases, membrane antigens of tumor cells become soluble and, released into the intercellular fluid, “intercept” antitumor antibodies and block T-killers “at distant approaches.” It is possible that during the development of anti-blastoma immunity, a gene mutation occurs in tumor cells, which leads to the loss of the specificity of their antigens.

It is assumed that the protection of tumor cells is determined by their production of cytokines that reduce CTL activity. This function can, for example, be performed by TFR A and p, as well as IL-10, which inhibits the synthesis of cytokines by Txl cells (including γ-IFN).

There is an idea that in the tumor process
immunotolerance to tumors often develops
antigens, which was reproduced experimentally by inoculating cancer cells that do not cause tumor formation and do not induce immunity.

The development of tumors can also be explained by the activation of suppressor cells. In this case, the role of suppressors can be played by macrophages, hypothetical veto cells, Th2 lymphocytes, which are antagonists of Txl cells, or tumor cells themselves, producing the same cytokines as Th2 cells.

Human immune status

The body's resistance is ensured by the balanced action of many constitutional and acquired humoral-cellular factors of the immune system. The quantitative contribution of each of them to the total immunity fluctuates around its characteristic average indicator (norm), which is called immune status.

Studies of the mechanisms of immune status have revealed that the ability to respond to pathogens is genetically encoded. According to the strength of the immune response, some individuals can be highly responsive to one of them and weakly responsive to another, and the entire population is conventionally divided into three types - strong, weak and moderate. Immunoreactivity genes are called Ir genes. Among them, some control the process of antigen processing by macrophages, others control the rate of proliferation and differentiation of T and B cells, and others control the overall level of antibody formation and cytokine synthesis. All these genes are linked to the major histocompatibility complex locus, encoding MHC antigens on immunocytes and thereby controlling the processes of their cooperation.

Age-related features of the formation of immune status. The body of a newborn and children in the first 6 months of life reacts to the introduction of antigen with weak phagocytic activity and a low level of antibody production (mainly IgM). The immune system begins to function fully from the second year of life, when the normal process of IgG formation is established. By the 4th-6th year, their titers reach values typical for adults. Only a deficiency in the production of secretory IgAS persists, which makes children highly sensitive to pathogens of respiratory and intestinal infections. Fully balanced functioning of protective factors is established only at 15-16 years of age and, under favorable conditions, remains throughout life. In older people, a decrease in the level of immunity occurs as a result of a disruption in the process of antigen recognition and the production of immunoglobulins, which most often occurs against the background of secondary immunodeficiencies that develop in somatic and infectious diseases. Usually they are temporary, functional in nature, disappearing after recovery, but if individual parts of the immune system are damaged, then immunodeficiencies progress.

The state of the immune status is judged by a number of tests of nonspecific and acquired resistance: by the quantitative content in the blood serum of patients of complement, lysozyme, interferons a and P, phagocytic activity of macrophages and, most importantly, by the percentage or absolute number of T-lymphocytes, B-lymphocytes cytes and the content of immunoglobulins, the normal level of which in the blood is 1000-2000 T cells/μl, 100-300 B cells/μl, 0.5-1.9 g IgM/l, 8-17 g IgG/l , 1.4-3.2 g IgA/l.

When immunological disorders are detected, correction is resorted to using biologically active drugs that modify the immune response and have a beneficial effect on immunocompetent cells or the regulatory products they produce.

Principles of immunotherapy

Immunotherapy is treatment with immunotropic natural and synthetic agents that act on the immune system or the immunological phase of pathological processes. Among immunotherapeutic agents, a distinction is made between immunostimulants-immunocorrectors, which activate (correct) immunological processes, and immunosuppressants, which inhibit (suppress) inappropriately strong immune reactions. They are all called immunomodulators. Among them, according to their therapeutic effect, two groups are distinguished - with a predominantly stimulating or corrective effect and immunosuppressants.

Immunomodulators with stimulating and corrective action. According to the source of origin (receipt), there are 5 subgroups of stimulant-correctors:

1) human immunoglobulin preparations (see “Immune sera”);

2) peptides from bovine thymus extract (tactivin, thymalin, timoptan, thymostimulin), used in the treatment of diseases affecting the T-immune system and autoimmune processes;

3) cytokines, primarily: a) recombinant interferons a (reaferon), P (betaferon), y (gammaferon), used for the treatment of hepatitis, acute respiratory viral infections, malignant neoplasms, purulent and septic processes, b) interleukins, c in particular IL-2 (proleukin and roncoleukin), effective in melanoma, leukemia and lymphomas, c) recombinant colony-stimulating factors (molgrastim, lenograstim), which are used to normalize hematopoiesis;

4) preparations from pseudomonad lipopolysaccharides (pyrogenal and prodigiosan), bacterial proteoglycans (lykopid), ribosomes of Klebsiella and streptococci (ribomunil), yeast RNA hydrolysate (sodium nucleinate), activating neutrophils, macrophages, endothelial cells, inducing the formation of anti-inflammatory drugs. nal cytokines and expression of adhesins;

5) levamisole, diucifon, thymogen and other synthetic immunomodulators used for immunodeficiencies.

Immunosuppressants. Substances of two generations are used as immunosuppressants. The first of them includes azathioprine, synthesized on the basis of 6-mer-captopurine, and cyclophosphamide, which disrupt the process of DNA replication and indiscriminately damage all dividing cells that enter into an immune response, as a result of which the processes of tissue renewal and hematopoiesis are disrupted. Unfortunately, the first generation of immunosuppressants weakens the body's resistance to infectious diseases and often promotes the occurrence of tumors.

Second generation immunosuppressants are more advanced. The best of them is cyclosporine A, isolated from a soil fungus Tylopocladium infantum, substance FK506 and the antibiotic rapamycin, obtained from streptomyces. Differing in structure and some features of the mechanism of action, they do not destroy, but only block the activation of T-lymphocytes and the production of IL-2, as a result of which they do not cause side effects and are used as ideal drugs for suppressing the rejection reaction during allotransplantation of organs and tissues, as well as treatment of various autoimmune diseases. Glucocorticoids, in particular prednisolone and especially drugs such as dexamethasone and betamethasone with high activity, long-lasting action and a pronounced anti-inflammatory effect, turned out to be gentle immunosuppressants. These hormonal drugs are used in the treatment of collagenosis and allergic diseases.

In recent years, attempts have been made to use immunotoxins, which are hybrid molecules consisting of monoclonal antibodies or cytokines associated with toxins (in particular, ricin), capable of penetrating into target cells and causing their lysis, as highly specific immunosuppressants.

Orenburg State Agrarian University

Department of Microbiology

Abstract on the topic:

"Microbial immunomodulators"

Orenburg, 2010

1. Immunity and immune system.

2. Immunomodulators

1. Immunity and immune system.

Immunity is the protection of the body from genetically foreign agents of exogenous and endogenous origin, aimed at preserving and maintaining the genetic homeostasis of the body, its structural, functional, biochemical integrity and antigenic individuality. Immunity is one of the most important characteristics for all living organisms created in the process of evolution. The principle of operation of defense mechanisms is to recognize, process and eliminate foreign structures. Protection is carried out using two systems - nonspecific (innate, natural) and specific (acquired) immunity. These two systems represent two stages of a single process of protecting the body. Nonspecific immunity acts as the first line of defense and as its final stage, and the acquired immunity system performs intermediate functions of specific recognition and memory of a foreign agent and the activation of powerful innate immunity at the final stage of the process. The innate immune system operates on the basis of inflammation and phagocytosis, as well as protective proteins (complement, interferons, fibronectin, etc.). This system reacts only to corpuscular agents (microorganisms, foreign cells, etc.) and toxic substances that destroy cells and tissues, or rather , on the corpuscular products of this destruction. The second and most complex system - acquired immunity - is based on the specific functions of lymphocytes, blood cells that recognize foreign macromolecules and respond to them either directly or by producing protective protein molecules (antibodies).

In addition to somatic and infectious diseases that are widespread among people, the human body is affected by social (inadequate and unhealthy nutrition, living conditions, occupational hazards), environmental factors, and medical measures (surgical interventions, stress, etc.), which First of all, the immune system suffers, and secondary immunodeficiencies occur. Despite the constant improvement of methods and tactics of basic disease therapy and the use of deep reserve drugs using non-drug methods of influence, the effectiveness of treatment remains at a fairly low level. Often the reason for these features in the development, course and outcome of diseases is the presence of certain disorders of the immune system in patients. Research conducted in recent years in many countries around the world has made it possible to develop and introduce into widespread clinical practice new integrated approaches to the treatment and prevention of various nosological forms of diseases using immunotropic drugs of targeted action, taking into account the level and degree of disorders in the immune system. An important aspect in preventing relapses and treating diseases, as well as in preventing immunodeficiencies, is the combination of basic therapy with rational immunocorrection. Currently, one of the urgent tasks of immunopharmacology is the development of new drugs that combine such important characteristics as effectiveness and safety of use.

2. Immunomodulators

Immunomodulators– these are drugs that, when used in therapeutic doses, restore the functions of the immune system (effective immune defense).

Immunomodulators (immunocorrectors) - a group of drugs of biological (preparations from animal organs, plant materials), microbiological and synthetic origin, which have the ability to normalize immune reactions.

2.1. Clinical use of immunomodulators.

The most justified use of immunomodulators seems to be in cases of immunodeficiency, manifested by an increased infectious morbidity. The main target of immunomodulatory drugs remains secondary immunodeficiencies, which are manifested by frequent recurrent, difficult-to-treat infectious and inflammatory diseases of all locations and any etiology. Each chronic infectious-inflammatory process is based on changes in the immune system, which are one of the reasons for the persistence of this process. Studying the parameters of the immune system may not always reveal these changes. Therefore, in the presence of a chronic infectious-inflammatory process, immunomodulatory drugs can be prescribed even if an immunodiagnostic study does not reveal significant deviations in the immune status.

As a rule, in such processes, depending on the type of pathogen, the doctor prescribes antibiotics, antifungals, antivirals or other chemotherapeutic drugs. According to experts, in all cases when antimicrobial agents are used for phenomena of secondary immunological deficiency, it is advisable to prescribe immunomodulatory drugs.

The main requirements for immunotropic drugs are:

Immunomodulatory properties;
high efficiency;
natural origin;
safety, harmlessness;
no contraindications;
lack of addiction;
no side effects;
lack of carcinogenic effects;
lack of induction of immunopathological reactions;
do not cause excessive sensitization and do not potentiate it in other medications;
easily metabolized and excreted from the body;
do not interact with other drugs and
have high compatibility with them;
non-parenteral routes of administration.

Currently, the basic principles of immunotherapy have been developed and approved:

1. Mandatory determination of immune status before starting immunotherapy;
2. Determination of the level and extent of damage to the immune system;
3. Monitoring the dynamics of immune status during immunotherapy;
4. Use of immunomodulators only in the presence of characteristic clinical signs and changes in immune status indicators
5. Prescription of immunomodulators for preventive purposes to maintain immune status (oncology, surgical interventions, stress, environmental, occupational and other influences)

Currently, there are 6 main groups of immunomodulators based on their origin:

Microbial immunomodulators;

Thymic immunomodulators;
bone marrow immunomodulators;
cytokines;
nucleic acids;
chemically pure.

3. Immunomodulators of microbial origin

Immunomodulators of microbial origin can be divided into three generations. The first drug approved for medical use as an immunostimulant was the BCG vaccine, which has a pronounced ability to enhance factors of both innate and acquired immunity.

First-generation microbial preparations also include drugs such as pyrogenal and prodigiosan, which are polysaccharides of bacterial origin.

Currently, due to pyrogenicity and other side effects, they are rarely used.

Second-generation microbial preparations include lysates (Bronchomunal, IPC-19, Imudon, the Swiss-made drug Broncho-Vaxom, which recently appeared on the Russian pharmaceutical market) and ribosomes (Ribomunil) of bacteria, which are mainly related to the causative agents of respiratory infections Klebsiella pneumoniae, Streptococcus pneumoniae , Streptococcus pyogenes, Haemophilus influezae, etc. These drugs have a dual purpose: specific (vaccinating) and nonspecific (immunostimulating).

Likopid, which can be classified as a third-generation microbial preparation, consists of a natural disaccharide - glucosaminylmuramyl and a synthetic dipeptide - L-alanyl-D-isoglutamine attached to it. In the body, the main target for immunomodulators of microbial origin are phagocytic cells. Under the influence of these drugs, the functional properties of phagocytes are enhanced (phagocytosis and intracellular killing of absorbed bacteria are increased), and the production of anti-inflammatory cytokines necessary for the initiation of humoral and cellular immunity increases. As a result, antibody production may increase and the formation of antigen-specific T-helper and T-killer cells may be activated.

3.1. Preparations of microbial origin.

Bifiform, bifidumbacterin, probifor, linex, acipol, kipacid, enterol, bactisubtil, bificol, gastrofarm, acylact, bronchomunal, BCG, imudon, IRS-19, sodium nucleinate, prodigiosan, ribomunil, ruzam

Table 4.The main immunomodulators of microbial origin, approved for use in Russia

Preparation	Origin	Clinical indications
Broncho-munal	Bacteria lysate Str. pneumonia, H. influenzae, Klebsiella pneumonia, Kl. ozaenae, Staphylococcus aureus, Str. viridans, Str. pyogenes, M. catarrhalis	Treatment and prevention of recurrent respiratory tract infections
	Bacteria lysate L.lactis, L. acidophilus, L. helveticus, L. fermentatum,St. aureus, Kl. pneumonia, Corynobacterium pseudodiphteriticum, Fusobacterium nucleatum, Candida albicans	Gingivitis, periodontitis, alveolar pyorrhea, pericoronitis, periodontal abscesses, glossitis, stomatitis, oral candidiasis
	Lysate Str. pneumonia,St. aureus, Neisseria,Kl. pneumonia, M. cataralis, H. influenzae,Acinetobacter, Enterococcus faecium, E. faecalis	Therapy and prevention of recurrent upper respiratory tract infections
Sodium nucleinate	Sodium salt of nucleic acid derived from yeast	Chronic viral and bacterial infections, leukopenia
Pyrognal	Lipopolysaccharide Ps. aerogenosa	Chronic infections, some allergic processes, psoriasis, dermatoses
Prodigiosan	Lipopolysaccharide Ps. prodigisiosum	Chronic infections, long-term non-healing wounds
Ribomunil	Ribosomes Kl. pneumonia, Str. pneumonia,Str. pyogenes, H. influenzae, peptidoglycan Kl. pneumonia	Chronic nonspecific respiratory diseases
	Waste product of thermophilic staphylococcus	Chronic nonspecific lung diseases, bronchial asthma

The immunomodulatory role of Mycobacterium tuberculosis has been known for more than half a century. The BCG vaccine currently has no independent significance as an immunomodulator. An exception is the method of immunotherapy for bladder cancer using the BCG-Imuron vaccine. The BCG-Imuron vaccine is live lyophilized bacteria of the BCG-1 vaccine strain. The drug is used in the form of instillations into the bladder.

Living mycobacteria, multiplying intracellularly, lead to nonspecific stimulation of the cellular immune response. BCG-Imuron is intended for the prevention of recurrence of superficial bladder cancer after surgical removal of the tumor, as well as for the treatment of small bladder tumors that cannot be removed.

Study of the mechanism of the immunomodulatory effect of the BCG vaccine. showed that it is reproduced using the inner layer of the cell wall of Mycobacterium tuberculosis - peptidoglycan, and the active principle in peptidoglycan is muramyl dipeptide, which is part of the peptidoglycan of the cell wall of almost all known gram-positive and gram-negative bacteria. However, due to high pyrogenicity and other undesirable side effects, muramyl dipeptide itself turned out to be unsuitable for clinical use. Therefore, the search for its structural analogues began.

This is how the drug Lykopid (glucosaminylmuramyl dipeptide) appeared, which, along with low pyrogenicity, has higher immunomodulatory potential.

Lykopid has an immunomodulatory effect primarily due to the activation of cells of the phagocytic immune system (neutrophils and macrophages). The latter, by phagocytosis, destroy pathogenic microorganisms and, at the same time, secrete mediators of natural immunity - cytokines (interleukin-1, tumor necrosis factor, colony stimulating factor, gamma interferon), which, affecting a wide range of target cells, cause further development protective reaction of the body. Ultimately, Lykopid affects all three main components of immunity: phagocytosis, cellular and humoral immunity, stimulates leukopoiesis and regenerative processes.

The main indications for prescribing licopid: chronic nonspecific lung diseases, both in the acute stage and in remission; acute and chronic purulent-inflammatory processes (postoperative, post-traumatic, wound), trophic ulcers; tuberculosis; acute and chronic viral infections, especially genital and labial herpes, herpetic keratitis and keratouveitis, herpes zoster, cytomegalovirus infection; lesions of the cervix caused by the human papillomavirus; bacterial and candidal vaginitis; urogenital infections.

The advantage of licopid is its ability to be used in pediatrics, including neonatology. Lykopid is used in the treatment of bacterial pneumonia in full-term and premature infants. Likopid is used in the complex treatment of chronic viral hepatitis in children. Since Likopid is able to stimulate the maturation of glucuronyltransferase in the liver of newborns, its effectiveness in conjugative hyperbilirubinemia in the neonatal period is being tested.

Microorganisms from exopolysaccharides of various compositions microbial origin, as well as mucin produced... and teichoic acids, known polyclonal inducers immunomodulators. Study of anti-infective and immunostimulating activity of L. ...

Immunomodulators are a group of pharmacological drugs that activate the body’s immunological defense at the cellular or humoral level. These drugs stimulate the immune system and increase the body's nonspecific resistance.

main organs of the human immune system

Immunity is a unique system of the human body that is capable of destroying foreign substances and needs proper correction. Normally, immunocompetent cells are produced in response to the introduction of pathogenic biological agents into the body - viruses, microbes and other infectious agents. Immunodeficiency states are characterized by decreased production of these cells and are characterized by frequent morbidity. Immunomodulators are special drugs, united by a common name and a similar mechanism of action, used to prevent various ailments and strengthen the immune system.

Currently, the pharmacological industry produces a huge number of products that have immunostimulating, immunomodulating, immunocorrective and immunosuppressive effects. They are freely sold in pharmacy chains. Most of them have side effects and have a negative impact on the body. Before purchasing such medications, you should consult your doctor.

Immunostimulants strengthen the human immune system, ensure more efficient functioning of the immune system and provoke the production of protective cellular components. Immunostimulants are harmless for persons who do not have immune system disorders and exacerbations of chronic pathologies.
Immunomodulators correct the balance of immunocompetent cells in autoimmune diseases and balance all components of the immune system, suppressing or increasing their activity.
Immunocorrectors have an effect only on certain structures of the immune system, normalizing their activity.
Immunosuppressants suppress the production of immunity in cases where its hyperactivity causes harm to the human body.

Self-medication and inadequate medication use can lead to the development of autoimmune pathology, in which the body begins to perceive its own cells as foreign and fight them. Immunostimulants should be taken according to strict indications and as prescribed by the attending physician. This is especially true for children, because their immune system is fully formed only by the age of 14.

But in some cases, you simply cannot do without taking drugs from this group. In severe diseases with a high risk of developing serious complications, taking immunostimulants is justified even in children and pregnant women. Most immunomodulators are low-toxic and quite effective.

Use of immunostimulants

Preliminary immunocorrection is aimed at eliminating the underlying pathology without the use of basic therapy drugs. It is prescribed to persons with diseases of the kidneys, digestive system, rheumatism, and in preparation for surgical interventions.

Diseases for which immunostimulants are used:

Congenital immunodeficiency,
Malignant neoplasms,
Inflammation of viral and bacterial etiology,
Mycoses and protozooses,
Helminthiasis,
Kidney and liver pathology,
Endocrinopathology – diabetes mellitus and other metabolic disorders,
Immunosuppression due to the use of certain medications - cytostatics, glucocorticosteroids, NSAIDs, antibiotics, antidepressants, anticoagulants,
Immunodeficiency caused by ionizing radiation, excessive alcohol intake, severe stress,
Allergy,
Conditions after transplantation,
Secondary post-traumatic and post-intoxication immunodeficiency states.

The presence of signs of immune deficiency is an absolute indication for the use of immunostimulants in children. Only a pediatrician can choose the best immunomodulator for children.

People who are most often prescribed immunomodulators:

Children with weak immune systems
Elderly people with weakened immune systems,
People with a busy lifestyle.

Treatment with immunomodulators should be under the supervision of a physician and an immunological blood test.

Classification

The list of modern immunomodulators today is very large. Depending on their origin, immunostimulants are distinguished:

Independent use of immunostimulants is rarely justified. They are usually used as an adjunct to the main treatment of pathology. The choice of drug is determined by the characteristics of immunological disorders in the patient’s body. The effectiveness of drugs is considered to be maximum during exacerbation of the pathology. The duration of therapy usually varies from 1 to 9 months. The use of adequate doses of medication and proper adherence to the treatment regimen allows immunostimulants to fully realize their therapeutic effects.

Some probiotics, cytostatics, hormones, vitamins, antibacterial drugs, and immunoglobulins also have an immunomodulatory effect.

Synthetic immunostimulants

Synthetic adaptogens have an immunostimulating effect on the body and increase its resistance to adverse factors. The main representatives of this group are “Dibazol” and “Bemitil”. Due to their pronounced immunostimulating activity, the drugs have an antiasthenic effect and help the body quickly recover after prolonged exposure to extreme conditions.

For frequent and prolonged infections, Dibazol is combined with Levamisole or Decamevit for preventive and therapeutic purposes.

Endogenous immunostimulants

This group includes preparations of the thymus, red bone marrow and placenta.

Thymic peptides are produced by thymus cells and regulate the functioning of the immune system. They change the functions of T-lymphocytes and restore the balance of their subpopulations. After the use of endogenous immunostimulants, the number of cells in the blood is normalized, which indicates their pronounced immunomodulatory effect. Endogenous immunostimulants enhance the production of interferons and increase the activity of immunocompetent cells.

"Timalin" has an immunomodulatory effect, activates regeneration and repair processes. It stimulates cellular immunity and phagocytosis, normalizes the number of lymphocytes, increases the secretion of interferons, and restores immunological reactivity. This drug is used to treat immunodeficiency conditions that have developed against the background of acute and chronic infections and destructive processes.
"Imunofan"– a drug widely used in cases where the human immune system cannot independently resist the disease and requires pharmacological support. It stimulates the immune system, removes toxins and free radicals from the body, and has a hepatoprotective effect.

Interferons

Interferons increase the nonspecific resistance of the human body and protect it from viral, bacterial or other antigenic attacks. The most effective drugs that have a similar effect are "Cycloferon", "Viferon", "Anaferon", "Arbidol". They contain synthesized proteins that push the body to produce its own interferons.

Naturally occurring drugs include leukocyte human interferon.

Long-term use of drugs in this group minimizes their effectiveness and suppresses a person’s own immunity, which ceases to function actively. Inadequate and too long-term use of them has a negative impact on the immunity of adults and children.

In combination with other medications, interferons are prescribed to patients with viral infections, laryngeal papillomatosis, and cancer. They are used intranasally, orally, intramuscularly and intravenously.

Preparations of microbial origin

Medicines in this group have a direct effect on the monocyte-macrophage system. Activated blood cells begin to produce cytokines, which trigger innate and acquired immune responses. The main task of these drugs is to remove pathogenic microbes from the body.

Plant adaptogens

Herbal adaptogens include extracts of echinacea, eleutherococcus, ginseng, and lemongrass. These are “mild” immunostimulants, widely used in clinical practice. Drugs from this group are prescribed to patients with immunodeficiency without a preliminary immunological examination. Adaptogens trigger the work of enzyme systems and biosynthetic processes, and activate the body’s nonspecific resistance.

The use of plant adaptogens for prophylactic purposes reduces the incidence of acute respiratory viral infections and, resists the development of radiation sickness, weakens the toxic effect of cytostatics.

To prevent a number of diseases, as well as for a speedy recovery, patients are recommended to drink ginger tea or cinnamon tea daily, and take black peppercorns.

Video: about immunity – School of Dr. Komarovsky

Drugs that stimulate immune processes (immunostimulants) are used for immunodeficiency conditions, chronic, indolent infections, as well as for some cancers.

Immunodeficiency– this is a violation of the structure and function of any part of the integral immune system, the body’s loss of the ability to resist any infections and restore damage to its organs. In addition, with immunodeficiency, the process of renewal of the body slows down or even stops. The basis of the hereditary immunodeficiency state ( primary immunological deficiency) are genetically determined defects in cells of the immune system. At the same time, acquired immunodeficiency ( secondary immunological deficiency) is the result of the influence of environmental factors on the cells of the immune system. The most extensively studied factors for acquired immunodeficiency include radiation, pharmacological agents, and human acquired immunodeficiency syndrome (AIDS), caused by the human immunodeficiency virus (HIV).

Classification of immunostimulants.

1. Synthetic: LEVAMISOL (Dekaris), DIBAZOL, POLYOXIDONIUM.

2. Endogenous and their synthetic analogues:

Preparations of thymus, red bone marrow, spleen and their synthetic analogues: THYMALIN, THIMOGEN, TACTIVIN, IMUNOFAN, MYELOPID, SPLENIN.
Immunoglobulins: human polyvalent immunoglobulin (INTRAGLOBIN).
Interferons: human immune interferon-gamma, recombinant interferon gamma (GAMMAFERON, IMUKIN).

3. Preparations of microbial origin and their synthetic analogues: PRODIGIOSAN, RIBOMUNIL, IMUDON, LYKOPID.

4. Herbal preparations.

1. Synthetic drugs.

LEVAMIZOLE is an imidazole derivative used as an anthelmintic and immunomodulatory agent. The drug regulates the differentiation of T-lymphocytes. Levamisole increases the response of T lymphocytes to antigens.

POLYOXIDONIUM is a synthetic water-soluble polymer compound. The drug has an immunostimulating and detoxifying effect, increases the body's immune resistance against local and generalized infections. Polyoxidonium activates all natural resistance factors: cells of the monocyte-macrophage system, neutrophils and natural killer cells, increasing their functional activity with initially reduced levels.

DIBAZOL. Immunostimulating activity is associated with the proliferation of mature T - and B-lymphocytes.

2.Polypeptides of endogenous origin and their analogues.

2.1. TIMALIN and TACTIVIN are a complex of polypeptide fractions from the thymus (thymus gland) of cattle. The drugs restore the number and function of T-lymphocytes, normalize the ratio of T- and B-lymphocytes and cellular immune reactions, and enhance phagocytosis.

Indications for the use of drugs: complex therapy of diseases accompanied by a decrease in cellular immunity - acute and chronic purulent and inflammatory processes, burn disease (a set of dysfunctions of various organs and systems resulting from extensive burns), trophic ulcers, suppression of hematopoiesis and immunity after radiation and chemotherapy .

MYELOPID is obtained from a culture of bone marrow cells of mammals (calves, pigs). The mechanism of action of the drug is associated with stimulation of proliferation and functional activity of B and T cells. Myelopid is used in the complex treatment of infectious complications after surgery, trauma, osteomyelitis, nonspecific pulmonary diseases, and chronic pyoderma.

IMUNOFAN is a synthetic hexapeptide. The drug stimulates the formation of interleukin-2 and has a regulatory effect on the production of immune mediators (inflammatory) and immunoglobulins. Used in the treatment of immunodeficiency conditions.

2.2. Immunoglobulins.

Immunoglobulins are a completely unique class of immune molecules that neutralize most infectious pathogens and toxins in our body. The fundamental feature of immunoglobulins is their absolute specificity. This means that to neutralize each type of bacteria, viruses and toxins, the body produces its own immunoglobulins, unique in structure. Immunoglobulins (gamma globulins) are purified and concentrated preparations of the serum protein fraction containing high titers of antibodies. An important condition for the effective use of serums and gamma globulins for the treatment and prevention of infectious diseases is their administration as early as possible from the moment of illness or infection.

2.3. Interferons.

These are species-specific proteins produced by the cells of vertebrates in response to the action of causative agents. Interferon preparations are classified according to the type of active component into alpha, beta and gamma, according to the method of preparation into:

a) natural: INTERFERON ALPHA, INTERFERON BETA;

b) recombinant: INTERFERON ALPHA-2a, INTERFERON ALPHA-2b, INTERFERON BETA-lb.

Interferons have antiviral, antitumor and immunomodulatory effects. As antiviral agents, interferon preparations are most active in the treatment of herpetic eye diseases (topically in the form of drops, subconjunctivally), herpes simplex localized on the skin, mucous membranes and genitals, herpes zoster (topically in the form of an ointment), acute and chronic viral hepatitis B and C (parenteral, rectal in suppositories), in the treatment and prevention of influenza and acute respiratory viral infections (intranasal in the form of drops).

In case of HIV infection, recombinant interferon preparations normalize immunological parameters and reduce the severity of the disease in more than 50% of cases.

3 . Preparations of microbial origin and their analogues.

Immunostimulants of microbial origin are:

Purified bacterial lysates (BRONCHOMUNAL, IMUDON);

Bacterial ribosomes and their combinations with membrane fractions (RIBOMUNIL);

Lipopolysaccharide complexes (PRODIGIOZAN);

Bacterial cell membrane fractions (LICOPID).

BRONCHOMUNAL and IMUDON are lyophilized lysates of bacteria that most often cause respiratory tract infections. The drugs stimulate humoral and cellular immunity. Increases the number and activity of T-lymphocytes (T-helpers), natural killer cells, increases the concentration of IgA, IgG and IgM in the mucous membrane of the respiratory tract. Used for infectious diseases of the respiratory tract resistant to antibiotic therapy.

RIBOMUNIL is a complex of the most common pathogens of infections of the ENT organs and respiratory tract (Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes, Haemophilus influenzae). Stimulates cellular and humoral immunity. The ribosomes included in the drug contain antigens identical to the surface antigens of bacteria and cause the formation of specific antibodies to these pathogens in the body. Ribomunil is used for recurrent infections of the respiratory tract (chronic bronchitis, tracheitis, pneumonia) and ENT organs (otitis media, rhinitis, sinusitis, pharyngitis, tonsillitis, etc.).

PRODIGIOSAN is a high-polymer lipopolysaccharide complex isolated from the microorganism Bac. prodigiosum. The drug enhances nonspecific and specific resistance of the body, primarily stimulates B-lymphocytes, increasing their proliferation and differentiation into plasma cells that produce antibodies. Activates phagocytosis and killer activity of macrophages. Enhances the production of humoral immunity factors - interferons, lysozyme, especially when administered locally in inhalations. Used in complex therapy of diseases accompanied by a decrease in immunological reactivity: in chronic inflammatory processes, in the postoperative period, in the treatment of chronic diseases with antibiotics, in slow-healing wounds, radiation therapy.

LIKOPID in chemical structure is an analogue of a product of microbial origin - a semi-synthetic dipeptide - the main structural component of the bacterial cell wall. Has an immunomodulatory effect.

4. Herbal preparations.

IMMUNAL and other drugs ECHINACEA . Immunal is a stimulant of nonspecific immunity. The juice of Echinacea purpurea, which is part of Immunal, contains active substances of a polysaccharide nature that stimulate bone marrow hematopoiesis and also increase the activity of phagocytes. Indications: prevention of colds and flu; weakening of the functional state of the immune system caused by various factors (exposure to ultraviolet rays, chemotherapy drugs); long-term antibiotic therapy; chronic inflammatory diseases. Echinacea tinctures and extracts, juice and syrup are also used.

Side effects of immunostimulants:

Immunomodulators of synthetic origin – allergic reactions, pain at the injection site (for injectable drugs)

Thymus preparations – allergic reactions; bone marrow preparations – pain at the injection site, dizziness, nausea, increased body temperature.

Immunoglobulins - allergic reactions, increased or decreased blood pressure, increased body temperature, nausea, etc. With slow infusion, many patients tolerate these drugs well.

Interferons have adverse drug reactions of varying severity and frequency, which may vary depending on the drug. In general, interferons (injectable forms) are not well tolerated by everyone and may be accompanied by a flu-like syndrome, allergic reactions, etc.

Bacterial immunomodulators – allergic reactions, nausea, diarrhea.

Plant immunomodulators - allergic reactions (Quincke's edema), skin rash, bronchospasm, lowering blood pressure.

Contraindications for immunostimulants

Autoimmune diseases, such as rheumatoid arthritis;
- blood diseases;
- allergies;
- bronchial asthma;
- pregnancy;
- age up to 12 years.

IV. Consolidation.

1. What is the main function of the human immune system?

2. What is an allergy?

3. What are the different types of allergic reactions?

4. How are antiallergic drugs classified?

5. What is the primary use of first generation drugs? II generation? III generation?

6. What drugs are classified as mast cell membrane stabilizers?

7. What are mast cell membrane stabilizers used for?