Immunomodulators

Immunomodulators are drugs that stimulate activity immune system. They modify the natural defense against infection, tumor. They are used to support tumors, infections, inflammation, autoimmune diseases, AIDS.

Non-specific immunomodulators
Not only do they stimulate a response to a specific antigen, but their action is complex. The exact mechanism of action is usually unclear.

Synthetic immunomodulators
Inosine
 * Immunomodulatory and antiviral effect. It inhibits viral replication and stimulates the maturation and differentiation of T-lymphocytes and the production of cytokines (INFγ). It is used to treat immunodeficient patients with severe or recurrent viral diseases (HSV, CMV, EBV, HPV),  measles or  subacute sclerosing panencephalitis.
 * The most common side effect is an increase in serum uric acid levels (reversible). Furthermore, GIT difficulties, rashes, headaches and arthralgia. Hypersensitivity to uric acid or dna is a contraindication. It should not be given with immunosuppressants, medicines that increase uremia and medicines that can cause kidney dysfunction.

Imiquimod
 * Antiviral and antitumor effects. Langerhans cells are activated after skin application. Induces apoptosis. Intended for the treatment of small superficial basal cell carcinomas, warts and keratoses where no other therapy is possible.

Bacterial immunomodulators
A group of drugs that are made from the bodies of killed bacteria or parts of them. They can also be used in anticancer treatment (adjuvant treatment).


 * Treatment of recurrent infections
 * So-called autovaccines are used, which are made from the bodies of pathogens removed from the patient's infection site. They affect the mucosal immune system. They are indicated as prevention of recurrent infections.


 * Treatment of tumors
 * The ability of mycobacteria to stimulate the immune system is used. Suspensions of attenuated Mycobacterium bovis (BCG) strains are used. Analogs of mifamurtide cell wall components can also be used. They non-specifically activate the anti-inflammatory response, which indirectly elicits a tumor response.
 * They are used for local treatment of bladder carcinomas and resectable osteosarcoma in non-metastases.

Products of the immune system
This group includes substances produced by cells of the immune system, fibroblasts, endothelium, etc., which can be collectively called cytokines.
 * Transfer factor
 * Peripheral blood leukocyte extract. It comprehensively stimulates the immune system. It activates chemotaxis and phagocytosis, induces cytokine production (anti-inflammatory effect) and normalizes the number of T-lymphocytes.
 * Used mainly for secondary immune disorders.


 * Cytokines
 * Important regulators of immune responses. They are mostly produced by recombinant human DNA. For example, IL-2 (aldesleukin) is used.


 * Interferon-α (IFN-α)
 * Treatment of chronic hepatitis B and  C, anticancer treatment (leukemia,  lymphoma, multiple myeloma, carcinoid, renal cell carcinoma and malignant melanoma).


 * Tumor necrosis factor α (TNF-α)
 * Adjuvant or palliative therapy of soft tissue sarcomas. E.g. tasonermin.


 * G-CSF (filgrastim)
 * Granulocyte stimulating factor. It is used to treat severe neutropenia (febrile, cyclic, idiopathic, after chemotherapy, in patients with advanced HIV infection). It is also used to reduce the duration of neutropenia in patients on myeloablative treatment before bone marrow transplantation.

Specific immunomodulation
Increasing an individual's defenses against a particular antigen. They are most often used for infectious diseases.

Methods of use can be divided into active and passive immunization.

Related Articles

 * Cytokines
 * Interleukins
 * Immunosuppressants
 * Active immunization
 * Passive immunization
 * Simultaneous combined immunization

Used literature

 * LINCOVÁ, Dagmar, et al. Základní a aplikovaná farmakologie. 1. vydání. GALÉN, 2002. 601 s.  ISBN 80-7262-168-8.


 * ŠVIHOVEC, Jan, et al. Farmakologie. 1. vydání. Praha : Grada, 2018.  ISBN 978-80-271-2150-2.