IMMUNOLOGY TEXTBOOK - Mercury Podillya 2013

BASIC PRINCIPLES OF IMMUNODEFICIENCY TREATMENT

Main Criteria for Prescribing Immunotropic Drugs

The rationale for immunotherapy is based on the results of Clinical and immunological examination. Based on the data from this assessment, 3 groups of individuals can be distinguished:

1. Individuals presenting with clinical signs of immune system impairment alongside alterations in immunological parameters.

2. Individuals presenting with clinical signs of immune system dysfunction in the absence of changes in immunological parameters detected by standard Laboratory tests.

3. Individuals exhibiting exclusively altered immunological parameters without any clinical signs of immune system deficiency.

4. The main immunotropic medicinal products approved for medical use in Western countries and Japan are listed in Table 85, while those approved for medical use in Ukraine and Russia are presented in Table 86.

Class="center">Table 85. Immunotropic drugs approved for medical use in Western countries and Japan

Table 86. Immunotropic drugs approved for medical use in Ukraine and Russia

Patients in group 1 must receive immunotherapy. Analysis of The Immune System in group 2 individuals helps identify defects in the phagocytic, T-, and B-cell immune systems, Complement pathways, and the underlying cause of immunological insufficiency. Patients exhibiting signs of immunological deficiency should also be prescribed immunotropic therapy.

Clinical manifestations allow for a presumptive Diagnosis and an estimation of the extent of immune system damage. For instance, frequent bacterial infections, such as otitis media and Pneumonia, typically stem from defects in the humoral arm of immunity, whereas fungal and viral infections usually indicate a predominant defect in the T-cell immune system.

Based on the clinical picture, a deficiency in the secretory IgA system may be suspected; varying susceptibility of the body to pathogenic microorganisms points to defects in The Biosynthesis of IgG subclasses, as well as in the complement and phagocytic systems. Despite the absence of visible changes in immune parameters in group 2 patients, their course of immunotherapy must be administered under the guidance of immune status monitoring. Regarding group 3 individuals, the question arises whether the detected alterations will progress into a pathological process or if the compensatory reserves of the body as a whole, and the immune system in particular, will prevent such progression. This patient cohort requires ongoing immunological monitoring.

The primary target of drugs of microbial origin is the Cells of the mononuclear phagocyte system, whose natural function is the elimination of microbes from the body. These agents enhance the functional activity of these cells by stimulating phagocytosis and microbicidal capacity. Concurrently, they activate the cytotoxic function of macrophages, manifesting as their ability to destroy tumor cells in vivo. Activated monocytes and macrophages begin to synthesize cytokines such as IL-1, IL-3, TNF-α, GM-CSF, and others. Consequently, this leads to the activation of both humoral and cellular arms of the immune system.

The target of thymic-derived preparations is T lymphocytes, which is manifested by the induction of T-cell cytokine synthesis and enhanced proliferation, differentiation, and cytotoxic properties.

The target of bone marrow-derived preparations is B lymphocytes, which leads to enhanced antibody synthesis.

The choice of immunomodulatory agent and its administration regimen are determined by an immunologist based on the severity of the underlying disease, comorbidities, and the type of identified immunological defect.

Indications for immunomodulatory (immunocorrective) therapy arise in the presence of immunopathology:

- relapsing mixed infections associated with immunodeficiency;

- protracted and chronic infectious-Inflammatory Diseases suspected to involve immunodeficiency;

- allergic conditions accompanied by immune deficiency.

Immunomodulators generally lack efficacy in patients with primary

genetically determined forms of immunodeficiency. However, in cases of secondary immunodeficiencies, Immunomodulatory therapy can prove to be the most optimal approach for restoring immune system function and achieving immunorehabilitation.

Indications for immunomodulatory therapy are determined not only by the patient's clinical data, but also by altered laboratory immunological parameters.

For many immunomodulatory drugs, a dose-dependent effect has been established. Depending on the dose, route of administration, and the patient's clinical condition, the exact same drug can produce opposite effects by either enhancing or suppressing immune system Functions.