Immunomodulatory agents

Wagner H, Kraus S (2000) In Paulsen BS (ed) Bioactive Carbohydrate Polymers. Proc Phytochem Soc of Europe. Kluwer Academic Publishers, Dordrecht, p 1 Wagner El, Kraus S, Jurcic K (1999) In Wagner H (ed) Immunomodulatory agents from plants. Birkhauser, Basel, p 1... 

Recently, thalidomide (50-100 mg capsule form, approved by FDA), an immunomodulatory agent is used in erythema nodosum leprosum (ENL) which is a complication of leprosy occurring in approximately one half of borderline lepromatous and lepromatous leprosy patients. 

Bauer, R. 1999a. Clinical investigations of Echinacea phytopharmaceuticals. In Immunomodulatory Agents from Plants (H. Wagner, ed.), pp. 41-88. Birkhauser Verlag, Basel, Switzerland. 

Leflunomide (le FLEW nom eyed) is an isoxazole immunomodulatory agent that preferentially causes cell arrest of the autoimmune lymphocytes through its action on dihydroorotate dehydrogenase (DHODH). Stimulation of a T cell by an antigen-presenting cell drives the lymphocyte into its replicative cycle. Many enzymes, including those required for de novo purine, pyrimidine, RNA, and membrane synthesis, are upregulated in the G1 phase of the cycle. 

Hendrickx AG, Makori N, Peterson P. Nonhuman primates their role in assessing developmental effects of immunomodulatory agents. Hum Exp Toxicol 2000 19 219-25. 

Recently, thalidomide has gained approval for use in the United States as an immunomodulatory agent in the treatment of HIV-associated diseases, arthritis, myeloma, and diabetic retinopathy. The FDA has instituted the System of Thalidomide Education and Prescribing Safety (STEPS) to prevent accidental exposures during pregnancy. 

Leflunomide (Arava) is an oral immunomodulatory agent, which is considered effective for the treatment of RA. Leflunomide is a disease-modifying antirheumatic drug that is approved for treatment of RA (Bartlett et al., 1991 Strand et al, 1999 Smolen et al. 1999 Emery et al. 2000 Breedveld and Dayer, 2000). 

Chronic dry eye is the result of an underlying cytokine and receptor-mediated inflammatory process that affects the ocular surface and lacrimal gland, leading to decreased tear production or altered tear film contents. Hormonal, anti-inflammatory, or immunomodulatory agents may be able to suppress the inflammation and normalize the neural reflex between the ocular smrfece and lacrimal glands. 

Sjogren s Syndrome. SS is an autoimmune disorder characterized by the triad of dry eye, dry mouth (xerostomia), and a connective tissue disease. At least two components of the triad need to be present for the diagnosis of SS to be made. Primary SS, an exocrinopathy, is characterized by a lymphocytic infiltration and subsequent destruction of salivary and lacrimal glandular tissues. Symptoms include both dry eyes and dry mouth. Secondary SS includes dry eyes or xerostomia, plus a connective tissue disease, most frequently rhemnatoid arthritis but also lupus, scleroderma, polyarteritis, or other related diseases. Unfortimately, there is no cure for SS at this time. Clinical trials using oral immunomodulatory agents have produced mixed results. 

Immunomodulatory Agents. For many years some practitioners treated severe dry eye with topical steroids although anecdotal evidence was plentiful as to the benefit of this therapeutic strategy, it was not universally accepted because of a lack of understanding of the inflammatory nature of dry eye disease. Now, steroids and nonsteroidal anti-inflammatory agents are much more frequently used in the treatment of dry eye, particularly at initial diagnosis. 

Women who are taking or considering hormone replacement therapy should be informed of the potential increased risk of dry eye syndrome with this therapy. Women on oral contraceptives who complain of dry eye or in whom ocular surface disease is noted should be advised of the potential causative aspects of their medication. In either case, therapies for dry eye are usually based on topical administration of tear substitutes, lid treatments, environmental modification, and immunomodulatory agents for inflammatory-related ocular surfece disease. Hormone-based eyedrops are being studied with respect to targeting postmenopausal women with dry eye. 

Galetta SL, Markowitz C, Lee AG (2002) Immunomodulatory agents for the treatment of relapsing multiple sclerosis A systematic review. Arch Intern Med 162 2161—2169. 

Toyka KV, Gold R (2003). The pathogenesis of CIDP Rationale for treatment with immunomodulatory agents. Neurology 60 S2-S7. 

Miller, G.G., L.I. Sweet, J.V. Adams, G.M. Omann, D.R. Passino-Reader and P.G. Meier. In vitro toxicity and interactions of environmental contaminants (Arochlor 1254 and mercury and immunomodulatory agents (lipopolysaccharide and cortisol) on thymocytes from lake trout (Salvelinus namaycush). Fish Shellfish Immunol. 13 11-26, 2002. 

Current strategies to eradicate HBV include the use of antiviral agents that alter viral replication or immunomodulatory agents that modify the host immune response. IFN-a2b (Intron A) was approved by the FDA for use in chronic HBV in 1992. IFN-a2b monotherapy... 

Nagaoka Y, Otsuki K, Fujita T et al (2008) Effects of phosphorylation of immunomodulatory agent FTY720 (fingolimod) on antiproliferative activity against breast and colon cancer cells. Biol Pharm Bull 31 1177-1181... 

Kuo YC, Tsai WJ, Wang JY, Chang SC, Lin CY, Shiao MS. Regulation of bronchoalveolar lavage fluids cell function by the immunomodulatory agents from Cordyceps sinensis. Life Sci 68(9) 1067-1082, 2001. 

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