Immunosuppressants genetic factors

A patient developed atorvastatin-induced severe autoimmune hepatitis and a lupus-like syndrome. Although the drug was immediately withdrawn, the disease persisted and deteriorated to a fulminant form with acute hepatic failure. There was no response to conventional immunosuppression with glucocorticoids and azathioprine. Only the introduction of intense immunosuppressive therapy, as used in solid organ transplantation, led to a complete and sustained recovery. The patient had the HLA haplotypcs DR3 and DR4, which are well-known genetic factors associated with autoimmune diseases. 

We are not convinced that acnte, asymptomatic injuries that result in clinical disease truly exist. It is conceivable that certain synergistic situations can develop, such as would happen if co-factors or preexisting conditions (immunosuppression, genetic deficiency, or an additional chronic subclinical exposure) were triggered by some otherwise uneventful insult. This is certainly an unknown for mustard exposure at this time. The best that can be done is to draw analogies to other circumstances. 

Elevated cholesterol levels in transplant patients are due to a culmination of factors such as age, genetic disposition, renal dysfunction, DM, proteinuria, body weight, and immunosuppressive therapy. Many of the immunosuppressive agents can produce elevations in serum lipid levels. 

Cancer occurs when the growth and function of cells are out of control in relation to normal tissue. The combination of genetic alterations and environmental toxins is the most frequent contributor to the process of carcinogenesis. In the development of skin cancer, the risk factors are categorized as environmental (solar UV radiation), genetic (family history), immunosuppression, and previous history of melanoma.10... 

Is the effect reversible Reversibility of a response is dependent on the drug itself, exposure levels/duration, and factors related to the test animal (metabolic capability, genetic susceptibility, etc.). Most effects produced by immunosuppressive drugs have been shown to be reversible after cessation of therapy, such as those produced during cancer chemotherapy. However, if a tumor develops before the immune system is restored, the effect is not reversible, as is the case of secondary tumors related to chemotherapy. 

In most cases, the cause of cancer is multifactorial. About 75% of cancers are due to environmental factors, some of which are within the control of the individual, e.g. tobacco smoking, exposure to sunlight. Growing understanding of cancer genetics and inherited disease suggests that fewer than 10% of cancers are familial.The different systemic modalities used to treat cancer patients are discussed. Immunosuppressive drugs are described here as they share many characteristics with cytotoxics. 

The authors of the last case suggested that several factors, including voriconazole uptake, immunosuppression, and genetic background, could explain the occurrence of fast-developing skin carcinomas. 

Time-course Intermediate Susceptibility factors Genetic (blacks dipeptidyl peptidase IV deficiency) sex (female) exogenous factors (drugs— NSAIDs, vaccines, immunosuppressants surgery—dental and maxillofacial procedures devices—polyacrylonitrile membranes in hemodialysis) diseases... 

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