Immunosuppressants multiple sclerosis

Use antineoplastic, immunosuppressive, multiple sclerosis therapeutic, antiangiogenic, disease modifying drug, systemic lupus erythematosus therapeutic... 

Corticotropin is used for diagnostic testing of adrenocortical function. This drug may also be used for the management of acute exacerbations of multiple sclerosis, nonsuppurative thyroiditis, and hypercalcemia associated with cancer. It is also used as an anti-inflammatory and immunosuppressant drug when conventional glucocorticoid therapy lias not been effective (see Display 50-1). 

Cyclosporine and tacrolimus are calcineurin inhibitors that are administered as part of immunosuppressive regimens in kidney, liver, heart, lung, and bone marrow transplant recipients. In addition, they are used in autoimmune disorders such as psoriasis and multiple sclerosis. The pathophysiologic mechanism for ARF is renal vascular vasoconstriction.41 It often occurs within the first 6 to 12 months of treatment, and can be reversible with dose reduction or drug discontinuation. Risk factors include high dose, elevated trough blood concentrations, increased age, and concomitant therapy with other nephrotoxic drugs.41 Cyclosporine and tacrolimus are extensively metabolized by... 

As a consequence of their immunosuppressive activity, Tregs may function as a cellular therapeutic agent that ameliorates allergies and autoimmune diseases. This has been proven in several disease models including asthma, inflammatory bowel disease, multiple sclerosis and CHS reactions. Others and we have studied the effects of in vivo applied Tregs as a possible therapeutical means to curb... 

Immunosuppressive therapy is utilized in chronic severe asthma, where cyclosporine is often effective and sirolimus is another alternative. Omalizumab (anti-IgE antibody) has recently been approved for the treatment of severe asthma (see previous section). Tacrolimus is currently under clinical investigation for the management of autoimmune chronic active hepatitis and of multiple sclerosis, where IFN-3 has a definitive role. 

Until the role of echinacea in immune modulation is better defined, this agent should be avoided in patients with immune deficiency disorders (eg, AIDS, cancer), autoimmune disorders (eg, multiple sclerosis, rheumatoid arthritis), and patients with tuberculosis. While there are no reported drug interactions for echinacea, some preparations have a high alcohol content and should not be used with medications known to cause a disulfiram-like reaction. In theory, echinacea should also be avoided in persons taking immunosuppressant medications (eg, organ transplant recipients). 

Neurologic disease Decreased inflammation and immunosuppression Tuberculous meningitis, multiple sclerosis, myasthenia gravis... 

Medical observations and research suggest that oxidative stress can be related to the occurrence of memory loss, implying that this adverse effect can be restricted by application of bilirubin as an antioxidant. It has been found that bilirubin possesses antioxidative activity and prevents pathological changes which appear in multiple sclerosis patients, but does not reveal any immunosuppressive effects (Liu et al. 2003). Lack of oxidative and antioxidative balance in pneumonia can activate such transcription factors as NF-kB and activating protein-1 (AP-1), which are sensitive to the redox potential (Rahman 2000). 

Natalizumab (Tysabri), an anti-a4 integrin monoclonal antibody approved for the treatment of multiple sclerosis, was recently withdrawn from the market temporarily due to cases of progressive multifocal leukoencephalopathy, a demyelinating disease of the central nervous system associated with immunosuppression [32], These cases highlight our incomplete understanding of the immune system and the translation of preclinical results to humans. 

There is indirect evidence of sex differences in immunology. Women have a higher incidence of autoimmune diseases such as multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus. The influence of sex hormones on the immune system may provide insight into these immunological disorders. For example, estrogen stimulates both humoral and cell-mediated immunity, whereas testosterone has the opposite effect (126). Therefore, it is not surprising that there is sex-dependent variability in response to immunosuppressive agents. 

The failure of immunosuppression to ameliorate type-Idiabetes or chronic progressive multiple sclerosis, predominantly immune mediated diseases, invaUdates the role of immune mechanisms in initiating these disorders. 

Alemtuzumab (campath-lH) is a humanized monoclonal antibody specific for the CDw52 antigen, present on cell membranes of lymphocytes and monocytes. It has been used for treatment of patients with rheumatoid arthritis and vasculitis, is being investigated for the treatment of chronic lymphocytic leukemia, and has been used to deplete circulating lymphocytes in patients with multiple sclerosis (1). In 2001, alemtuzumab was approved in Europe for the treatment of chronic B cell lymphocytic leukemia that had been treated previously with alkylating agents and was refractory to fludarabine (2). It has also been used for induction of immunosuppression/tolerance in liver transplant recipients (3,4) and kidney/pancreas transplant recipients (5). 

Multiple sclerosis Beta interferons, glatiramer acetate, glucocorticoids, antispasmodics, amantadine, stimulants, immunosuppressants Number of exacerbations, self-injection technique, injection site reactions, amount of spasticity, amount of fatigue, CBC and infections (immunosuppressants), medication-specific adverse effects... 

Nash RA, Bowen JD, McSweeney PA, et al. High-dose immunosuppressive therapy and autologous peripheral blood stem cell transplantation in severe multiple sclerosis. Blood 2003 102 2364-2372. 

Not surprisingly, disturbance in the KP has been implicated in a number of diseases, and pharmacological intervention has thus potential for treatment. The immunosuppressive effects of the KP metabolites in the periphery are used in the treatment of multiple sclerosis (MS), where synthetic kynurenines are undergoing clinical development. Furthermore, IDO inhibitors are in preclinical development to treat cancers, for example, ovarian and colorectal [34]. This has been reviewed extensively elsewhere [3, 35], and the focus of the discussion in this review will be on the role of KP metabolites in brain pathophysiology. 

Besides exerting local effects in the skin, ultraviolet radiation may, through the production of circulating mediators, also cause systemic immunosuppression. This could be an explanation of the suppression of autoimmune conditions, such as multiple sclerosis and diabetes mellitus type 1, noted to occur less frequently in those countries with abundant sun. 

Since FTY720 does not generally impair lymphocyte proliferation and function, it could provide a new strategy for immunosuppression, which would be useful in transplantation, multiple sclerosis (MS), or autoimmune diabetes. 

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