Concerning immunosuppression and immunomodulation:
Immunosuppression describes the decrease in the immune response magnitude generally.
Immunomodulation refers to targeted therapy directed to particular molecular "driver" of the immune response, an example being cytokines.
Both
Neither
Prevention as well as treatment of transplant rejection may involve use of both polyclonal and monoclonal antibodies directed against lymphocyte cell surface antigen targets.
True
False
Polyclonal antibodies:
Polyclonal antibodies are likely to be different batch to batch in both toxicity and efficacy.
Monoclonal antibodies (mAbs) tend to exhibit
a greater limitation target specificity compared to polyclonals. However, mAbs utilization eliminates efficacy variability
and toxicity seen with polyclonals.
Both
Either
Leflunomide (Arava):
Prodrug inhibitor of
primidine synthesis.
Teriflunomide is the major leflunomide active metabolite.
Both
Neither
Leflunomide and
teriflunomide:
Affect pyrimidine synthesis by inhibiting of mitochondrial enzyme, dihydroorotate dehydrogenase.
Reduced pyrimidine synthesis is associated with reduced lymphocyte activation, which is the immunomodulatory effect.
Both
Neither
Leflunomide:
Liver toxicity
Teratogenicity
Both
Neither
Mitoxantrone (Novantrone):
Used in cancer chemotherapy
Immunosuppressive effects occur due to toxic action on B- and T-lymphocytes as well as on macrophages
Both
Neither
Primary
clinical indications for mitoxantrone is to reduce neurologic disabilities and
to manage clinical relapse in those patients with multiple sclerosis.
True
False
Teriflunomide is received FDA approval for clinical use in treating relapsing-remitting multiple cirrhosis.
True
False
Pentostatin, an adenosine deaminase inhibitor:
Primary use is in treating lymphoid malignancies given that it induces substantial lymphopenia.
Also used, frequently, and for steroid-resistant graft-versus-host (GVH) disease following allogenic stem cell transplantation.
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Source Material:
Rothlin C Gutkind J Chapter 39
Immunosuppressants, Immunomodulation and Tolerance In
Goodman & Gilman's The Pharmacological Basis of Therapeutics
(Brunton LL Knollman BC eds) McGraw Hill LLC (2023).
Lake D & Briggs A Ch 55 Immunopharmacology
in Katzung's Basic & Clinical Pharmacology (Vanderah TW, ed)
16e McGraw Hill 2023.
Chrouos G Ch 39 Adrenocorticosteroids &
Adrenocortical Antagonists in Katzung's Basic & Clinical
Pharmacology (Vanderah TW, ed) 16e McGraw Hill 2023
Brezinski E Klickstein L Armstrong A Ch 46
Pharmacology of Immunosuppression in Principles of
Pharmacology: The Pathophysiologic Basis of Drug Therapy.
(Golan DE Armstrong EJ Armstrong AW, eds) 4e 2017 ls) 4e
2017
Ritter JM Flower R Henderson G Loke YK
MacEwan D Robinson E Fullerton J Ch 54 Anti-inflammatory and
Immunosuppressant Drugs Rang & Dale's Pharmacology 10e
Elsevier 2024.
Burchum J Rosenthal L Lehne's Pharmacology
for Nursing Care Ch 72 Immunosuppressants Elsevier 2022.
Burchum J Rosenthal L Lehne's Pharmacology
for Nursing Care Ch 75 Glucocorticoids in Nonendrocrine
Disorders Elsevier 2022.
Bass A Rogatsky Ch 32 Immunomodulatory Drugs
in Goldman-Cecil Medicine (Goldman L Schafer, eds) Elsevier
26e 2020
Leiva M Takemoto Ch 238 Immunosuppressants in
Lippincott Illustrated Reviews: Pharmacology 8e ((Walen et
al, eds) Wolters Kluwer 2023.
Hall J Hall M Ch 78 Adrenocortical
Hormones Guyton and Hall Textbook of Medical Physiology 14e
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Waller DG Sampson A Hitchings Ch 38 A
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