Medicines with immunostimulating effects. Multivitamins to strengthen defenses

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Today, a variety of immunostimulants are sold without a prescription at any pharmacy. However, first it makes sense to understand whether your body really needs them.

At a minimum, immunostimulants have strict indications. For example, chronic diseases (bronchitis, tonsillitis, sinusitis), frequent lingering colds - at least six times a year. Also, do not try to choose the right drug on your own. “Each of them has its own tasks and capabilities,” explains immunologist, Professor Alexander Poletaev. — You can only understand which drug you need after being examined by an immunologist. To do this, special tests should be done to determine the amount of interferon proteins in the blood. In addition, these medications can provoke exacerbation of chronic diseases and allergies.” Finally, it is still not known for certain whether long-term use of immunostimulants leads to a depletion of the body’s immune resources.

Currently, there are more than a hundred immunostimulants in the Russian Medicines Register. For example, live and killed vaccines, bacterial preparations (ribomunil, bronchomunal) stimulate immunity to specific pathogens. They familiarize the body with the microbe in absentia, ensuring the production of appropriate specific antibodies, so that when encountering a real infection, the body can give it a worthy rebuff.

Other pharmaceuticals stimulate the immune system in general, without targeting a specific pathogen (thymogen, thymalin). Essentially, these are hormones isolated from the thymus gland of cattle or synthesized artificially. The main principle of their action is to increase the number of lymphocytes. The effectiveness of these drugs is controversial in the scientific community, and the use of such drugs is always associated with a certain danger. Firstly, no preparations made from animal material can be guaranteed to be free from viruses and prions like mad cow disease. Secondly, the rapid production of lymphocytes can cause them to attack healthy cells in the body. This is how severe autoimmune diseases arise. Even worse, forcibly stimulating the complex process of division can provoke cancerous degeneration of cells. In general, such drugs should only be prescribed by a specialist and only in the most extreme cases.

People are especially fond of medications that either contain immune interferon proteins (interal, viferon, intron A) or stimulate their formation (amexin, arbidol). Interferons are among the first to fight foreigners and indirectly activate all cells of the immune system. Today, these drugs are synthesized artificially, so they are significantly safer than thymogens. However, they also have their contraindications. Immunostimulants containing interferon inducers cannot be used in the acute phase of the disease. In this case, they can cause a surge in the reproduction of the pathogens themselves. But these drugs are good for prevention.

For preventive purposes, many experts recommend the use of immunostimulants of plant origin (adaptogens). These are, for example, extracts of ginseng, eleutherococcus, Schisandra chinensis, Rhodiola rosea, Manchurian aralia, as well as numerous dietary supplements based on them. There are different opinions about the mechanism of action of such drugs. Some immunologists believe that herbs contain substances that regulate the immune response. Others are sure that they do not have any effect on the immune system at all, but simply work like antibiotics - they destroy pathogens.

Despite their natural origin, adaptogens are also not harmless. They may be allergenic. In addition, there is a risk of exceeding the dose or period of use of drugs and overstimulation: increased blood pressure, tachycardia and insomnia. Therefore, such medications are not prescribed to people with hypertension, increased excitability, as well as pregnant and lactating women.

Perhaps the only harmless immunostimulants are vitamins, in particular C and A. They have antioxidant activity and help remove foreign cells destroyed by lymphocytes from the body. You need to take such complexes in courses and on the recommendation of a doctor - everything here is also very individual.

Classification of immunoactive agents:

A: Immunostimulating agents:

I IS of bacterial origin

1. Vaccines (BCG, CP)

2. Microbial lipopolysaccharides of Gr-negative bacteria

rium (prodigiosan, pyrogenal, etc.)

3. Low molecular weight immunocorrectors

II Preparations of animal origin

1. Preparations of thymus, bone marrow and their analogues (ti

malin, taktivin, thymogen, vilosen, myelopid, etc.)

2. Interferons (alpha, beta, gamma)

3. Interleukins (IL-2)

III Herbal preparations

1. Yeast polysaccharides (zymosan, dextrans, glucans)

IV Synthetic immunoactive agents

1. Pyrimidine derivatives (methyluracil, pentoxyl,

orotic acid, diucifon)

2. Imidazole derivatives (levamisole, dibazole)

3. Microelements (Compounds of Zn, Cu, etc.)

V Regulatory peptides (tuftsin, dolargin)

VI Other immunoactive agents (vitamins, adaptogens)

B: Immunosuppressive drugs

I Glucocorticoids

II Cytostatics

1. Antimetabolites

a) purine antagonists;

b) pyrimidine antagonists;

c) amino acid antagonists;

d) folic acid antagonists.

2. Alkylating agents

3. Antibiotics

4. Alkaloids

5. Enzymes and enzyme inhibitors

Along with the above means, there are physical and biological methods of influencing the immune system:

1. Ionizing radiation

2. Plasmapheresis

3. Drainage of the thoracic lymphatic duct

4. Antilymphocyte serum

5: Monoclonal antibodies

Pathology of immune processes occurs very often. According to far from complete data, the participation, to one degree or another, of the immune system in the pathogenesis of diseases of internal organs has been proven for 25% of patients in the country's therapeutic clinics.

The rapid development of experimental and clinical immunology, the deepening of knowledge about the pathogenesis of immune disorders in various diseases, determined the need to develop a method of immunocorrection, the development of experimental and clinical immunopharmacology. Thus, a special science was formed - immunopharmacology, a new medical discipline, the main task of which is the development of pharmacological regulation of impaired functions of the immune system using immunoactive (immunotropic) agents. The action of these drugs is aimed at normalizing the functions of cells involved in the immune response. Here it is possible to modulate two conditions encountered in the clinic, namely immunosuppression or immunostimulation, which significantly depends on the characteristics of the patient’s immune response. In this regard, the problem arises of conducting optimal immunotherapy that modulates immunity in a clinically necessary direction. Thus, the main goal of immunotherapy is to specifically influence the patient’s body’s ability to respond to the immune system.

Based on this, and also taking into account the fact that in the clinical practice of a doctor there may be a need to carry out both immunosuppression and immunostimulation, all immunoactive agents are divided into immunosuppressants and immunostimulants.

Immunostimulants are usually called drugs that integrally and generally increase the humoral and cellular immune response.

Due to the complexity of choosing a specific drug, regimen and duration of therapy, it is necessary to dwell in more detail on the characteristics and clinical use of the most promising immunostimulating drugs that have been tested in the clinic.

The need to stimulate the immune system arises with the development of secondary immunodeficiencies, that is, with a decrease in the function of effector cells of the immune system caused by a tumor process, infectious, rheumatic, bronchopulmonary diseases, pyelonephritis. which ultimately leads to chronicity of the disease, the development of opportunistic infections, and resistance to antibacterial treatment.

The main feature of immunostimulants is that their action is not directed at the pathological focus or pathogen, but at nonspecific stimulation of monocyte populations (macrophages, T- and B-lymphocytes and their subpopulations).

Depending on the type of exposure, there are two ways to enhance the immune response:

1. Active

2. Passive

The active method, like the passive one, can be specific and nonspecific.

An active specific method of enhancing the immune response includes the use of methods for optimizing the antigen administration schedule and antigenic modification.

An active nonspecific method of enhancing the immune response includes, in turn, the use of adjuvants (Freund, BCG, etc.), as well as chemical and other drugs.

A passive specific method of enhancing the immune response involves the use of specific antibodies, including monoclonal antibodies.

A passive nonspecific method includes the introduction of donor plasma gamma globulin, bone marrow transplantation, and the use of allogeneic drugs (thymic factors, lymphokines).

Since there are certain limitations in clinical settings, the main approach to immunocorrection is nonspecific therapy.

Currently, the number of immunostimulating agents used in the clinic is quite large. All existing immunoactive agents are used as pathogenetic therapy drugs that can influence various parts of the immune response, and therefore these agents can be considered as homeostatic agents.

In terms of their chemical structure, method of preparation, and mechanism of action, these agents represent a heterogeneous group, so there is no single classification. The most convenient classification of immunostimulants by origin seems to be:

1. IS of bacterial origin

2. IP of animal origin

3. IP of plant origin

4. Synthetic ICs of various chemical structures

5. Regulatory peptides

6. Other immunoactive agents

Immunostimulants of bacterial origin include vaccines, lipopolysaccharides of Gr-negative bacteria, and low-molecular immunocorrectors.

In addition to inducing a specific immune response, all vaccines cause immunostimulating effects to varying degrees. The most studied vaccines are BCG (containing the non-pathogenic bacillus Calmette-Guerin) and CP (Corynobacterium parvum) - pseudodiphtheroid bacteria. When they are administered, the number of macrophages in tissues increases, their chemotaxis and phagocytosis intensifies, and monoclonosis is observed.

nal activation of B-lymphocytes, the activity of natural killer cells increases.

In clinical practice, vaccins are used mainly in oncology, where the main indications for their use are the prevention of relapses and metastases after combined treatment of a tumor carrier. Typically, the start of such therapy should be a week ahead of other methods of treatment. For the administration of BCG, for example, you can use the following scheme: 7 days before surgery, 14 days after it and then 2 times a month for two years.

Side effects include many local and systemic complications:

Ulceration at the injection site;

Long-term persistence of mycobacteria at the injection site;

Regional lymphadenopathy;

Heartache;

Collapse;

Leukothrombocytopenia;

DIC syndrome;

Hepatitis;

With repeated injections of the vaccine into the tumor, anaphylactic reactions may develop.

The most serious danger when using vaccines to treat patients with neoplasms is the phenomenon of immunological enhancement of tumor growth.

Due to these complications and their high frequency, vaccines as immunostimulants are finding less and less use.

Bacterial (microbial) lipopolysaccharides

The frequency of use of bacterial lipopolysaccharides in the clinic is rapidly increasing. LPS from gram-negative bacteria are especially intensively used. LPS are structural components of the bacterial wall. The most commonly used is prodigiosan, derived from Bac. prodigiosum and pyrogenal, obtained from Pseudomonas auroginosa. Both drugs increase resistance to infection, which is achieved primarily by stimulating nonspecific defense factors. The drugs also increase the number of leukocytes and macrophages, enhance their phagocytic activity, the activity of lysosomal enzymes, and the production of interleukin-1. This is probably why LPS are polyclonal stimulators of B-lymphocytes and inducers of interferons, and in the absence of the latter they can be used as their inducers.

Prodigiosan (Sol. Prodigiosanum; 1 ml of 0.005% solution) is administered intramuscularly. Typically, a single dose for adults is 0.5-0.6 ml, for children 0.2-0.4 ml. Administer at intervals of 4-7 days. The course of treatment is 3-6 injections.

Pyrogenal (Pyrogenalum in amp. 1 ml (100; 250; 500; 1000 MPD minimum pyrogenic doses)) The dose of the drug is selected individually for each patient. Administer intramuscularly once a day (every other day). The initial dose is 25-50 MTD, the body temperature rises to 37.5-38 degrees. Or they introduce 50 MTD, daily increasing the dose by 50 MTD, bringing it to 400-500 MTD, then gradually reduce it by 50 MTD. The course of treatment is up to 10-30 injections, a total of 2-3 courses with a break of at least 2-3 months.

Indications for use:

For prolonged pneumonia,

Some variants of pulmonary tuberculosis,

Chronic ostiomyelitis,

To reduce the severity of allergic reactions

(for atopic bronchial asthma),

To reduce the incidence of anemia in patients with chronic

Kim tonsillitis (with prophylactic endonasal administration

Pyrogenal is also indicated:

To stimulate recovery processes after

damage and diseases of the central nervous system,

For resorption of scars, adhesions, after burns, injuries, spa

eternal illness,

For psoriasis, epidymitis, prostatitis,

For some persistent dermatitis (urticaria),

For chronic inflammatory diseases of females

organs (long-term, sluggish inflammation of the appendages),

As an additional remedy in the complex therapy of syphilis.

Side effects include:

Leukopenia

Exacerbation of chronic intestinal diseases, diarrhea.

Prodigiosan is contraindicated in case of myocardial infarction, central disorders: chills, headache, fever, joint and lower back pain.

Low molecular weight immunocorrectors

This is a fundamentally new class of immunostimulating drugs of bacterial origin. These are peptides with a small molecular weight. Many drugs are known: bestatin, amastatin, ferfenetsin, muramyl dipeptide, biostim, etc. Many of them are at the clinical trial stage.

The most studied is bestatin, which has shown itself especially well in the treatment of patients with rheumatoid arthritis.

In France, in 1975, a low molecular weight peptide, muramyl dipeptide (MDP), was obtained, which is a minimal structural component of the mycobacterial cell wall (a combination of a peptide and a polysaccharide).

Biostim is now widely used in the clinic - it is very active

nal glycoprotein isolated from Klebsiellae pneumoniae. This is a polyclonal B-lymphocyte activator, induces the production of interleukin-1 by macrophages, activates the production of nucleic acids, increases macrophage cytotoxicity, and increases the activity of cellular nonspecific defense factors.

Indicated for patients with bronchopulmonary pathology. The immunostimulating effect of Biostim is achieved by administering a dose of 1-2 mg/day. The effect is persistent, duration is 3 months after cessation of drug administration.

There are practically no side effects.

Speaking about immunostimulants of bacterial, but not corpuscular origin in general, we should distinguish three main stages, and in fact three generations of immunostimulants of bacterial origin:

Creation of purified bacterial lysates, they have specific vaccine properties and are nonspecific immunostimulants. The best representative of this generation is the drug Bronchomunal (Bronchomunalum; capsules of 0.007; 0.0035), a lysate of the eight most pathogenic bacteria. It has a stimulating effect on humoral and cellular immunity, increases the number of macrophages in the peritoneal fluid, as well as the number of lymphocytes and antibodies. The drug is used as an adjuvant in the treatment of patients with infectious diseases of the respiratory tract. When taking bronchomunal, side effects such as dyspepsia and allergic reactions are possible. The main disadvantage of this generation of immunostimulating agents of bacterial origin is their weak and unstable activity.

Creation of fractions of bacterial cell walls that have a pronounced immunostimulating effect, but do not have the properties of vaccines, that is, do not cause the formation of specific antibodies.

The combination of bacterial ribosomes and cell wall fractions represents a new generation of drugs. A typical representative of it is Ribomunal (Ribomunalum; in a tablet of 0.00025 and an aerosol of 10 ml) - a drug containing ribosomes of 4 main pathogens of upper respiratory tract infections (Klebsiella pneumoniae, Streptococcus pneumoniae, Streptococcus pyogenes A, Haemophillus influenzae) and Klebsiella membrane proteoglycans pneumoniae Used as a vaccine to prevent recurrent infections of the respiratory tract and ENT organs. The effect is achieved by increasing the activity of natural killer cells, B lymphocytes, increasing the level of IL-1, IL-6, alpha interferon, secretory immunoglobulin A, as well as by increasing the activity of B lymphocytes and the formation of specific serum antibodies to 4 ribosomal antigens. There is a specific regimen for taking the drug: 3 tablets in the morning for 4 days a week for 3 weeks, and then for

4 days a month for 5 months; subcutaneously: administered once a week for 5 weeks, and then once a month for 5 months.

The drug reduces the number of exacerbations, the duration of episodes of infections, the frequency of antibiotic prescriptions (by 70%) and causes an increase in the humoral response.

The greatest effectiveness of the drug is manifested when administered parenterally.

With subcutaneous administration, local reactions are possible, and with inhalation, transient rhinitis.

Immunoactive drugs of animal origin

This group is the most widely and frequently used. Of greatest interest are:

1. Preparations of thymus, bone marrow and their analogues;

2. New group of B-lymphocyte stimulators:

Interferons;

Interleukins.

Thymus preparations

Every year the number of compounds obtained from the thymus gland and differing in chemical composition and biological properties increases. Their effect is such that, as a result, the maturation of precursors of T-lymphocytes is induced, the differentiation and proliferation of mature T-cells, the expression of receptors on them is ensured, and antitumor resistance is also strengthened and repair processes are stimulated.

The following thymus preparations are most often used in the clinic:

Timalin;

Thymogen;

Taktivin;

Wilosen;

Timoptin.

Thymalin is a complex of polypeptide fractions isolated from the thymus gland of cattle. Available in bottles in the form of lyophilized powder.

Used as an immunostimulant for:

Diseases accompanied by a decrease in cellular immunity

In acute and chonic purulent processes and inflammatory

diseases;

For burn disease;

For trophic ulcers;

In case of suppression of immunity and hematopoietic function after radiation therapy

chemotherapy or chemotherapy in cancer patients.

The drug is administered intramuscularly at 10-30 mg daily for

5-20 days. If necessary, the course is repeated after 2-3 months.

A similar drug is timoptin (unlike thymalin, it does not act on B cells).

Taktivin also has a heterogeneous composition, that is, it consists of several thermostable fractions. It is more active than thymalin. Has the following effects:

Restores the number of T-lymphocytes in patients with low T-lymphocytes

Increases the activity of natural killer cells, as well as killer

new activity of lymphocytes;

In low doses, it stimulates the synthesis of interferons.

Thymogen (in the form of a solution for injection and a solution for instillation into the nose) is an even more purified and more active drug. It is possible to obtain it synthetically. Significantly superior in activity to tactivin.

A good effect when taking the listed drugs is achieved when:

Therapy for patients with rheumatoid arthritis;

For juvenile rheumatoid arthritis;

With recurrent heretic lesions;

In children with lymphoproliferative diseases;

In patients with primary immunodeficiency;

For mucocutaneous candidiasis.

An essential condition for the successful use of thymic preparations is initially altered indicators of T-lymphocyte function.

Vilosen, a non-protein low molecular weight extract of the bovine thymus, stimulates the proliferation and differentiation of T-lymphocytes in humans, suppresses the formation of reagins and the development of HRT. The best effect is achieved when treating patients with allergic rhinitis, rhinosinusitis, and hay fever.

Thymus preparations, essentially being factors of the central organ of cellular immunity, correct the T-link and macrophages of the body.

In recent years, new, more active agents whose action is aimed at B lymphocytes and plasma cells have been widely used. These substances are produced by bone marrow cells. Based on low molecular weight peptides isolated from supernatants of animal and human bone marrow cells. One of the drugs in this group is B-activin or myelopid, which has a selective effect on the B-immune system.

Myelopid activates cells that produce antibodies, selectively induces the synthesis of antibodies at the time of maximum development of the immune reaction, enhances the activity of killer T-effectors, and also has an analgesic effect.

It has been proven that myelopid acts on currently inactive

time period of the population of B-lymphocytes and plasma cells, increasing the number of antibody producers without increasing their antibody production. Myelopid also enhances antiviral immunity and is indicated primarily for:

Hematological diseases (chronic lymphocytic leukemia,

macroglobulinemia, myeloma);

Diseases accompanied by protein loss;

Management of surgical patients, as well as after chemotherapy and radiation therapy

chevy therapy;

Bronchopulmonary diseases.

The drug is non-toxic and does not cause allergic reactions, does not have teratogenic or mutagenic effects.

Myelopid is prescribed subcutaneously at a dose of 6 mg, per course - 3 injections every other day, repeated 2 courses after 10 days.

Interferons (IFs) are low molecular weight glycopeptides and are a large group of immunostimulants.

The term “interferon” arose when observing patients who had a viral infection. It turned out that during the convalescence stage they were protected, to one degree or another, from the effects of other viral agents. In 1957, the factor responsible for this phenomenon of viral interference was discovered. Now the term “interferon” refers to a number of mediators. Although interferon is found in different tissues, it comes from different types of cells:

There are three types of interferons:

JFN-alpha - from B lymphocytes;

JFN-beta - from epithelial cells and fibroblasts;

JFN-gamma - from T- and B-lymphocytes with the assistance of macrophages.

Currently, all three types can be obtained using genetic engineering and recombinant technology.

IFs also have an immunostimulating effect by activating the proliferation and differentiation of B lymphocytes. As a result, the production of immunoglobulins may increase.

Interferons, despite the diversity of genetic material in viruses, IFs “intercept” their reproduction at the stage required for all viruses - blocking the beginning of translation, that is, the beginning of the synthesis of virus-specific proteins, and also recognize and discriminate viral RNAs among cellular ones. Thus, IFs are substances with a universally broad spectrum of antiviral action.

IF medical preparations are divided into alpha, beta and gamma according to their composition, and according to the time of creation and use into natural (I generation) and recombinant (II generation).

I Natural interferons:

Alpha-ferons - human leukocyte IF (Russia),

egiferon (Hungary), welferon (England);

Betaferons - toraiferon (Japan).

II Recombinant interferons:

Alpha-2A - reaferon (Russia), roferon (Switzerland);

Alpha-2B - intron-A (USA), inrek (Cuba);

Alpha-2C - berofer (Austria);

Beta - betaseron (USA), fron (Germany);

Gamma-gammaferon (Russia), immunoferon (USA).

Diseases in the treatment of which IFs are most effective are divided into 2 groups:

1. Viral infections:

The most studied (thousands of observations) are various herpetic

Kie and cytomegalovirus lesions;

Less studied (hundreds of observations) are acute and chronic

Russian hepatitis;

Influenza and other respiratory diseases are even less studied.

2. Oncological diseases:

Hairy cell leukemia;

Juvenile papilloma;

Kaposi's sarcoma (AIDS marker disease);

Melanoma;

Non-Hodgkin's lymphomas.

An important advantage of interferons is their low toxicity. Only when using megadoses (in oncology) are side effects observed: anorexia, nausea, vomiting, diarrhea, pyrogenic reactions, leuko-thrombocytopenia, proteinuria, arrhythmias, hepatitis. The severity of the complications causes an indication of the clarity of the indications.

A new direction in immunostimulating therapy is associated with the use of mediators of interlymphocyte relationships - interleukins (IL). It is a known fact that IFs induce the synthesis of ILs and together with them create a cytokine network.

In clinical practice, 8 interleukins (IL1-8) have been tested that have certain effects:

IL 1-3 - stimulation of T-lymphocytes;

IL 4-6 - growth and differentiation of B cells, etc.

Clinical data are available only for IL-2:

Significantly stimulates the function of T-helper cells, as well as B-limbs

phocytes and interferon synthesis.

Since 1983, IL-2 has been produced in recombinant form. This IL has been tested for immunodeficiencies caused by infection, tumors, bone marrow transplantation, rheumatic diseases, SLE, AIDS. The data is contradictory, there are many complications: fever, vomiting, diarrhea, weight gain, dropsy, rash, eosinophilia, hyperbilirubinemia - treatment regimens are being developed and doses are being selected.

A very important group of immunostimulating agents are growth factors. The most prominent representative of this group is leukomax (GM-CSF) or molgramostim (manufacturer - Sandoz). This is a recombinant human granulocyte-macrophage colony-stimulating factor (a highly purified water-soluble protein of 127 amino acids), thus being an endogenous factor involved in the regulation of hematopoiesis and the functional activity of leukocytes.

Main effects:

Stimulates proliferation and differentiation of progenitors

hematopoietic organs, as well as the growth of granulocytes, monocytosis

tov, increasing the content of mature cells in the blood;

Quickly restores the body's defenses after chemotherapy

otherapy (5-10 mcg/kg 1 time per day);

Accelerates recovery after autologous bone transplantation

brain;

Has immunotropic activity;

Stimulates the growth of T-lymphocytes;

Specifically stimulates leukopoiesis (anti-leukopenic

means).

Herbal preparations

This group includes yeast polysaccharides, the effect of which on the immune system is less pronounced than the effect of bacterial polysaccharides. However, they are less toxic and do not have pyrogenicity or antigenicity. Just like bacterial polysaccharides, they activate the functions of macrophages and neutrophilic leukocytes. Drugs of this group have a pronounced effect on lymphoid cells, and this effect on T-lymphocytes is more pronounced than on B-cells.

Yeast polysaccharides - primarily zymosan (a biopolymer of the yeast shell of Saccharomyces cerevisi; in amp. 1-2 ml), glucans, dextrans are effective against infectious, hematological complications that arise during radiotherapy and chemotherapy of cancer patients. Zymosan is administered according to the following scheme: 1-2 ml intramuscularly every other day, 5-10 injections per course of treatment.

Yeast RNA is also used - sodium nucleinate (sodium salt of nucleic acid obtained by hydrolysis of yeast and through further purification). The drug has a wide range of effects and biological activity: regeneration processes are accelerated, bone marrow activity is activated, leukopoiesis is stimulated, phagocytic activity increases, as well as the activity of macrophages, T- and B-lymphocytes, and nonspecific protective factors.

The advantage of the drug is that its structure is precisely known. The main advantage of the drug is the complete absence of complications when taking it.

Sodium nucleinate is effective for many diseases, but especially

It is especially indicated for leukopenia, agranulocytosis, acute and protracted pneumonia, obstructive bronchitis, and is also used in the recovery period in patients with blood pathologies and cancer patients.

The drug is used according to the following scheme: orally 3-4 times a day, daily dose 0.8 g - course dose - up to 60 g.

Synthetic immunoactive agents of different groups

1. Pyrimidine derivatives:

Methyluracil, orotic acid, pentoxyl, diucifon, oxymethacyl.

The nature of the stimulating effect of drugs in this group is close to that of yeast RNA drugs, since they stimulate the formation of endogenous nucleic acids. In addition, drugs in this group stimulate the activity of macrophages and B-lymphocytes, increase leukopoiesis and the activity of components of the compliment system.

These agents are used as stimulators of leukopoiesis and erythropoiesis (methyluracil), anti-infective resistance, as well as to stimulate repair and regeneration processes.

Side effects include allergic reactions and the reverse effect in severe leukopenia and erythropenia.

2. Imidazole derivatives:

Levamisole, dibazole.

Levamisole (Levomisolum; in tablets of 0.05; 0.15) or decaris - a heterocyclic compound was originally developed as an anthelmintic drug; it has also been proven to enhance anti-infectious immunity. Levamisole normalizes many functions of macrophages, neutrophils, natural killer cells and T-lymphocytes (suppressors). The drug has no direct effect on B cells. A distinctive feature of levamisole is its ability to restore impaired immune function.

The most effective use of this drug is for the following conditions:

Recurrent ulcerative stomatitis;

Rheumatoid arthritis;

Sjögren's disease, SLE, scleroderma (DSTD);

Autoimmune diseases (chronic progressive

Crohn's disease;

Lymphogranulomatosis, sarcoidosis;

T-link defects (Wiskott-Aldridge syndrome, cutaneous mucus

thy candidiasis);

Chronic infectious diseases (toxoplasmosis, leprosy,

viral hepatitis, herpes);

Tumor processes.

Previously, levamisole was prescribed at a dose of 100-150 mg/day. New data have shown that the desired effect can be achieved at 1-3 ra

With the introduction of 150 mg/week, undesirable effects are reduced.

Among the side effects (frequency 60-75%) the following are noted:

Hyperesthesia, insomnia, headache - up to 10%;

Individual intolerance (nausea, decreased appetite

that, vomiting) - up to 15%;

Allergic reactions - up to 20% of cases.

Dibazole is an imidazole derivative, mainly used as an antispasmodic and antihypertensive agent, but has an immunostimulating effect by increasing the synthesis of nucleic acids and proteins. Thus, the drug stimulates the production of antibodies, enhances the phagocytic activity of leukocytes and macrophages, improves the synthesis of interferon, but acts slowly, therefore it is used for the prevention of infectious diseases (influenza, ARVI). For this purpose, Dibazol is taken 1 time per day, every day for 3-4 weeks.

There are a number of contraindications for use, such as severe liver and kidney diseases, as well as pregnancy.

Regulatory peptides

The practical use of regulatory peptides makes it possible to have the most physiological and targeted impact on the body, including the immune system.

The most comprehensively studied is Tuftsin, a tetrapeptide from the heavy chain region of immunoglobulin-G. It stimulates the production of antibodies, increases the activity of macrophages, cytotoxic T-lymphocytes, and natural cells. Tuftsin is used clinically to stimulate antitumor activity.

From the group of oligopeptides, Dolargin (Dolarginum; powder in amp. or bottle. 1 mg - diluted in 1 ml of saline; 1 mg 1-2 times a day, 15-20 days) is of interest - a synthetic analogue of enkephalins (biologically active substances of the class of endogenous opioid peptides, isolated in 1975).

Dolargin is used as an antiulcer drug, but as studies have shown, it has a positive effect on the immune system, and is more powerful than cimetidine.

Dolargin normalizes the proliferative response of lymphocytes in patients with rheumatic diseases, stimulates the activity of nucleic acids; In general, it stimulates wound healing and reduces the exocrine function of the pancreas.

The group of regulatory peptides has great prospects in the market of immunoactive drugs.

To select selective immunoactive therapy, a comprehensive quantitative and functional assessment of macrophages, T- and B-lymphocytes, their subpopulations is required, followed by the formulation of an immunological diagnosis and the choice of immunoactive agents for se

lexical action.

The results of studying the chemical structure, pharmacodynamics and pharmacokinetics, and the practical use of immunostimulants do not provide a clear answer to many questions regarding indications for immunostimulation, the choice of a specific drug, treatment regimens and duration of treatment.

When treating with immunoactive agents, individualization of therapy is determined by the following objective prerequisites:

The structural organization of the immune system, which is based on populations and subpopulations of lymphoid cells, monocytes and macrophages. Knowledge of the mechanisms of dysfunction of each of these cells, changes in the relationships between them lies at the basis of individualization of treatment;

Typological disorders of the immune system in various diseases.

Thus, in patients with the same disease with a similar clinical picture, differences in changes in the functions of the immune system and pathogenetic heterogeneity of diseases are found.

Due to the heterogeneity of pathogenetic disorders in the immune system, it is advisable to isolate clinical and immunological variants of the disease for selective immunoactive therapy. To date, there is no unified classification of immunostimulating agents.

Since for clinicians the division of immunoactive agents by origin, methods of preparation and chemical structure is not very convenient, it seems more convenient to classify these agents according to their selectivity of action into populations and subpopulations of monocytes, macrophages, T- and B-lymphocytes. However, the attempt at such a separation is complicated by the lack of selectivity of the existing immunoactive drugs.

The pharmacodynamic effects of the drugs are due to the simultaneous inhibition or stimulation of T and B lymphocytes, their subpopulations, monocytes and effector lymphocytes. This results in the unpredictability of the final effect of the drug and a high risk of undesirable consequences.

Immunostimulants also differ from each other in the strength of their effect on cells. Thus, the BCG and C. parvum vaccine stimulates the function of macrophages more and has less effect on B- and T-lymphocytes. Thymomimetics (thymus preparations, Zn, levamisole), on the contrary, have a greater effect on T-lymphocytes than on macrophages.

Pyrimidine derivatives have a greater effect on nonspecific protective factors, and myelopids have a greater effect on B lymphocytes.

In addition, there are differences in the activity of drugs on a specific cell population. For example, the effect of levamisole on macrophage function is weaker than that of the BCG vaccine. These properties of immunostimulating drugs can be the basis for their

classification according to their relative selectivity of the form-dynamic effect.

Relative selectivity of pharmacodynamic effect

immunostimulants:

1. Drugs that primarily stimulate nonspecific

protective factors:

Purine and pyrimidine derivatives (isoprinosine, methyluracil, oxymethacyl, pentoxyl, orotic acid);

Retinoids.

2. Drugs that primarily stimulate monocytes and poppy

Sodium Nucleinate; - muramyl peptide and its analogues;

Vaccines (BCG, CP) - plant lipopolysaccharides;

Lipopolysaccharides of Gr-negative bacteria (pyrogenal, biostim, prodigiosan).

3. Drugs that primarily stimulate T-lymphocytes:

Imidazole compounds (levamisole, dibazole, immunothiol);

Thymus preparations (thymogen, tactivin, thymalin, vilosen);

Zn preparations; - Na lobenzarite;

Interleukin-2 - thiobutarite.

4. Drugs that primarily stimulate B-lymphocytes:

Myelopids (B-activin);

Oligopeptides (tuftsin, dalargin, rigin);

Low molecular weight immunocorrectors (bestatin, amastatin, forfenicin).

5. Drugs that primarily stimulate natural

killer cells:

Interferons;

Antiviral drugs (isoprinosine, tilorone).

Despite a certain conventionality of the proposed classification, this division is necessary, since it allows drugs to be prescribed based not on clinical, but on immunological diagnosis. The lack of selective drugs significantly complicates the development of methods of combined immunostimulation.

Thus, to individualize immunoactive therapy, clinical and immunological criteria that predict treatment outcome are necessary.

The main factors that protect the body from pathogenic microorganisms are antibodies, of which in most animals there is approximately 1% of the blood mass, or 1020 protein molecules. During infection, the number of antibodies increases sharply. Their producers are plasma cells, the precursors of which are lymphocytes (leukocytes containing a round nucleus). Plasma cells are divided into 2 groups: thymus-dependent - T-lymphocytes (produced by the thymus) and burso-dependent - B-lymphocytes (produced by the bone marrow). In the remaining lymphatic organs and in the blood plasma there are both cells, where they cooperate and “work” together. In turn, T-lymphocytes are divided into T-helpers (helpers), T-suppressors (depressants) and T-killers (“killers”).

The body's immune response looks schematically as follows. The macrophage supplies the foreign protein (antigen) to the T-helper, which activates the B-lymphocyte, from which the plasma cell and the antibody itself are formed. The process is regulated (restrained) by the T-suppressor. T-killers “independently” fight against antigens, since they have receptors for them. Therefore, when antigens enter the body, killer T-cells themselves begin to multiply intensively. Of course, the immune response in the body is much more complex than the described scheme. A whole series of immune mediators are involved in the process, and many other body systems are also affected. Nevertheless, this scheme allows for more targeted study and differentiation of drugs that affect the body's immune response.

During various pathological processes in the body, the production of T- and B-lymphocytes may decrease, a more pronounced reaction of inhibition of leukocyte migration (TLM) may develop, the absorption capacity of neutrophils may decrease (by phagocytic number and phagocytic index), the production of T-helpers, T-killers and mediators of the immune response. An imbalance occurs in the immune system. This imbalance is largely facilitated by feeding disturbances (protein deficiency) of animals and the effects of various xenobiotics on the body (increasing chemicalization of the national economy). That is why recently we are increasingly faced with a new pathology in animals - immunodeficiency. In such a situation, it is simply necessary to use immunostimulants that correct immunological processes in the body. These drugs:

correct the immune status of the body, increase resistance to adverse factors, enhance the immune response during vaccination;

promote better wound healing by stimulating regeneration processes;

have growth-stimulating properties;

have an adaptogenic effect and correct (weaken) the effects of stress factors on the body.

Today, immunostimulants can be divided into 4 groups:

1) synthetic drugs: levamisole, etimizole, isamben, methyluracil, camisole, dimephosphone, etc.;

2) preparations of a bacterial nature: pyrogenal, prodigiosan;

3) products from animal organs and tissues: thymus preparations, agaric tissue preparation, sodium nucleinate, etc.;

4) herbal remedies: eleutherococcus, ginseng, lemongrass, etc.

Levamisole. Phenylamidazothiazole derivative. White powder, soluble in water. Selectively stimulates the regulatory function of T-lymphocytes, enhances phagocytosis, corrects (weakens or strengthens) cellular immunity. Increases the overall resistance of the body. Prescribed intramuscularly for various immunodeficiency conditions.

Izamben. Derivative of pyridinecarboxylic acid amides. Powder, soluble in water. It has anti-inflammatory and immunostimulating effects - it enhances the phagocytic activity of leukocytes, lysozyme and other factors of nonspecific resistance. Effective for dyspepsia in calves (orally) and increasing the defenses of chickens (aerosols).

Methyluracil. Pyrimidine derivative. White powder, slightly soluble in water. It has anabolic activity, accelerates the processes of cellular regeneration, wound healing, stimulates cellular and humoral protection factors, and has an anti-inflammatory effect. It is a stimulator of erythro- and especially leukopoiesis and exhibits an antioxidant effect.

Camizol. Phenylimidazothiazole derivative. White amorphous powder, soluble in water.

Increases the functional activity of cellular and humoral immunity: has a direct effect on the proliferation, differentiation and specialization of T-system cells, enhances the interferon-synthesizing activity of leukocytes, increases the activity of T-killers, macrophages and indirectly activates the functions of B-lymphocytes.

Used intramuscularly (young animals) and orally (poultry) to increase immunobiological reactivity, activate the immune response and increase productivity.

Dimephosphone. Oxobutylphosphonic acid dimethyl ester. Colorless or slightly yellowish liquid.

The normalizing effect on metabolic processes exhibits anti-acidotic, membrane-stabilizing, anti-inflammatory, and immunocorrective effects. Increases the number of T-lymphocytes, rosette-forming cells, increases phagocytic activity, the level of lysozyme and properdin in the blood.

Used in the complex treatment of animals suffering from bronchopneumonia, chronic pesticide poisoning and various immunodeficiencies.

Pyrogenal. Lipopolysaccharide formed during the life of certain microorganisms. Amorphous powder, soluble in water.

Increases body temperature, stimulates leukopoiesis, increases tissue permeability, and promotes better penetration of chemotherapeutic substances into the lesion. Increases the overall resistance of the body. Used as an additional nonspecific remedy for some infectious diseases.

Prodigiozan. High-polymer lipopolysaccharide complex isolated from microorganisms. Amorphous powder, difficult to dissolve in water.

Stimulates factors of nonspecific and specific resistance of the body. Activates the T-system of immunity and the function of the adrenal cortex. Used as an additional agent to chemotherapy for bacterial and viral infections.

Timalin. A complex of polypeptide fractions isolated from the thymus. Amorphous powder, slightly soluble in water.

Corrects the body's immunological reactivity: regulates the number of T- and B-lymphocytes, activates the cellular immune response, enhances phagocytosis, stimulates regeneration processes. Used for immunodeficiency conditions and to activate the immune response.

B-activation. A drug from a group of low-molecular peptides isolated from pig bone marrow cell cultures. White powder with a yellowish tint.

Restores the quantitative and functional indicators of the B- and T-immune systems, stimulates the production of antibodies, the functional activity of macrophages and other immunocompetent cells.

Used for the prevention and treatment of acute respiratory diseases of viral, bacterial, mycoplasma and chlamydial etiology and nonspecific bronchopneumonia of calves, increasing the general resistance of the body in immunodeficiency states.

Thymogen. Synthetic thymus peptide - glutamyl tryptophan. White or yellowish powder, soluble in water.

Increases the immunological reactivity of the body, enhances the processes of differentiation of lymphoid cells, normalizes the number of T-helpers, T-suppressors and their ratio in the blood and lymphoid organs, stimulates regeneration processes, activates cellular metabolic processes, enhances the growth rate of animals and poultry.

Prescribed for immunodeficiencies, disorders of regenerative processes, for the prevention of viral and bacterial infections, increasing the immune response and growth rate of animals.

CAFI (complex of activating immune factors). Protein-free thymus preparation. Liquid or porous mass.

Stimulates immune processes, activates immunocompetent cells (T- and B-lymphocytes), accelerates regeneration processes, and increases overall resistance.

Used intramuscularly as an immunostimulating agent for calves and piglets.

Sodium nucleinate. Sodium salt of nucleic acid obtained by hydrolysis of yeast. White powder, soluble in water.

Helps accelerate regeneration, stimulates bone marrow activity, leukopoiesis, cooperation of T- and B-lymphocytes, phagocytosis and the activity of nonspecific resistance factors.

Used for immunodeficiency and complex chemotherapy.

Herbal remedies with immunostimulating properties, represented by preparations of eleutherococcus, ginseng, lemongrass, radiola, aloe and other plants, are classified as central nervous system stimulants. All these drugs have pronounced tonic properties, especially in depressive states of the body, activate the body's defenses and are good adaptogens. At the same time, there are reports of stimulation by these drugs of factors of nonspecific and specific defense of the body.

Substances that stimulate nonspecific resistance of the body (NRO) and immunity (humoral and cellular immune reactions). In the literature, the term immunomodulators is often used as a synonym for the term immunostimulants, although today these terms have ceased to be synonymous.

The main cause of most infectious diseases can be called a weak human immune system, incapable of adequately resisting the attack of foreign microorganisms. This human condition is called immunodeficiency. The problem of immunodeficiency can be solved; for this purpose, various immunostimulants are released onto the market. There are already so many of them that even experts sometimes get confused. And everyone needs to have an idea of ​​what immunostimulants are.

Immunostimulants general characteristics

Designed to enhance immune response to a weakened immune system. In other words, drugs that increase and strengthen immunity.

Quite often in the press there is a mention of an immunomodulator. Usually the concepts of immunostimulants are considered identical. Meanwhile, this is not entirely true. Immunomodulators are a more general definition of all immune drugs that bring a person into an adequate state. The system can be either weak (the so-called immunodeficiency state) or hyperactive (the so-called autoimmune state). In the latter case, it is suppressed to normal levels. Immunosuppressants are used to suppress. And to increase and strengthen immunity, immunostimulants are taken. This is where the difference lies.

Immunomodulators are drugs that help the body fight bacteria and viruses by strengthening the body's defenses. Adults and children are allowed to take such medications only as prescribed by a doctor. Immunotherapy drugs have a lot of adverse reactions if the dosage is not observed and the drug is selected incorrectly.

In order not to harm the body, you need to choose immunomodulators wisely.

Description and classification of immunomodulators

What immunomodulatory drugs are in general terms is clear, now it’s worth understanding what they are. Immunomodulatory agents have certain properties that affect human immunity.

The following types are distinguished:

1. Immunostimulants- These are unique immunoboosting drugs that help the body develop or strengthen existing immunity to a particular infection.
2. Immunosuppressants– suppress the activity of the immune system if the body begins to fight against itself.

All immunomodulators perform different functions to some extent (sometimes even several), so they also distinguish:

• immunostrengthening agents;
• immunosuppressants;
• antiviral immunostimulating drugs;
• antitumor immunostimulating agents.

It makes no sense to choose which drug is the best of all groups, since they are on the same level and help with various pathologies. They are incomparable.

Their action in the human body will be aimed at immunity, but what they will do depends entirely on the class of the chosen drug, and the difference in choice is very great.

An immunomodulator may be by nature:

• natural (homeopathic medicines);
• synthetic.

Also, an immunomodulatory drug can be different in the type of synthesis of substances:

• endogenous - substances are synthesized already in the human body;
• exogenous - substances enter the body from the outside, but have natural sources of plant origin (herbs and other plants);
• synthetic - all substances are grown artificially.

The effect of taking a drug from any group is quite strong, so it is also worth mentioning why these drugs are dangerous. If immunomodulators are used uncontrolled for a long time, then when they are canceled, the person’s real immunity will be zero and there will be no way to fight infections without these drugs.

If medications are prescribed for children, but the dosage is not correct for some reason, this may contribute to the fact that the growing child’s body will not be able to independently strengthen its defenses and subsequently the baby will often get sick (you need to choose special children’s medications). In adults, such a reaction can also be noted due to the initial weakness of the immune system.

Video: advice from Dr. Komarovsky

What is it prescribed for?

Immune drugs are prescribed to those people whose immune status is significantly lower than normal, and therefore their body is unable to fight various infections. The prescription of immunomodulators is appropriate when the disease is so severe that even a healthy person with good immunity cannot overcome it. Most of these drugs have an antiviral effect, and therefore are prescribed in combination with other drugs to treat many diseases.

Modern immunomodulators are used in the following cases:

• for allergies to restore the body's strength;
• for herpes of any type to eliminate the virus and restore immunity;
• for influenza and ARVI to eliminate the symptoms of the disease, get rid of the causative agent of the disease and maintain the body during the rehabilitation period, so that other infections do not have time to develop in the body;
• for a cold for a speedy recovery, so as not to use antibiotics, but to help the body recover on its own;
• in gynecology, an immunostimulating drug is used to treat some viral diseases to help the body cope with it;
• HIV is also treated with immunomodulators of various groups in combination with other drugs (various stimulants, drugs with antiviral effects and many others).

Even several types of immunomodulators can be used for a certain disease, but all of them must be prescribed by a doctor, since self-prescription of such strong drugs can only worsen a person’s health condition.

Features in purpose

Immunomodulators should be prescribed by a doctor so that he can select an individual dosage of the drug according to the patient’s age and illness. These medications come in different forms of release, and the patient may be prescribed one of the most convenient forms for administration:

• pills;
• capsules;
• injections;
• candles;
• injections in ampoules.

Which is better for the patient to choose, but after coordinating his decision with the doctor. Another plus is that inexpensive but effective immunomodulators are sold, and therefore the price problem will not arise in the way of eliminating the disease.

Many immunomodulators have natural herbal components in their composition, others, on the contrary, contain only synthetic components, and therefore it will not be difficult to choose a group of drugs that is better suited in a particular case.

It should be borne in mind that such medications should be prescribed with caution to people from certain groups, namely:

• for those who are preparing for pregnancy;
• for pregnant and breastfeeding women;
• It is better not to prescribe such drugs to children under one year of age unless absolutely necessary;
• children from 2 years of age are prescribed strictly under the supervision of a doctor;
• To old people;
• people with endocrine diseases;
• for severe chronic diseases.

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The most common immunomodulators

There are many effective immunomodulators sold in pharmacies. They will differ in their quality and price, but with proper selection of the drug they will greatly help the human body in the fight against viruses and infections. Let's consider the most common list of drugs in this group, the list of which is indicated in the table.

Photos of drugs:

Interferon

Lycopid

Dekaris

Kagocel

Arbidol

Viferon

Amiksin