Medicines with immunostimulating action. Multivitamins to strengthen the defenses

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Today, a variety of immunostimulants are sold without a prescription in any pharmacy. However, first it makes sense to understand whether they are really so necessary for your body.

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

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

Other pharmaceuticals stimulate the immune system in general, not focusing on a specific pathogen (thymogen, thymalin). In fact, these are hormones isolated from the thymus gland of cattle or artificially synthesized. 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 prescription of such drugs is always associated with a certain danger. First, no preparations made from animal material can be guaranteed to be free from viruses and prions like mad cow disease. Second, the rapid production of lymphocytes can cause them to attack healthy cells in the body. This is how severe autoimmune diseases occur. Worse, forcible stimulation of the complex process of division can provoke cancerous degeneration of cells. In general, only a specialist should prescribe such drugs and only in the most extreme cases.

Medicines that either contain immune interferon proteins (interal, viferon, intron A) or stimulate their formation (amexin, arbidol) are especially loved by the people. Interferons are among the first to enter the fight against strangers and indirectly activate all cells of the immune system. Today, these drugs are synthesized artificially, so they are much safer than thymogens. However, they also have their contraindications. Immunostimulants containing interferon inducers should not 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 herbal immunostimulants (adaptogens). This, for example, is an extract of ginseng, eleutherococcus, Chinese magnolia vine, 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 immunity at all, but simply work like antibiotics - they destroy pathogens.

Despite their natural origin, adaptogens are also not harmless. They may be allergic. In addition, there is a risk of exceeding the dose or duration of the use of drugs and earn overstimulation: increased blood pressure, tachycardia and insomnia. Therefore, such drugs are not prescribed to people with hypertension, irritability, 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 to remove foreign cells destroyed by lymphocytes from the body. You need to drink such complexes in courses and on the recommendation of a doctor - everything here is also very individual.

Classification of immunoactive agents:

A: Immunostimulants:

I IS of bacterial origin

1. Vaccines (BCG, CP)

2. Microbial lipopolysaccharides of Gr-negative bacteria

riy (prodigiosan, pyrogenal, etc.)

3. Low molecular weight immunocorrectors

II Preparations of animal origin

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

raspberries, taktivin, thymogen, vilozen, 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. Derivatives of pyrimidines (methyluracil, pentoxyl,

orotic acid, diucifon)

2. Imidazole derivatives (levamisole, dibazol)

3. Trace elements (Compounds Zn, Cu, etc.)

V Regulatory peptides (tuftsin, dolargin)

VI Other immunoactive agents (vitamins, adaptogens)

B: Immunosuppressants

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, physical and biological methods of influencing immunity are distinguished:

1. Ionizing radiation

2. Plasmapheresis

3. Drainage of the thoracic lymphatic duct

4. Anti-lymphocyte serum

5: Monoclonal antibodies

The pathology of immune processes is very common. 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 therapeutic polyclinics of the country.

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 agents is aimed at normalizing the functions of cells involved in the immune response. Here, modulation of two conditions encountered in the clinic, namely immunosuppression or immunostimulation, is possible, which significantly depends on the characteristics of the patient's immune response. This raises the problem of optimal immunotherapy that modulates immunity in the clinically necessary direction. Thus, the main goal of immunotherapy is a directed impact on the ability of the patient's body to an immune response.

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

As a rule, drugs are called immunostimulants, which integrally, in general, 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 infection, resistance to antibiotic treatment.

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

By 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 non-specific.

Active specific method of enhancing the immune response includes the use of methods for optimizing the scheme of administration of the antigen and antigenic modification.

An active non-specific way to enhance the immune response includes, in turn, the use of adjuvants (Freund, BCG, etc.), as well as chemical and other drugs.

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

Passive non-specific method includes the introduction of donor plasma gamma globulin, bone marrow transplantation, the use of allogeneic drugs (thymic factors, lymphokines).

Since there are certain limitations in the clinical setting, the main approach to immunocorrection is non-specific therapy.

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

According to the chemical structure, method of preparation, mechanism of action, these agents represent a heterogeneous group, therefore there is no single classification. The classification of immunostimulants by origin seems to be the most convenient:

1. IS of bacterial origin

2. IP of animal origin

3. IP of vegetable origin

4. Synthetic ICs of various chemical structures

5. Regulatory peptides

6. Other immunoactive agents

Immunostimulators of bacterial origin include vaccines, lipopolysaccharides of Gram-negative bacteria, low molecular weight immunocorrectors.

In addition to inducing a specific immune response, all vaccines cause immunostimulatory effects to varying degrees. The best studied vaccines are BCG (which contains the non-pathogenic Calmette-Guérin bacillus) and CP (Corynobacterium parvum), pseudodiphtheroid bacteria. With their introduction, the number of macrophages in tissues increases, their chemotaxis and phagocytosis increase, monoclonal

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

In clinical practice, vackins 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. Usually, the start of such therapy should be a week ahead of other treatments. For the introduction 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;

Prolonged 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 in the use of vaccines for the treatment of patients with neoplasms is the phenomenon of immunological enhancement of tumor growth.

Due to these complications, their high frequency, vaccines as immunostimulants are becoming less and less used.

Bacterial (microbial) lipopolysaccharides

The frequency of use of bacterial lipopolysaccharides in the clinic is rapidly increasing. LPS of gram-negative bacteria are especially intensively used. LPS are structural components of the bacterial wall. The most commonly used prodigiosan is derived from Bac. prodigiosum and pyrogenal obtained from Pseudomonas auginosa. 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. Usually a single dose for adults is 0.5-0.6 ml, for children 0.2-0.4 ml. Enter with an interval of 4-7 days. The course of treatment is 3-6 injections.

Pyrogenal (Pyrogenalum in amp. 1 ml (100; 250; 500; 1000 MPI minimum pyrogenic doses)) The dose of the drug is selected individually for each patient. Enter intramuscularly once a day (every other day). The initial dose is 25-50 MPD, while the body temperature rises to 37.5-38 degrees. Either 50 MTD are administered, 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, only 2-3 courses with a break of at least 2-3 months.

Indications for use:

For persistent pneumonia

Some variants of pulmonary tuberculosis,

chronic osteomyelitis,

To reduce the severity of allergic reactions

(with atopic bronchial asthma),

To reduce the incidence of anemia in patients with chronic

Kim tonsillitis (with prophylactic endonasal administration

Pyrogenal is also shown:

To stimulate recovery processes after

injuries and diseases of the central nervous system,

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

bowel disease,

With psoriasis, epidymitis, prostatitis,

For some stubborn dermatitis (urticaria),

In chronic inflammatory diseases of the female polo

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

As an additional tool in the complex therapy of syphilis.

Side effects include:

Leukopenia

Exacerbation of chronic bowel disease, diarrhea.

Prodigiosan is contraindicated in 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, ferfenecin, muramyl dipeptide, biostim, etc. Many of them are at the stage of clinical trials.

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 the minimum structural component of the cell wall of mycobacteria (a combination of peptide and polysaccharide).

The clinic now widely uses biostim - a very active

ny glycoprotein isolated from Klebsiellae pneumoniae. It is a polyclonal B-lymphocyte activator that 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.

It is indicated for patients with broncho-pulmonary pathology. The immunostimulating effect of Biostim is achieved by administering a dose of 1-2 mg/day. The action is stable, duration - 3 months after the cessation of the drug administration.

There are practically no side effects.

Speaking about immunostimulants of bacterial, but not of corpuscular origin in general, three main stages should be distinguished, but in fact three generations of immunostimulating agents of bacterial origin:

Creation of purified bacterial lysates, they have the specific properties of vaccines and are non-specific immunostimulants. The best representative of this generation is Bronchomunalum (capsules 0.007; 0.0035), a lysate of eight of the 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 in the form of dyspepsia and allergic reactions are possible. The main disadvantage of this generation of immunostimulating agents of bacterial origin is weak and unstable activity.

Creation of fractions of cell membranes of bacteria 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 tab. 0, 00025 and aerosol 10 ml) - a preparation 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. It is used as a vaccine for the prevention of recurrent infections of the respiratory tract and ENT organs. The effect is achieved by increasing the activity of natural killers, 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 1 time per week for 5 weeks, and then 1 time per month for 5 months.

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

The greatest effectiveness of the drug is manifested when it is 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. A new group of B-lymphocyte stimulators:

Interferons;

Interleukins.

Thymus preparations

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

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

Timalin;

Thymogen;

Taktivin;

Vilozen;

Timoptin.

Timalin is a complex of polypeptide fractions isolated from the thymus of cattle. Available in vials as a lyophilized powder.

It is used as an immunostimulant for:

Diseases accompanied by a decrease in cellular immunity

In acute and chronic purulent processes and inflammatory

diseases;

With burn disease;

With trophic ulcers;

With suppression of immunity and hematopoietic function after lu

chemotherapy or chemotherapy in cancer patients.

The preparation is administered intramuscularly at a dose of 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 effect:

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

Increases the activity of natural killers, as well as killer

ny activity of lymphocytes;

In low doses, it stimulates the synthesis of interferons.

Thymogen (in the form of a solution for injections 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 taktivin.

A good effect when taking these drugs is achieved when:

Therapy of patients with rheumatoid arthritis;

With juvenile rheumatoid arthritis;

With recurrent herpetic lesions;

In children with lymphoproliferative diseases;

In patients with primary immunodeficiency;

With mucocutaneous candidiasis.

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

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

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

In recent years, new, more active agents have been widely used, the action of which is directed to B-lymphocytes and plasma cells. These substances are produced by the cells of the bone marrow. 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-system of immunity.

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

It has been proven that myelopid acts on currently inactive

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

Hematological diseases (chronic lymphocytic leukemia,

macroglobulinemia, myeloma);

Diseases accompanied by loss of protein;

Management of surgical patients, as well as after chemo- and lu

Chevoy therapy;

Bronchopulmonary diseases.

The drug is non-toxic and does not cause allergic reactions, does not give teratogenic and 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 (IF) - low molecular weight glycopeptides - a large group of immunostimulants.

The term "interferon" arose when observing patients who had a viral infection. It turned out that in the stage of convalescence they were protected, to one degree or another, from the effects of other viral agents. In 1957, the factor responsible for this viral interference phenomenon 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, IF "intercept" their reproduction at the stage required for all viruses - blocking the start of translation, that is, the beginning of the synthesis of virus-specific proteins, and also recognize and discriminate viral RNA among cellular ones. Thus, IFs are substances with a universally broad spectrum of antiviral activity.

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

I Natural interferons:

Alpha-ferons - human leukocyte IF (Russia),

egiferon (Hungary), velferon (England);

Beta-ferons - 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 IF is most effective are divided into 2 groups:

1. Viral infections:

The most studied (thousands of observations) are various herpetic

cue and cytomegalovirus lesions;

Less studied (hundreds of observations) 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) side effects are noted: anorexia, nausea, vomiting, diarrhea, pyrogenic reactions, leuko-thrombocytopenia, proteinuria, arrhythmias, hepatitis. The severity of 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 known that IF, inducing the synthesis of IL, creates a cytokine network with them.

In clinical practice, 8 interleukins (IL1-8) are tested with certain effects:

IL 1-3 - stimulation of T-lymphocytes;

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

Clinical use data are available only for IL-2:

Significantly stimulates the function of T-helpers, as well as B-lim

phocytes and the synthesis of interferons.

Since 1983, IL-2 has been produced in recombinant form. This IL has been tested in immunodeficiencies caused by infection, tumors, bone marrow transplantation, rheumatic diseases, SLE, AIDS. The data are contradictory, there are many complications: fever, vomiting, diarrhea, weight gain, dropsy, rash, eosinophilia, hyperbilirubinemia - treatment regimens are being developed, 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). It is a recombinant human granulocyte-macrophage colony-stimulating factor (a highly purified water-soluble protein of 127 amino acids), thus 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, monocy

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

Quickly restores the body's defenses after chemotherapy

otherapy (5-10 mcg/kg once a day);

Accelerates recovery after autologous bone grafting

leg brain;

Possesses immunotropic activity;

Stimulates the growth of T-lymphocytes;

Specifically stimulates leukopoiesis (antileukopenic

means).

Herbal preparations

This group includes yeast polysaccharides, whose effect on the immune system is less pronounced than that of bacterial polysaccharides. However, they are less toxic, do not possess pyrogenicity, antigenicity. As well as bacterial polysaccharides, they activate the functions of macrophages and neutrophilic leukocytes. The 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 in infectious, hematological complications arising from radio and chemotherapy of cancer patients. Zimozan is administered according to the 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 yeast hydrolysis and further purification). The drug has a wide range of effects, 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, nonspecific protection 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 in many diseases, but especially

It is specifically indicated for leukopenia, agranulocytosis, acute and prolonged pneumonia, obstructive bronchitis, it is also used in the recovery period in patients with blood pathology and in cancer patients.

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

Synthetic immunoactive agents of different groups

1. Pyrimidine derivatives:

Methyluracil, orotic acid, pentoxyl, diucifon, oxymethacil.

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

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

Among the side effects are allergic reactions and the phenomenon of the opposite effect in severe leukopenia and erythropenia.

2. Derivatives of imidazole:

Levamisole, dibazol.

Levamisole (Levomisolum; in tablets of 0.05; 0.15) or decaris - a heterocyclic compound was originally developed as an anthelmintic drug, and it has also been proven to enhance anti-infective immunity. Levamisole normalizes many functions of macrophages, neutrophils, natural killers 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 in the following conditions:

Recurrent ulcerative stomatitis;

Rheumatoid arthritis;

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

autoimmune disease (chronic progressive disease)

Crohn's disease;

Lymphogranulomatosis, sarcoidosis;

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

ty candidiasis);

Chronic infectious diseases (toxoplasmosis, leprosy,

viral hepatitis, herpes);

tumor processes.

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

the initial administration of 150 mg / week, while the 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.

Dibazol 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, macrophages, improves the synthesis of interferon, but acts slowly, therefore it is used to prevent infectious diseases (flu, SARS). For this purpose, dibazol is taken 1 time per day daily for 3-4 weeks.

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

Regulatory peptides

The practical use of regulatory peptides makes it possible to most physiologically and purposefully influence 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, natural cells. In the clinic, tuftsin is used to stimulate antitumor activity.

From the group of oligopeptides, Dolargin (Dolarginum; powder in amp. or in a vial. 1 mg - diluted in 1 ml of saline solution; 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 studies have shown that it has a positive effect on the immune system, and more powerful than cimetidine.

Dolargin normalizes the proliferative response of lymphocytes in patients with rheumatic diseases, stimulates the activity of nucleic acids; generally stimulates wound healing, 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 drugs.

lective action.

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

In the treatment with immunoactive agents, the 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 violation of the functions of each of these cells, changes in the relationship between them and underlies the 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, pathogenetic heterogeneity of diseases are found.

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

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

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

Immunostimulators also differ from each other in terms 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 - on B-lymphocytes.

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

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

Relative selectivity of the pharmacodynamic effect

immunostimulants:

1. Drugs that primarily stimulate non-specific

protection factors:

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

Retinoids.

2. Drugs primarily stimulating monocytes and poppy

sodium nucleinate; - muramylpeptide and its analogues;

Vaccines (BCG, CP) - vegetable lipopolysaccharides;

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

3. Drugs that primarily stimulate T-lymphocytes:

Imidazole compounds (levamisole, dibazol, immunitiol);

Thymus preparations (timogen, taktivin, thymalin, vilozen);

Zn preparations; - lobenzarite Na;

Interleukin-2 - thiobutarit.

4. Drugs that primarily stimulate B-lymphocytes:

Myelopids (B-activin);

Oligopeptides (tuftsin, dalargin, rigin);

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

5. Predominantly natural stimulants

killer cells:

Interferons;

Antiviral drugs (isoprinosine, tilorone).

Despite a certain conventionality of the proposed classification, this division is necessary, as it allows prescribing drugs based on immunological rather than clinical diagnosis. The absence of drugs with selective action significantly complicates the development of combined immunostimulation methods.

Thus, for the individualization of immunoactive therapy, clinical and immunological criteria are needed to predict the outcome of treatment.

The main factors protecting the body from pathogenic microorganisms are antibodies, which in most animals are about 1% of the blood mass, or 1020 protein molecules. With infection, the number of antibodies increases dramatically. 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 bursa-dependent - B-lymphocytes (produced by the bone marrow). In the rest of the lymphatic organs and in the blood plasma, there are both those and other cells, where they cooperate and “work” together. In turn, T-lymphocytes are divided into T-helpers (assistants), T-suppressors (depressants) and T-killers ("killers").

The body's immune response is schematically as follows. The macrophage delivers a 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, as they have receptors on them. Therefore, when antigens enter the body, T-killers themselves begin to multiply intensively. Of course, the immune response in the body is much more complicated than the described scheme. A whole series of immune mediators is involved in the process, and many other body systems are also affected. Nevertheless, this scheme allows a more targeted study and differentiation of drugs that affect the body's immune response.

Under various pathological processes in the body, the production of T- and B-lymphocytes may decrease, a more pronounced reaction of inhibition of leukocyte migration (TML) may develop, the absorption capacity of neutrophils (according to the phagocytic number and phagocytic index) may decrease, the production of T-helpers, T-killers and mediators of the immune response. There is an imbalance in the immune system. This imbalance is largely facilitated by violations of feeding (protein deficiency) of animals and the impact on the body of various xenobiotics (increasing chemicalization of the national economy). That is why in recent years we are increasingly confronted with a new pathology in animals - immunodeficiency. In such a situation, it is simply necessary to use immunostimulants that correct the 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;

contribute to better wound healing, stimulating regeneration processes;

have growth-promoting properties;

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

To date, immunostimulants can be divided into 4 groups:

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

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

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

4) herbal remedies: eleutherococcus, ginseng, magnolia vine, etc.

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

Isamben. A 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 in calf dyspepsia (by mouth) and increasing the defenses of chickens (aerosols).

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

Camizol. A derivative of phenylimidazothiazole. White amorphous powder, soluble in water.

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

It is used intramuscularly (young animals) and inside (poultry) to increase immunobiological reactivity, activate the immune response and increase productivity.

Dimephosphon. Dimethyl ester of oxobutylphosphonic acid. Colorless or slightly yellowish liquid.

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

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

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

Increases body temperature, stimulates leukopoiesis, increases tissue permeability, promotes better penetration of chemotherapeutic substances into the lesion. Increases the overall resistance of the body. It is used as an additional non-specific remedy for some infectious diseases.

Prodigiosan. High polymer lipopolysaccharide complex isolated from microorganisms. Amorphous powder, hardly soluble in water.

Stimulates the factors of nonspecific and specific resistance of the body. Activates the T-system of immunity and the function of the adrenal cortex. It is used as an adjunct to chemotherapy drugs for bacterial and viral infections.

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

Corrects the immunological reactivity of the body: regulates the number of T- and B-lymphocytes, activates the reaction of cellular immunity, enhances phagocytosis, stimulates regeneration processes. It is used in immunodeficiency states and to activate the immune response.

B-activation. A preparation from the group of low molecular weight peptides isolated from a culture of porcine bone marrow cells. Powder of white color with a yellowish shade.

It restores the quantitative and functional parameters of the B- and T-systems of immunity, stimulates the production of antibodies, the functional activity of macrophages and other immunocompetent cells.

It is used for the prevention and treatment of acute respiratory diseases of viral, bacterial, mycoplasmic and chlamydial etiology and nonspecific bronchopneumonia in calves, increasing the overall resistance of the body in immunodeficient conditions.

Thymogen. The thymus synthetic peptide is glutamyl tryptophan. White or yellowish powder, soluble in water.

It 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 the processes of cellular metabolism, enhances the intensity of growth of animals and birds.

It is prescribed for immunodeficiencies, disorders of regenerative processes, for the prevention of viral and bacterial infections, to increase the immune response and the growth rate of animals.

KAFI (immune activating factor complex). Thymus protein-free preparation. Liquid or porous mass.

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

It is used intramuscularly as an immunostimulating agent for calves and piglets.

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

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

Used for immunodeficiencies and complex chemotherapy.

Herbal remedies with immunostimulating properties are represented by preparations of eleutherococcus, ginseng, magnolia vine, radiola, aloe and other plants, they are classified as CNS 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 of nonspecific and specific body defense factors by these drugs.

Substances that stimulate nonspecific resistance of the body (NRO) and immunity (humoral and cellular immune responses). In the literature, the term immunomodulators is often used as a synonym for the term immunostimulants, although today these terms are no longer synonymous.

The main cause of most infectious diseases can be called a weak human immune system, unable to adequately resist the attack of foreign microorganisms. This condition is called immunodeficiency. The problem of immunodeficiency is solvable; for this, various immunostimulants are released on 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 the immune response in a weakened immune system. In other words, drugs that increase and strengthen the immune system.

Quite often in the press there is a mention of an immunomodulator. Usually the concepts of immunostimulants and are considered identical. Meanwhile, this is not entirely true. Immunomodulators - 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 a normal level. Immunosuppressive agents are used to suppress. And to increase and strengthen immunity, immunostimulants are taken. Therein lies the difference.

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 medicines only as directed by a doctor. Immunopreparations have a lot of adverse reactions in case of non-compliance with the dosage and improper selection of the drug.

In order not to harm the body, you need to competently approach the choice of immunomodulators.

Description and classification of immunomodulators

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

There are such types:

1. Immunostimulants- These are a kind of immuno-boosting drugs that help the body develop or strengthen the already existing immunity to a particular infection.
2. Immunosuppressants- suppress the activity of immunity in the event that the body begins to fight with itself.

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

• immunosuppressive agents;
• immunosuppressive agents;
• antiviral immunostimulating drugs;
• antitumor immunostimulating agents.

Which drug is the best of all groups, it makes no sense to choose, 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 selected drug, and the difference in choice is very large.

An immunomodulator can be by its nature:

• natural (homeopathic preparations);
• synthetic.

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

• endogenous - substances are already synthesized 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 how dangerous these drugs are. If immunomodulators are used uncontrollably for a long time, then if they are canceled, the person’s real immunity will be zero and there will be no way to fight infections without these drugs.

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

Video: Dr. Komarovsky's advice

What are they prescribed for?

Immune drugs are prescribed to those people whose immune status is much lower than normal, and therefore their body is not able to fight various infections. The appointment of immunomodulators is appropriate when the disease is so strong 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 for the treatment of many diseases.

Modern immunomodulators are used in such cases:

• with allergies to restore the body's strength;
• with herpes of any type to eliminate the virus and restore immunity;
• with influenza and SARS 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;
• with a cold for a speedy recovery, so as not to use antibiotics, but to help the body recover on its own;
• in gynecology, for the treatment of certain viral diseases, an immunostimulating drug is used to help the body cope with it;
• HIV is also treated with immunomodulators of various groups in combination with other drugs (various stimulants, antiviral drugs, and many others).

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

Features in the appointment

Immunomodulators should be prescribed by a doctor so that he can choose an individual dosage of the drug according to the age of the patient and his illness. These drugs are different in their form of release, and the patient can be prescribed one of the most convenient forms for taking:

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

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

Many immunomodulators have natural plant 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 the intake of such drugs should be prescribed with caution to people from certain groups, namely:

• for those who are preparing for pregnancy;
• for pregnant and lactating women;
• for children under one year old, it is better not to prescribe such drugs at all 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;
• in severe chronic diseases.

Stories from our readers

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The most common immunomodulators

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

Photo of preparations:

Interferon

Likopid

Decaris

Kagocel

Arbidol

Viferon

Amiksin