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Immune System Drugs


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What are the 4 classes of immunosuppressive drugs?
1. adrenocorticol steroids
2. cytotoxic agents
3. fungal agents
4. antibodies
What are 3 cytotoxic drugs and how do they act?
1. azathioprine
2. 6-mercaptopurine
3. methotrexate

They act by destroying rapidly dividing T and B cells.
What is azathiopurine?
It's a purine anti-metabolite and a prodrug of 6-mercaptopurine. It inhibits both cell-mediated and humoral immunity and is a powerful anti-inflammatory agent.

Potentiates allopurinol's effects.

Largely replaced by cyclosporine.
How does cyclophosphamide work?
Toxic to B cells more than T cells, so suppresses humoral immunity more effectively.
How does methotrexate work? When is it used?
Inhibits folate metabolism, used in conjunction with azathioprine and cyclosporine in marrow transplants. Used because of its oral bioavailability and intrinsic antileukemic activity in bone marrow transplants.
prednisolone and methylprednisolone
- corticosteroids, limited use due to toxicity
- induce a rapid, transient reduction in blood lymphocytes following a large single dose
- anti-inflammatory response since they turn off cytokine production and inhibit synthesis of arachidonic acid metabolites
- orally active
- great for transplant patients
- specific for T-cells, inhibits the primary and secondary phases of cell-mediated immunity and the primary phase of the antibody-mediated response
- inhibitor of chronic and immune-mediated inflammation
- mxn: blocks the transcription of IL-2 gene
FK506 (tacrolimus)
- macrolide antibiotic, 100x more potent than cyclosporine in prolonging graft survival
- similar mxn to cyclosporine
- also binds FKBP, but works by inhibiting T-cell proliferation by interfering with the signal transduction pathway of the T cell growth factor
promotes T-cell proliferation and has been used to treat renal cell carcinoma and melanoma in combination with cellular therapy
interferon alpha
used to fight hep B, hep C, genital warts caused by HPV, CML, squamous carcinomas
interferon gamma
reduces the frequency and severity of serious infections associated with chronic granulomatous disease

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