What Are Immunomodulators?

Geisha A. Legazpi

Immunomodulators are substances that regulate or modify the function of the immune system. They may act as immunosuppressants by inhibiting the immune response or as immunostimulants by stimulating the immune response. Immunosuppressants are helpful in treating autoimmune diseases, such as Crohn’s disease, and in preventing the rejection of organ transplants. Immunostimulants are helpful in improving the immune function of people with chronic infectious diseases, immunodeficiency disorders, and cancers. Tolerogens, a substance that induces tolerance and makes certain tissues less responsive or nonresponsive to specific antigens, are the third type of immunomodulators.

Crohn's disease causes inflammation of the lining and wall of the large and/or small intestine.
Crohn's disease causes inflammation of the lining and wall of the large and/or small intestine.

It is unclear how immunomodulators work, but it is hypothesized that they act on certain points of the immune activation pathways. Cytokines are natural immunomodulators, and are produced by lymphoreticular cells. They have multiple interacting roles in the immune pathways.

Side effects of interferons may include headache.
Side effects of interferons may include headache.

Interferons (IFNs) are a group of cytokines with immune-enhancing properties and are thus called immunostimulants. Interferon-gamma increases antigen presentation to immune cells and stimulates the activation of various immune cells, including natural killer (NK) cells, macrophages, and cytotoxic T lymphocytes. It is used for the treatment of chronic granulomatous diseases. Interferon-alpha is used for the treatment of infections, such as hepatitis B and C, and cancers, such as chronic myelogenous leukemia, Kaposi’s sarcoma, hairy cell leukemia, and malignant melanoma. Interferons may cause side effects such as fever, chills, body pain, headache, and depression.

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Thalidomide was once used to control pregnancy-associated vomiting.
Thalidomide was once used to control pregnancy-associated vomiting.

Other examples of immunostimulants include levamisole and thalidomide. Levamisole is a drug that was originally used for helminth infections, and are now used for colon cancer. Thalidomide was once used to control pregnancy-associated vomiting, but it was removed from the market because of its teratogenic effects. It has recently found a new use as an immunomodulator drug for rheumatoid arthritis, multiple myeloma, and erythema nodosum leprosum.

Side effects of interferons may include fever and chills.
Side effects of interferons may include fever and chills.

Immunomodulation therapy can control symptoms of inflammation. Those that inhibit the function of inflammatory cytokines, such as interleukin-1 (IL-1) and tumor necrosis factor-alpha, can greatly benefit people suffering from chronic inflammatory conditions. For instance, azathioprine, 6-mercaptopurine, cyclosporine, and tacrolimus may be used to maintain remission in Crohn's disease and ulcerative colitis patients. Azathioprine, cyclophosphamide, methotrexate, and mycophenolate mofetil (MMF) are examples of antiproliferative or cytotoxic drugs, while cyclosporine and tacrolimus are examples of calcineurin inhibitors or specific T-cell inhibitors.

Blood tests are needed to monitor the effects of immunomodulators on the liver.
Blood tests are needed to monitor the effects of immunomodulators on the liver.

Immunomodulators act on the immune system. Blood tests are needed to monitor the effects of these drugs on the bone marrow, kidneys, and liver. Women who are pregnant or planning to get pregnant should consult their doctor regarding the use of immunomodulators because their use could lead to birth defects or miscarriage.

All types of white blood cells are a major part of the immune system.
All types of white blood cells are a major part of the immune system.
Blood tests will need to be performed to monitor the effects of immunomodulators on the kidneys.
Blood tests will need to be performed to monitor the effects of immunomodulators on the kidneys.
Individuals with Crohn's disease may experience nausea and vomiting.
Individuals with Crohn's disease may experience nausea and vomiting.
Women who are pregnant should consult their doctor about using immunomodulators, because they could lead to miscarriage.
Women who are pregnant should consult their doctor about using immunomodulators, because they could lead to miscarriage.

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