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B-Pharma-3Rd-Year-Pharmacology-Iii IMMUNOSTIMULANTS Immunostimulants are substances that stimulate the immune system Sp.., such as vaccines stimulate an immune response to specific antigenic intmunostimulants do not have antigenic specificity and are widely used ; chronic Infections, immunodeficiency, autoinimunity and neoplastic diseases. Types of Immunostitmulants : There are various type of immunostimulants are used such as bacterial vaccines, colony-stimulating factors, interferon, Interleukins, other inununostimulants, therapeutic vaccines , vaccine combinations and viral vaccines Bacterial vaccines: These contain killed or attenuated bacteria that activate the immune ,tem. Antibodies are built against that particular bacteria, and prevents the bacterial infection later. e.g. tuberculosis vaccine. Colony stimulating factors : These are glycoproteins that promote the production of white blood cells (mainly granulocytes such as neutrophIls), in response to infection. Administration of exogenous colony-stimulating factors stimulates the stem cells in the bcoz marrow to produce more of the particular white blood cells. The new white blot, in migrate into the blood and fight the infection. Colony-stimulating, facbtoioors,farceellu co, urns patients who are undergoing cancer treatment that causes low while blood factors tend (neutropenia) and puts the patient at risk of infection. The colony- stimulating factors tend to reduce the time where patients are neutropenic. Interleuins : These are a group of cytokines which are synthesized byliyrengupthaotico lymphocytes, of monocytes, macrophages, and certain other cells. They function especially y m the immune system. Eg. ILi, IL2 and a.. etc. Viral vaccines : These contain either inactivated viruses or attenuated (alive but not capable of causing disease) viruses. Inactivated or killed viral vaccines : these vaccines contain viruses , which have lost their ability to repilicate and in order for it to bring about a response it contains more antigen than live vaccines . Attenuated or live vaccines contain the live from the virus . These viruses are not pathogenic but are able to induce an immune response . vaccines combination merge antigens that prevent different disease , or that protect against multiple strains of infectious agent causing the same disease, into a single product . This reduces the number of injections required to prevent some diseases. CLASSIFICATION: Immunization vaccines 1. Bacillus calmette Guerin (BCG) 2. Varicella Zoster Vaccine(Live/Attenuated); 3. Yellow Fever Vaccine 4. Rotavirus vaccine Recombinant cytokines 1. Interleukins 2. Interferon’s 3. Colony-stimulating factors Others Levamisole IMMUNIZATION VACCINES : IT is suspensions of killkd or attenuated microorganisms (bacteria, viruses, fungi, protozoa, antigenic proteins, synthetic constructs, or other bio- molecular derivatives, administered for the prevention, amelioration, or treatment of infectious and other diseases. BACILLUS CALMETTE GUERIN (BCG) BCG VACCINE : Systemic live-attenuated bacteria vaccine, Tuberculosis prevention Antineoplastic. BCG vaccine has been investigated for the treatment of Neoplasms, Bladder Cancer, Neoplasnis by Site, Urologic Diseases, anti Urologic Neoplasms, among others. Mechanism of action of BCG Vaccine : BCG vaccine is a live vaccine( Live vaccines are prepared from attenuated strains that are almost or completely devoid of pathogenicity but are capable of inducing a protective immune response. 'They multiply in the human host and provide continuous antigenic stimulation over a period of time) , which contains attenuated strains of Mycobacterium bovis which are closely related to Mycobacterium tuberculosis. Side Effects of BCG Vaccine: Rash, Fever, Local indurations, Pain, lymphadenopathy, discharging ulcer , abcess formation, anaphylactic shock , lymphadenitis, difficulty in breathing, nausea, vomiting Phlyctenular conjunctivitis, Draining sinuses, and death Contra-indications of BCG Vaccine: Hypersensitivity to the BCG vaccines or any other vaccines, Radiotherapy, Chemotherapy ,Cancer, HIV positive, Steroids therapy, Infected skin conditions, Pyrexia Has had a vaccine in the last 3 weeks. Typical Dosage for BCG Vaccine: 0.1ml intradermal from birth to 2 weeks; on the upper part of left arm Not, The vaccine causes a nodule at the site of administration in about 4-6 weeks. This gradually settles down or breaks down and forms a sore with discharge. Varicella Zoster Vaccine (Live/Attenuated) : It is indicated for the prevention of herpes zoster (shingles) in immunocompetent adults aged 50 years and older. Varivax vaccine is indicated for active immunization for the prevention of varicella in individuals 12 months of age and older. yellow Fever Vaccine, Yellow Fever Vaccine is indicated for active immunisation for the prevention of yellow fever Rotavirus Vaccine : Rotarix is indicated for prevention of rotavirus gastroenteritis caused by Gi, G3, G4, and G9 types in infants aged 6-24 weeks (FDA Label). Rotateq is indicated for the prevention of rotavirus gastroenteritis caused by G1, G2, G3, G4, and G9 types in infants aged 6- 32 week CYTOKINES : Non-antibody proteins secreted by inflammatory leukocytes and some non- leukocytic cells, that act as intercellular mediators. They differ from classical hormones in that they are produced by a number of tissue or cell types rather than by specialized glands. They generally act locally in a paracrine or autocrine rather than an endocrine manner. The drugs include Denileukindiftitox, Peginterferon alfa-2a,Interferon alfa-nl, Darbepoetinalfa, Erythropoietin,Interferon alfa-n3,Pegfilgrastim, Sargramostim, Peginterferon alb-2b and Analdnra. DENILEUKIN DIFTITOX : It is produced in an E. coil expression system.lt is a recombinant DNA -derived cytotoxic protein composed of the amino acid sequences for diphtheria toxin fragments A and B. It directs the cytocidal action of diphtheria toxin to cells which express the 1L-2 receptor. The human IL-2 receptor exists in three forms, low (CD25), intermediate (CD122/CD132) and high (CD25/CD122/CD132) affinity. Malignant cells expressing one ors more of the subunits of the 1L-2 receptor are found M certain leukemias and lymphoma including cutaneous T-cell lymphoma (CTCL). It interacts with the high affinity IL 2 receptor on the cell surface and inhibits cellular protein synthesis, resulting in cell death within hours Mechanism of action: It binds to the high-afty IL-2 receptor complex. The 1L-2 receptor (T.) subunit is expressed on activated but not resting lynlphocytes. The diphtheria toxin associated with Ontak then selectively kills the IL-2 bearing cells. Indications : It is used for the treatment of cutaneous T-cell lymphoma Adverse effects: The most common are lever, nausea, fatigue, .801b.I1 headache, swelling in the extremities, cough, difficulty in breathing and itching. Miscellaneous: Back pain, weakness, dizziness, lightheadedness, chest pain and sensory loss. Dose IV : The recommended dose is 9 or 18 mcg/kg/day, over 30-60 minutes infusion for 5 consecutive days every 21 days for 8 cycles. Brand Name: ontak INTERFERONS: Theseproteins secreted by vertebrate cells in response to a wide variety of inducers. They confer resistance against many different viruses, inhibit proliferation 0f normal and malignant cells, impede multiplication of intracellular parasites, enhance macrophage and granulocyte phagocytosis, augment natural killer cell activity, and show several other immunomodulatory functions. The drugs include Interferon alfa-nl, Interferon beta-1a, Interferon beta-lb, Peginterferon alfa-2a, Peginterferon alfa-2b and Interferon alfacon-1. INTERFERON ALFA-N1 : It up regulates the expression of MHC I proteins, allowing for increased presentation of peptides derived from viral antigens. This enhances the activation of CD8+ T cells that are the precursors for cytotoxic T lymphocytes (CTLs) and makes the macrophage a better target for CTL-mediated killing. Interferon alpha also induce the synthesis of several key antiviral mediators, including 2’-5’oligoadenylatesynthetase (2’-5’ Asynthetase) and protein kinase R. Mechanism of actions: ltinterferon alpha binds to type I interferon receptors (IFNAR1 and IFNAR2c) which, upon dimerization, activate two JAK (JANUS Kinase) tyrosine kinases (Jakl and TyK2). These transphosphorylate themselves and phosphorylate the receptors. The phosphorylated INFAR receptors is then bind to Stat 1 and Stat2 (signal transducers and activators of transcription) which is dimerize and activate multiple (-100) immunornodulatory and antiviral proteins. Interferon alpha binds less stably to type I interferon receptors than interferon beta. Adverse effects: The adverse effects includes fatigue, myalgia, headache, depression, pruritus and seizures. Neutropenia and thrombocytopenia Indications: It is used for treatment of venereal or genital warts caused by the Human Papiloma Virus. INTERLEUKINS: These are Soluble factors which stimulate growth-related activities of Leukocytes as well as other cell types. They enhance cell proliferation and differentiation, DNA synthesis, secretion of other biologically active molecules and responses to immune and inflammatory stimuli. The Drugs includes :Oprelvekin, Aldesleukin, Cintredekin Besudotox, Denileukindiftitox. OPRELVEKIN: It promotes hematopoiesis by stimulating megakaryocytopoiesis and thrombopoiesis. It is used in adult patients with nonmyeloid malignancies to prevent severe thrombocytopenia and reduce the need for platelet transfusions following therapies.
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