Immunomodulators

PRPP synthetase & PRPP amidotransferase

• Azathioprine
• Mercaptopurine
• thioguanine

antimetabolite/ cytotoxic

• USED:
• Auotimmune
• graft rejection
• type IV hypersensitivity

• MOA: use xanthine oxidase (inhibit enzymes to purine interconversion)
• inhibits de novo synthesis & salvage pathway

• A/E: BM suppression
• leukopenia
• thrombocytopenia
• hepatotoxic

• Antilymphocytic globulin (ALG)
• Antithymocytic globulins
• Rho(D) immune globulin
• Immune globulin IV

• Lymphotoxic
• From horses

• USED: prophylaxis of kidney transplant rejection
• aplastic anemia

MOA: bind T cells -> complement

A/E: Type I or III hypersensitivity

• Lymphotoxic
• from rabbits

Antibodies to CDs & HLA's

USED: acute renal transplant rejection

MOA: supresses mother's immune response to Rh + antigens presented in first child birth.

• lymphotoxic
• human polyclonal

Passive immunity

• USED: Kawaski's
• subacute lupus erythematous
• thrombocytopenic purpura

• Muromab
• Daclizumab
• Infliximab
• Aspraginase
• corticosteroids

CD3 orthoclone

MOA: block CD3 ag

USED: acute renal rejection w/ resistance to corticosteroid trtment

• A/E:
• cytokine release syndrome (use steroids or acetominophen)
• Pulmonary edema
• Bloodyscrasias, hearing loss, reactions, vision

MOA: binds cyclophilin A -> calcineurin inhibitor -> dec proto-oncogenes -> inc TGF-B -> no T cell proliferation

Fungus derived and lipophilic (needs to be given in some vehicle)

• A/E:
• nephrotoxicity
• neurotoxicity
• hyperlipidemia
• hyperuricemia
• osteoporosis
• hepatotoxicity

100X more potent than cyclosporine

Binds FKB12 -> calcineurin inhibitor -> no T cell proliferation

A/E: hyperkalemia, hyperglycemia, no LDL or uric effects, nephrotoxicity, neurotoxicity, hepatoxicity.

• (Rapamycin)
• marcoyclic lactone

• Used: similar to cyclosporine with dec in ab.
• to dec stenosis

MOA: FKBP12 -> inhibits mTOR (no protein synthesis) stopping G1 -> S

• A/E:
• myelosuppressive, inc cholesterol & triglycerides
• NOT NEPHROTOXIC

(replace azathioprine)

Used: PROPHYLAXIS of allogenic, renal, hepatic, and cardiac transplant rejection.

MOA: inhibit inosine monophosphate DH -> no guanine de novo synthesis

A/E: not with pregnancy, sepsis w/ cytomegalovirus

• Etancercept
• Infliximab
• Daclizumab

• (zenapax)
• IL2 receptor

USED: acute rejection of kidney, heart, or liver transplant.

w/ cyclosporine, mycofenolate mofetil & corticosteroids -> severe infection

• Used: acute rejection crisis
• w/ cyclosporine, tacrolimus, or azathioprine
• autoimmune

• MOA: inhibit T cell proliferation
• dec size of nodes and spleens
• dec infl. mediators
• dec chemotaxis

A/E prednisone dec IgG

MOA: enhance T cell mediated response

USE: Duke stage C colon cancer

A/E: neutropenia, anemia, agranulocytosis

non-specific immunostimulant

Use: Intravesica I therapy of bladder cancer

Inhibits TNF-a production

• inc class I MHC
• Dec class II MHC

• Use: Hairy cell leukemia
• Hep B/C
• cancer
• condyloma acuminatum

MS

granulomatous disease

MOA: activates phagocytes

IL

inc cytotoxic and NK cells

• USE: renal cancer
• metastatic melanoma

A/E: capillary leak syndrome

IL

inc platelet formation

Use: thrombocytopenia

CFU-G -> inc granulocytes

USE: BM recovery

GM-CSF graulocyte and macrophages

• USe: myeloid recovery (from high dose chemo)
• Non-Hodgkins lymphoma
• Acute lymphoblastic leukemia
• Hodgkins and BMT
• neutropenia of AIDS patient

• CONTRA:
• heart failure
• pulmonary edema
• yeast hypersenstivity (derived from yeast)

anemia treatment


Heart and liver toxic

• GM-CSF and IL13
• megakarycytopoesis

• USE: anemia
• neutropenia
• thrombocytopenia

inc platelet recovery of hematopoietic stem cell transplant