Immunosuppression

Immunosuppression
Intervention

Micrograph showing an opportunistic infection due to immunosuppression - large (blue) cell below-center-left infected with a polyomavirus. Urine cytology specimen.
MeSH D007165

Immunosuppression is a reduction of the activation or efficacy of the immune system. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions.

In general, deliberately induced immunosuppression is performed to prevent the body from rejecting an organ transplant, treating graft-versus-host disease after a bone marrow transplant, or for the treatment of auto-immune diseases such as systemic lupus erythematosus, rheumatoid arthritis, Sjögren's syndrome, or Crohn's disease. This is typically done using medications, but may involve surgery (spleen removal), plasmapharesis, or radiation.

A person who is undergoing immunosuppression, or whose immune system is weak for other reasons (for example, chemotherapy or HIV), is said to be immunocompromised. An immunosuppressant is any agent that weakens the immune system, including immunosuppressive drugs and some environmental toxins.

Deliberately induced

Further information: Immunosuppressive drug

Administration of immunosuppressive medications or immunosuppressants is the main method of deliberately induced immunosuppression. In optimal circumstances, immunosuppressive drugs are targeted only at any hyperactive component of the immune system, and in ideal circumstances would not cause any significant immunodeficiency. However, in essence, all immunosuppressive drugs have the potential to cause immunodeficiency. Immunodeficiency can cause increased susceptibility to opportunistic infections and decreased cancer immunosurveillance. The term immunotoxin is also sometimes used (incorrectly) to label undesirable immunosuppressants, such as various pollutants. Immunosuppressants may be prescribed when a normal immune response is undesirable, such as in autoimmune diseases.

Cortisone was the first immunosuppressant identified, but its wide ranging side-effects limited its use. The more specific azathioprine was identified in 1959, but it was the discovery of ciclosporin in 1970 that allowed significant expansion of kidney transplantation to less well-matched donor-recipient pairs as well as broad application to liver transplantation, lung transplantation, pancreas transplantation, and heart transplantation. After an organ transplantation, the body will nearly always reject the new organ(s) due to differences in human leukocyte antigen haplotypes between the donor and recipient. As a result, the immune system detects the new tissue as "foreign", and attempts to remove it by attacking it with recipient white blood cells, resulting in the death of the donated tissue. Immunosuppressants are given as an attempt to prevent this rejection; the side-effect is that the body becomes more vulnerable to infections and malignancy, as in advanced HIV infection. At the same time, people with previous cancer who require immunosuppression are not more likely to have a recurrence.[1]

Throughout its history, radiation therapy has been used to decrease the strength of the immune system. Dr. Joseph Murray of Harvard Medical School and chief plastic surgeon at Children's Hospital Boston from 1972-1985 was awarded the Nobel Prize in Physiology or Medicine in 1990 for his work on immunosuppression.

Non-deliberate immunosuppression

Further information: Immunodeficiency

Non-deliberate immunosuppression can occur in, for example, malnutrition, aging, many types of cancer (such as leukemia, lymphoma, multiple myeloma), and certain chronic infections such as Human Immunodeficiency virus (HIV).[2] The unwanted effect in non-deliberate immunosuppression is immunodeficiency that results in increased susceptibility to pathogens such as bacteria, viruses, or fungi.

Immunodeficiency is also a potential adverse effect of many immunosuppressant drugs. In this sense, the scope of the term immunosuppression in general includes both beneficial and potential adverse effects of decreasing the function of the immune system, whereas the term immunodeficiency in general refers solely to the adverse effect of increased risk for infection.

See also

References

  1. ↑ Shelton, Edward; Laharie, David; Scott, Frank I.; Mamtani, Ronac; Lewis, James D.; Colombel, Jean-Frederic; Ananthakrishnan, Ashwin N. (July 2016). "Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis". Gastroenterology. 151 (1): 97–109.e4. doi:10.1053/j.gastro.2016.03.037. PMID 27039969.
  2. ↑ Abbas, Abul K.; Lichtman, Andrew H. (29 January 2010). Basic Immunology: Functions and Disorders of the Immune System. Saunders/Elsevier. ISBN 978-1-4160-5569-3.
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