Immunosuppression
Encyclopedia
Immunosuppression involves an act that reduces the activation or efficacy
of the immune system
. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions.
Deliberately induced immunosuppression is generally done 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 rheumatoid arthritis
or Crohn's disease
. This is typically done using drugs, but may involve surgery (splenectomy
), plasmapharesis, or radiation.
A person who is undergoing immunosuppression, or whose immune system is weak for other reasons (for example, chemotherapy
, HIV
, and Lupus
) is said to be immunocompromised.
s is the main method of deliberately induced immunosuppression. Optimally, immunosuppressive drugs are targeted only at any hyperactive component of the immune system, and ideally would not cause any significant immunodeficiency
. In reality, essentially all immunosuppressive drugs have the side effect of potentially causing immunodeficiency. Immunodeficiency may manifest as increased susceptibility to opportunistic infection
s and decreased cancer immunosurveillance.
Cortisone
was the first immunosuppressant identified, but its wide range of side effects limited its use. The more specific azathioprine
was identified in 1959, but it was the discovery of cyclosporine
in 1970 that allowed for significant expansion of kidney transplantation
to less well-matched donor-recipient pairs as well as broad application of liver transplantation
, lung transplantation
, pancreas transplantation
, and heart transplantation
.
Historically, radiation therapy
was 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.
, aging, many types of cancer
(such as leukemia
, lymphoma
, multiple myeloma
) and certain chronic infections such as acquired immunodeficiency syndrome
(AIDS). The unwanted effect in in non-deliberate immunosuppression is immunodeficiency
that results in increased susceptibility to pathogen
s such as bacteria and virus.
Immunodeficiency is also a potential adverse effects of many immunosuppressant drugs. In this sense, the scope of the term immunosuppression generally includes both beneficial and potential adverse effects of decreasing the function of the immune system, while the term immunodeficiency generally refers solely to the adverse effect of increased risk for infection.
Efficacy
Efficacy is the capacity to produce an effect. It has different specific meanings in different fields. In medicine, it is the ability of an intervention or drug to reproduce a desired effect in expert hands and under ideal circumstances.- Healthcare :...
of the immune system
Immune system
An immune system is a system of biological structures and processes within an organism that protects against disease by identifying and killing pathogens and tumor cells. It detects a wide variety of agents, from viruses to parasitic worms, and needs to distinguish them from the organism's own...
. Some portions of the immune system itself have immuno-suppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions.
Deliberately induced immunosuppression is generally done to prevent the body from rejecting
Transplant rejection
Transplant rejection occurs when transplanted tissue is rejected by the recipient's immune system, which destroys the transplanted tissue. Transplant rejection can be lessened by determining the molecular similitude between donor and recipient and by use of immunosuppressant drugs after...
an organ transplant
Organ transplant
Organ transplantation is the moving of an organ from one body to another or from a donor site on the patient's own body, for the purpose of replacing the recipient's damaged or absent organ. The emerging field of regenerative medicine is allowing scientists and engineers to create organs to be...
, treating graft-versus-host disease
Graft-versus-host disease
Graft-versus-host disease is a common complication after a stem cell transplant or bone marrow transplant from another person . Immune cells in the donated marrow or stem cells recognize the recipient as "foreign". The transplanted immune cells then attack the host's body cells...
after a bone marrow transplant
Bone marrow transplant
Hematopoietic stem cell transplantation is the transplantation of multipotent hematopoietic stem cell or blood, usually derived from bone marrow, peripheral blood stem cells, or umbilical cord blood...
, or for the treatment of auto-immune diseases such as rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
or Crohn's disease
Crohn's disease
Crohn's disease, also known as regional enteritis, is a type of inflammatory bowel disease that may affect any part of the gastrointestinal tract from mouth to anus, causing a wide variety of symptoms...
. This is typically done using drugs, but may involve surgery (splenectomy
Splenectomy
A splenectomy is a surgical procedure that partially or completely removes the spleen.-Indications:The spleen, similar in structure to a large lymph node, acts as a blood filter. Current knowledge of its purpose includes the removal of old red blood cells and platelets, and the detection and fight...
), plasmapharesis, or radiation.
A person who is undergoing immunosuppression, or whose immune system is weak for other reasons (for example, chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
, HIV
HIV
Human immunodeficiency virus is a lentivirus that causes acquired immunodeficiency syndrome , a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive...
, and Lupus
Lupus
Lupus most commonly refers to the disease systemic lupus erythematosus.Lupus may also refer to:-Medicine:* Lupus erythematosus, a chronic autoimmune disease with several different forms...
) is said to be immunocompromised.
Deliberately induced
Administration of immunosuppressive drugImmunosuppressive drug
Immunosuppressive drugs or immunosuppressive agents are drugs that inhibit or prevent activity of the immune system. They are used in immunosuppressive therapy to:...
s is the main method of deliberately induced immunosuppression. Optimally, immunosuppressive drugs are targeted only at any hyperactive component of the immune system, and ideally would not cause any significant immunodeficiency
Immunodeficiency
Immunodeficiency is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Immunodeficiency may also decrease cancer immunosurveillance. Most cases of immunodeficiency are acquired but some people are born with defects in their immune system,...
. In reality, essentially all immunosuppressive drugs have the side effect of potentially causing immunodeficiency. Immunodeficiency may manifest as increased susceptibility to opportunistic infection
Opportunistic infection
An opportunistic infection is an infection caused by pathogens, particularly opportunistic pathogens—those that take advantage of certain situations—such as bacterial, viral, fungal or protozoan infections that usually do not cause disease in a healthy host, one with a healthy immune system...
s and decreased cancer immunosurveillance.
Cortisone
Cortisone
Cortisone is a steroid hormone. It is one of the main hormones released by the adrenal gland in response to stress. In chemical structure, it is a corticosteroid closely related to corticosterone. It is used to treat a variety of ailments and can be administered intravenously, orally,...
was the first immunosuppressant identified, but its wide range of side effects limited its use. The more specific azathioprine
Azathioprine
Azathioprine is a purine analogue immunosuppressive drug. It is used to prevent organ rejection following organ transplantation and to treat a vast array of autoimmune diseases, including rheumatoid arthritis, pemphigus, inflammatory bowel disease , multiple sclerosis, autoimmune hepatitis, atopic...
was identified in 1959, but it was the discovery of cyclosporine
Ciclosporin
Ciclosporin , cyclosporine , cyclosporin , or cyclosporin A is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the immune system, and therefore the risk of organ rejection...
in 1970 that allowed for significant expansion of kidney transplantation
Kidney transplantation
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ...
to less well-matched donor-recipient pairs as well as broad application of liver transplantation
Liver transplantation
Liver transplantation or hepatic transplantation is the replacement of a diseased liver with a healthy liver allograft. The most commonly used technique is orthotopic transplantation, in which the native liver is removed and replaced by the donor organ in the same anatomic location as the original...
, lung transplantation
Lung transplantation
Lung transplantation, or pulmonary transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor...
, pancreas transplantation
Pancreas transplantation
A pancreas transplant is an organ transplant that involves implanting a healthy pancreas into a person who usually has diabetes. Because the pancreas is a vital organ, performing functions necessary in the digestion process, the recipient's native pancreas is left in place, and the donated...
, and heart transplantation
Heart transplantation
A heart transplant, or a cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. As of 2007 the most common procedure was to take a working heart from a recently deceased organ donor and implant it into the...
.
Historically, radiation therapy
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
was used to decrease the strength of the immune system. Dr. Joseph Murray
Joseph Murray
Joseph Edward Murray is a retired American plastic surgeon. He performed the first successful human kidney transplant on identical twins on December 23, 1954....
of Harvard Medical School
Harvard Medical School
Harvard Medical School is the graduate medical school of Harvard University. It is located in the Longwood Medical Area of the Mission Hill neighborhood of Boston, Massachusetts....
and chief plastic surgeon at Children's Hospital Boston
Children's Hospital Boston
Children's Hospital Boston is a 396-licensed bed children's hospital in the Longwood Medical and Academic Area of Boston, Massachusetts.At 300 Longwood Avenue, Children's is adjacent both to its teaching affiliate, Harvard Medical School, and to Dana-Farber Cancer Institute...
from 1972-1985 was awarded the Nobel Prize in Physiology or Medicine
Nobel Prize in Physiology or Medicine
The Nobel Prize in Physiology or Medicine administered by the Nobel Foundation, is awarded once a year for outstanding discoveries in the field of life science and medicine. It is one of five Nobel Prizes established in 1895 by Swedish chemist Alfred Nobel, the inventor of dynamite, in his will...
in 1990 for his work on immunosuppression.
Non-deliberate immunosuppression
Non-deliberate immunosuppression can occur in, for example, malnutritionMalnutrition
Malnutrition is the condition that results from taking an unbalanced diet in which certain nutrients are lacking, in excess , or in the wrong proportions....
, aging, many types of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
(such as leukemia
Leukemia
Leukemia or leukaemia is a type of cancer of the blood or bone marrow characterized by an abnormal increase of immature white blood cells called "blasts". Leukemia is a broad term covering a spectrum of diseases...
, lymphoma
Lymphoma
Lymphoma is a cancer in the lymphatic cells of the immune system. Typically, lymphomas present as a solid tumor of lymphoid cells. Treatment might involve chemotherapy and in some cases radiotherapy and/or bone marrow transplantation, and can be curable depending on the histology, type, and stage...
, multiple myeloma
Multiple myeloma
Multiple myeloma , also known as plasma cell myeloma or Kahler's disease , is a cancer of plasma cells, a type of white blood cell normally responsible for the production of antibodies...
) and certain chronic infections such as acquired immunodeficiency syndrome
AIDS
Acquired immune deficiency syndrome or acquired immunodeficiency syndrome is a disease of the human immune system caused by the human immunodeficiency virus...
(AIDS). The unwanted effect in in non-deliberate immunosuppression is immunodeficiency
Immunodeficiency
Immunodeficiency is a state in which the immune system's ability to fight infectious disease is compromised or entirely absent. Immunodeficiency may also decrease cancer immunosurveillance. Most cases of immunodeficiency are acquired but some people are born with defects in their immune system,...
that results in increased susceptibility to pathogen
Pathogen
A pathogen gignomai "I give birth to") or infectious agent — colloquially, a germ — is a microbe or microorganism such as a virus, bacterium, prion, or fungus that causes disease in its animal or plant host...
s such as bacteria and virus.
Immunodeficiency is also a potential adverse effects of many immunosuppressant drugs. In this sense, the scope of the term immunosuppression generally includes both beneficial and potential adverse effects of decreasing the function of the immune system, while the term immunodeficiency generally refers solely to the adverse effect of increased risk for infection.