Immunosuppression

In the Immunosuppression unwanted defense reactions of the body's own immune system are inhibited or suppressed. This procedure is particularly indicated for patients with transplants and autoimmune diseases, since the immune system of such patients could otherwise damage the body's own tissue. Immunosuppression is associated with risks such as increased susceptibility to infections and side effects such as nausea.

What is immunosuppression?

Immunology deals with the biological and biochemical basics of the body's defense system. Pathogens such as bacteria and viruses as well as other exogenous substances and environmental toxins initiate immune responses, for example. In the event of various disorders and malfunctions of the defense mechanisms, the detection and inactivation of exogenous substances by the immune system no longer runs smoothly.

The human immune system plays a central role in numerous diseases. All immune system disorders are therefore also the subject of immunology. The same applies to therapeutic approaches with an immunological basis. One such approach is immunosuppression. This is the therapeutic suppression of all immune processes. Immunosuppressants are used to inactivate immunologically undesirable and misdirected processes and have proven to be an integral part of therapy in various indications. Interferon is one of the best-known immunosuppressants. The modes of action of immunosuppressive drugs are divided into extracellular and intracellular effects.

Function, effect & goals

In immunosuppression, an external intervention inhibits or suppresses the immune reaction in an unphysiological way. Therapeutic immunosuppression can take place at different levels. Interventions in the synthesis or signaling pathways of the immune system are common to all levels. One possibility for such an intervention is to inhibit or destroy immune stem cells in the bone marrow.

Apart from that, protein synthesis in the immunocompetent cells can be inhibited by immunosuppression. Immunocompetent cells produce antibodies. Their inhibition thus results in reduced antibody production, which has the effect of immunological weakening. In addition, the interleukin-mediated signaling pathways in the immunological lymphocytes can be interrupted or blocked as part of immunosuppression. This influences the regulation of the immune system from the outside and can be adapted to the individual case. Different conditions are an indication for immunosuppressive treatment. As a rule, immunosuppressants are always used when immunological processes would cause damage to an organism. This is the case with transplants, for example.

If the immune system recognizes the transplanted organ or tissue as foreign, it attacks the foreign substance and thus initiates a rejection reaction. Since the standard introduction of pre-transplant immunosuppression, the risks of rejection reactions have decreased significantly. Immunosuppression plays an equally relevant role for patients with autoimmune diseases. Autoimmune diseases are diseases with excessive reactions of the immune system, which are directed against the body's own tissue instead of against pathogens.

The patient's immune system recognizes the tissue of their own body as a foreign body to be combated and causes severe inflammatory reactions in the affected structures. Organ damage can be the result, in the case of multiple sclerosis, for example, irreversible damage and thus loss of function of the brain. Patients with allergies are also often given permanent immunosuppressants. Allergies are hypersensitivities of the immune system, which can be suppressed or at least weakened by immunosuppressive therapies.

As a rule, immunosuppression in allergy and autoimmune patients takes the form of long-term drug prophylactic treatment. While transplants, allergies and autoimmune diseases represent a medical indication for therapeutic immunosuppression, the body can also involuntarily be affected by immunosuppression. Pathological immunosuppression is known to exist in diseases such as HIV. The result is an immunodeficiency. A weakening of the immune system can also be observed in the immunosuppressive effect of UV-B rays.

Excessive UVB exposure of the skin therefore promotes the development of malignant skin tumors and reduces the defense against pathogens such as fungi and bacteria. In addition, physical and psychological overload lead to a suppression of various immune parameters. This immunosuppressive effect is known to lead to susceptibility to infections in overload situations.

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Risks, side effects & dangers

Therapeutic immunosuppression is associated with significant risks and side effects. This is especially true for oral immunosuppressants, which do not act locally but rather develop their effect throughout the body. The targeted suppression of individual parameters has so far been impossible. Therefore, immunosuppression dampens the immune system as a whole.

As a result, the body is less protected from both infection and cancer cells. A common side effect of immunosuppression is mucositis, an inflammation of the mucous membranes. Often times, this reaction occurs with chemotherapy or radiation therapy, in which case it is known as radiogenic mucositis. The inflammatory response can spread throughout the digestive tract. In immunosuppressed patients and patients with autoimmune diseases, the inflammation of the mucous membranes usually corresponds to an infection with various pathogens. The patient's weakened immune system is particularly susceptible to pathogens such as fungi, viruses or bacteria. These pathogens cause inflammation of the mucous membranes, which the doctor knows from patients with poor general and nutritional status, elderly patients or HIV patients.

Some immunosuppressants are also associated with side effects such as blood pressure disorders, blood sugar abnormalities, and high cholesterol. In addition to the kidneys and nerves, many of the drugs put a strain on the liver, cause nausea and even vomiting, or damage the gastrointestinal tract. Depending on the active ingredient, fatigue, depression and states of confusion can also occur. In detail, the risks and side effects of immunosuppressive therapy depend heavily on the drug in question and the dose administered. Because of the numerous risks and side effects, the advantages and disadvantages of immunosuppressive therapy must be weighed individually for each patient. Treatment is indicated only when the benefits clearly outweigh the benefits.