GROUP MEMBERS:

❑ Hira Shaheen
❑ Minahil Afzal
❑ Mahrukh Riaz
❑ Amina Rehman
❑ Nimra Ateeq
❑ Amina Zulfiqar
❑ M. Muneeb
❑ Zarrar Zafar
IMMUNO-MODULATING Pharmacology

Agents From Group: 02

TABLE OF CONTENT:
❑ Overview of the immune system
❑ Introduction
❑ Types of immuno-modulating agents
❑ Immuno-stimulants
❑ Immuno-supressants
❑ Therapeutic applications
❑ Advantages of immuno-modulating agents
❑ Challenges of immuno-modulating agents
❑ Immuno-modulating agents and cancer
❑ Immuno-modulating agents and rheumatoid cancer
❑ Future directions
❑ Conclusion
Overview of Immune System:
The immune system is a complex network of organs, cells
and proteins that defends the body against infection.
❑ The body's ability to prevent the invasion of pathogens is
called Immunity.
❑ Pathogens are foreign disease-causing substances, such as
bacteria and viruses
Introduction to
IMMUNO-MODULATING Agents:
Immunomodulating agents are also known as Immuno-modulators or Immuno-
modulatory drugs.
These agents are substances that can either enhance or suppress the immune response
in the body.
They are used to treat various immune-related disorders, such as autoimmune
diseases and conditions involving excessive or deficient immune responses.
Types of Agents:
Immunomodulating agents can include:
Immuno-suppressants: These agents dampen or suppress the immune response.
Immuno-stimulants: These agents enhance the immune response by boosting the activity
of specific immune cells or increasing the production of immune system components.
Biological Response Modifiers (BRMS): These are substances that modify the body's
natural immune response. They can stimulate or suppress immune activities as needed.
BRMS include cytokines, growth factors, and certain monoclonal antibodies.
Disease-modifying Antirheumatic Drugs (DMARDS): These drugs are used specifically
for autoimmune disorders like rheumatoid arthritis. They work by altering the course of the
disease and by modulating the immune response.
Monoclonal Antibodies: These are highly targeted antibodies that can be designed to
interact with specific molecules involved in the immune response. They can be used to
block or enhance immune activity as needed for various therapeutic purposes.
IMMUNO-STIMULANTS:
Immunostimulants are substances that enhance the immune system's response to
infections or diseases.
They work by activating various components of the immune system, such as immune
cells and signaling molecules, to better defend the body against pathogens and
abnormal cells (like cancer cells).
Immunostimulants can be
❖ Naturally occurring compounds,
❖ Synthetic molecules,

❖ Or even biological products etc.

BCG:
Clinical Use:
Bacille Calmette-Guérin (BCG, TheraCys, others) is an active bacterial strain that can be
administered systemically as a vaccine against tuberculosis.
This agent may also stimulate immune function and can be administered locally within the
bladder (intravascularly) to treat certain forms of superficial bladder cancer.
Mechanism of Action:
The exact reason that this agent is effective in treating cancer is unknown. Some evidence
suggests that it may activate macrophages locally at the site of the cancer and that these
macrophages engulf and destroy tumor cells.
Adverse Effects:
Systemic administration can cause dermatologic reactions (peeling or scaling of the skin),
allergic reactions, inflammation of lymph nodes, and local irritation or ulceration at the
injection site.
Immune Globulin:
Clinical Use: Immune globulin (gamimune, or gammagard, etc.) is prepared by extracting
immunoglobulins from donated human blood.
Immune globulin is administered intravenously to boost immune function in several conditions,
including primary immunodeficiency syndromes (congenital agammaglobulinemia, common
variable immunodeficiency, and severe combined immunodeficiency.
Mechanism of Action:
Commercial preparations of immune globulin mimic the normal role of endogenous
immunoglobulins. These preparations therefore directly act as antibodies against infectious
agents. They can also help modulate the activity of T lymphocytes, macrophages, and other
immune system cells to maintain immune system competence.
Adverse Effects:
Immune globulin may cause several side effects, such as joint and muscle pain, headache, general
malaise, and gastrointestinal disturbances (nausea, vomiting).
LEVAMISOLE :
Clinical Use: Levamisole (Ergamisol) is primarily used to treat
colorectal carcinoma. Specifically, this drug is administered with
fluorouracil (see Chapter 36) to prevent recurrence of colorectal
cancer after surgical removal of the primary tumor.
Mechanism of Action: Although the exact effects are not known,
levamisole may augment immune function by activating
macrophages and immune cells that selectively engulf and destroy
any residual cancerous cells.
Adverse Effects:
Levamisole may cause blood disorders such as agranulocytosis,
leukopenia, or thrombocytopenia.
Other side effects include nausea, diarrhea, and a metallic taste in the
mouth.
Immuno-Suppressants:
Immunosuppressants are a class of drugs that suppress or weaken the
immune system's response.
They are commonly used in medical treatments to prevent the immune
system from attacking healthy cells and tissues.
Especially in cases where the immune system's overactivity can lead to
harmful consequences, such as in autoimmune diseases or organ
transplantation.
AZATHIOPRINE:
Clinical use:
Azathioprine is primarily used to prevent the rejection of transplanted organs,
especially in patients with kidney transplants. Azathioprine may also be used to
suppress immune responses in a wide range of other conditions, such as systemic
lupus erythematosus, dermatomyositis, inflammatory myopathy, hepatic disease,
myasthenia gravis, and ulcerative colitis.

Adverse effects:
The primary side effects of azathioprine are related to suppression of bone marrow
function, including leukopenia, megaloblastic anemia, and similar blood
dyscrasias.
Other side effects include skin rash and gastrointestinal distress (appetite loss,
nausea, vomiting); hepatic dysfunction can also occur when higher doses are used.
Mechanism of action:
Although the exact mechanism of azathioprine is unknown, this drug probably
interferes with DNA synthesis in cells mediating the immune response. Azathioprine
appears to act like the antimetabolite drugs used in cancer chemotherapy
Cyclo-Phosphamide:
Clinical Use:
Cyclophosphamide (Cytoxan, Neosar) is an anticancer alkylating agent that is commonly used
in a variety of neoplastic disorders. This drug may also be helpful in suppressing the immune
response in certain autoimmune diseases, such as multiple sclerosis, systemic lupus
erythematosus, and rheumatoid arthritis.
Mechanism of Action:
This drug causes the formation of strong cross-links between strands of DNA and RNA, thus
inhibiting DNA/RNA replication and function.
Cyclophosphamide probably exerts immunosuppressant effects in a similar manner; that is,
this drug inhibits DNA and RNA function in lymphocytes and other key cells, thus limiting the
rapid proliferation of these cells during the immune response.
Adverse Effect:
Side effects include hematologic disorders (leukopenia, thrombocytopenia), cardiotoxicity,
nephrotoxicity, and pulmonary toxicity.
Metho-Trexate:
Clinical Use:
Methotrexate (Folex, Rheumatrex) was originally developed
as an anticancer agent, but this drug is also used
occasionally in certain noncancerous conditions that have an
autoimmune component. Methotrexate is also approved for
use in psoriasis.
Mechanism of Action:
This drug acts as an antimetabolite that interferes with the
production of DNA and RNA precursors in rapidly
proliferating cells. This interference produces a general
inhibition of the replication of lymphocytes inherent in the
immune response.
Adverse Effects: The major problems associated with
methotrexate include hepatic and pulmonary toxicity.
SULFA-SALAZINE:
Clinical Use: Sulfasalazine (Azulfidine, other names) Has unique properties, this drug is
primarily used to suppress the immune response associated with rheumatoid arthritis and
inflammatory bowel disease.
Mechanism of Action:
The exact mechanism of this drug in immune-related disorders is not fully understood.
Sulfasalazine may affect key components in the immune system, including suppression of NK
cells.
Adverse Effects:
Primary side effects include:
❖ Headache, Blood Dyscrasias
❖ Increased Sensitivity To Ultraviolet Light,
❖ Hypersensitivity Reactions (Fever, Skin Rash, Itching).
Hypersensitivity Can Be Severe Or Even Fatal In Susceptible Individuals.
THERAPEUTIC APPLICATIONS:
❖ Suppress overactive immune responses in autoimmune diseases (e.g., Rheumatoid
arthritis, lupus, multiple sclerosis).
❖ Manage chronic inflammation in conditions like inflammatory bowel disease (ibd) and
psoriasis.
❖ Activate the immune system to target and destroy cancer cells.
❖ Prevent organ rejection by modulating the immune response.
❖ Manage allergic reactions and hypersensitivity responses.
❖ Stimulate immune system to generate strong and lasting immunity.
❖ Regulate immune response during certain infections
ADVANTAGES of
Immuno-modulating Agents:
Immunomodulating agents offer a range of advantages over
traditional treatments:
❑ They can be more targeted and effective
❑ They work by modifying the immune system's response to
specific diseases or conditions. This means that they can
often be used in lower doses than traditional treatments,
reducing the risk of side effects.
❑ In addition, immunomodulating agents can be used in
combination with other treatments to enhance their
effectiveness. This makes them a valuable tool in the fight
against cancer and other diseases.
CHALLENGES of
Immunomodulating Agents:
❑ Overactivation of the immune system
❑ Suppression of immune responses
❑ One of the main concerns is the potential for side effects and risks associated
with altering the immune system. These can range from mild reactions like
fever and fatigue to more serious complications like infections and
autoimmune disorders.
❑ Thereis the issue of cost and accessibility, as these treatments can be
expensive and may not be available to all patients.
Immuno-Modulating Agents
and CANCER:
Immunomodulating agents are becoming an increasingly important tool in the fight against cancer.
These agents work by stimulating or suppressing the immune system to help it better target cancer
cells.
One example of an immunomodulating agent used in cancer treatment is Checkpoint Inhibitors,
which block certain molecules that prevent the immune system from attacking cancer cells. By
blocking these molecules, checkpoint inhibitors can help the immune system recognize and attack
cancer cells more effectively.

Second, Monoclonal Antibodies are designed to target specific proteins on cancer cells, making
them more visible to the immune system. Once the immune system recognizes the cancer cells, it
can mount a targeted attack to destroy them. Monoclonal antibodies can also be used to deliver
chemotherapy drugs directly to cancer cells, reducing damage to healthy cells.
Immunomodulating Agents
and RHEUMATOID ARTHRITIS:
❑ Rheumatoid arthritis is a chronic autoimmune disorder that causes inflammation
and pain in the joints.
❑ Immunomodulating agents are used to treat this condition by suppressing the
immune system's attack on the joints.
❑ One example of an immunomodulating agent used in the treatment of rheumatoid
arthritis is methotrexate. This drug works by inhibiting the production of cells that
cause inflammation, thereby reducing joint damage and pain.
FUTURE of
Immuno-Modulating Agents:
❖ The potential applications of immunomodulating agents in
medical treatments are vast and exciting.
❖ One area of particular interest is their use in combination with
other therapies, such as chemotherapy, to enhance their
effectiveness.
❖ Another area of focus is the development of more targeted
immunomodulating agents that can selectively target specific cells
or pathways in the immune system. This could lead to more
effective treatments with fewer side effects for patients.
CONCLUSION:
In conclusion, immunomodulating agents are a critical component of medical treatments for a
variety of conditions.
By regulating the immune system, these agents can effectively treat autoimmune diseases,
cancer, infectious diseases, and more.
They offer advantages over traditional treatments, such as greater specificity and effectiveness.
Ongoing research and development in the field may lead to even more applications for these
agents in medical treatments. It is clear that the importance of immunomodulating agents
cannot be overstated, and they will continue to play a crucial role in improving patient
outcomes.
ANY QUESTION…?????
THANKS