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The experimental and clinical use of immune-modulating drugs in the prophylaxis and treatment of infections

Die experimentelle und klinische Anwendung immunmodulierender Substanzen in der Prophylaxe und Therapie von Infektionen

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Summary

Therapeutic agents capable of stimulating immune responses could be of great value in the prophylaxis and treatment of infectious diseases. Three classes of compounds, each representing a separate approach to the goal of immune stimulation, are discussed with respect to recent experimental and clinical findings. The action of microbial structures and their derivatives can be understood on the basis of “acquired cellular immunity”, a phenomenon first described in connection with infections by mycobacteria and other intracellular organisms. In contrast, there is hardly a common denominator for synthetic compounds which are currently used as immune-stimulatory agents. Substances which influence purine metabolism in lymphocytes on the one hand and histamine H2 blockers such as cimetidine on the other hand seem to represent the most promising developments in this field to date. Products of immune cells such as transfer factor and lymphokines form the third and possibly most important group of immune-stimulating agents. Current experimental and clinical trends in this field are briefly described. It is suggested that the delineation of the mechanism of action of lymphokines will open the door to the identification or synthesis of artificial agonists and antagonists as has been the case in the pharmacology of the endocrine and nervous systems.

Zusammenfassung

Die Verfügbarkeit von Substanzen mit immunstimulierenden Eigenschaften hätte für die Therapie und Prophylaxe von Infektionskrankheiten erhebliche potentielle Bedeutung. In der vorliegenden Arbeit wird ein Überblick über den derzeitigen Stand experimenteller und klinischer Arbeiten auf dem Gebiet der Immunstimulation gegeben. Dabei werden drei prinzipiell voneinander verschiedene Ansätze zur Erreichung des Ziels Immunstimulation beschrieben. Jeder dieser Ansätze ist durch eine Reihe von Substanzen repräsentiert. Die Wirkungsweise mikrobieller Inhaltstoffe oder von ihnen abgeleiteter Derivate kann auf den gemeinsamen Nenner der „erworbenen zellulären Immunität” zurückgeführt werden. Dieses Phänomen wurde zunächst im Zusammenhang mit Infektionen durch Mykobakterien und andere intrazelluläre Erreger beschrieben. Im Gegensatz dazu läßt sich für die verschiedenen Synthetika, die heute als Immunstimulantien Verwendung finden, kaum eine gemeinsame mechanistische Grundlage nennen. Die interessantesten Entwicklungen auf diesem Gebiet betreffen zwei Gruppen von Verbindungen: einerseits Substanzen, die den Purinstoffwechsel in Lymphozyten beeinflussen, und andererseits Medikamente, die Histamin H2-Rezeptoren blockieren, wie zum Beispiel Cimitidin. Produkte von Immunzellen, wie Transferfaktor und Lymphokine, bilden die dritte und vielleicht wichtigste Gruppe immunstimulierender Agenzien. Wichtig gegenwärtig zu beobachtende Entwicklungen auf diesem Gebiet werden kurz geschildert. Die Aufklärung der immunologischen und biochemischen Wirkunksmechanismen der Lymphokine wird die Bemühungen zur Herstellung immunstimulierender Verbindungen auf eine neue Grundlage stellen. In Analogie zur Entwicklung der Pharmakologie des zentralen Nervensystems und des endokrinen Systems wäre auch im Bereich der Immunologie von der Synthese künstlicher Agonisten und Antagonisten der Lymphokine viel für die Therapie der Infektionskrankheiten zu erwarten.

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Drews, J. The experimental and clinical use of immune-modulating drugs in the prophylaxis and treatment of infections. Infection 13 (Suppl 2), S241–S250 (1985). https://doi.org/10.1007/BF01644438

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