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 The word immunity is derived from the Latin word ‘immunes’ which means exempt
from.
 Immunity is usually defined as a state of relative resistance to an infection
 Substances that are capable of stimulating immune mechanism are called as
antigens
 The oral cavity is a universe of various multiple diseases, which may be
developmental, infective, inflammatory and immunological etc .
 Immunology plays a very important role in homeostasis but it possesses two edge
sword actions. Either hypo or hyperimmunity both can cause systemic diseases
which will manifest in the oral cavity.
 Immunomodulators are the agents which modulate the body immunity according to
the need.
 There are natural and synthetic immunomodulatory agents .
Immunomodulators are natural or synthetic
substances that help to regulate or normalize
the immune system.
Immunomodulators modulate the immune
reaction and decrement inflammatory replication
All drugs which modify immune response generally categorized
as immunomodulators. These can either function as:
1.Immunosuppressants
2.Immunostimulants.
Some of these can have both the properties depending on which
component of immune response they affect.
There is also an
upcoming generation of immunosuppressants called tolerogens.
IMMUNOMODULATORS
IMMUNOSUPPRESSION IMMUNE TOLERANCE IMMUNOSTIMULANTS
Role of Immunomodulators
IMMUNOSUPPRESSANTS
GLUCOCORTICOIDS CALCINEURIN INHIBITORS
ANTIPROLIFERATIVE/
ANTI METABOLITES
BIOLOGICALS (ANTIBODIES)
a) Glucocorticoids
Glucocorticoids have broad anti-inflammatory effects
on multiple components of cellullar immunity.
Mechanism of action
To effect long term responses, steroids bind to receptors inside cells; either
these receptors, glucocorticoid-induced proteins, or interacting proteins
regulate the transcription of numerous other genes
Therapeutic uses
•Acute transplant rejection,
•Graft-versus-host disease in bonemarrow
transplantation
•Rheumatoid and other arthritides
•Systemic lupus erythematosus
•Systemic dermatomyositis
•Psoriasis and other skin conditions,
•Asthma and other allergic disorders,
•Inflammatory bowel disease,
•Inflammatory ophthalmic diseases.
Oral Indications
• Oral Lichen Planus,
• Oral submucous fibrosis,
• Aphthous stomatitis,
• Pemphigus,
• Pemphigoid,
• Erythema multiforme,
• Epidermolysis bullosa,
• Behcet’s Disease,
• Orofacial Granulomatosis,
• Sjogren syndrome.
Adverse effects
a) Side effects of systemic steroids:
•Cushing's habitus,
•Osteoporosis
•Growth retardation: in children
•Hyperglycemia
•May be glycosuria
•precipitation of diabetes
•Glaucoma
•Posterior Subcapsular cataract may also develop after long term use for several years, especially in
children
•Suppression of HPA axis- acute adrenal insufficiency,
•Psychiatric disturbances
•Peptic ulceration
•Delayed healing: of wounds and surgical incisions
•Susceptibility to infection
•Fragile skin
•Purple striae
•Muscular weakness.
b) Side effects of topical steroids
i) Local adverse effects of topical steroids
• Thinning of epidermis
• Dermal changes- Atrophy
• Telangiectasia
• Striae
• Easy bruising
• Hypopigmentation
• Delayed wound healing
• Fungal & bacterial infections
• Candidal infection (25-55%)
• Burning mouth
• Hypogeusia.
ii) Systemic side effects of topical steroids-
• Adrenal pituitary suppression– large amounts applied repeatedly.
A. Tacrolimus
B. Cyclosporine
a) Tacrolimus
Tacrolimus is a macrolide antibiotic produced by Streptomyces
tsukubaensis
Use
Prophylaxis of solid- organ allograft rejection.
Adverse drug reactions
• Nephrotoxixity
• Neurotoxixity
• GI complaints
• Hypertension
• Hyperkalemia
• Hyperglycemia and diabetes
Role of Immunomodulators
a) Levamisole
Levamisole a heterocyclic compound was
synthesized originally as an anthelmintic, but
appears to restore depressed immune function
of B lymphocytes, T lymphocytes, monocytes
and macrophages.
Adverse effects
• Flu-like symptoms
• GI disturbances
• Headache
• Dizziness
• Insomnia
• Thrombocytopenia
• Granulocytopenia
• Allergic manifestation
• Muscle pain.
b) Thalidomide
• Thalidomide was first marketed in West Germany in the year 1957 with the
trade-name Contergan.
• A German drug company named Chemie Grunenthal developed and
prescribed as a sedative or hypnotic and antiemetic for the treatment of
morning sickness.
• But now due to its immunomodulatory action it is used for a number of
conditions including: ,multiple myeloma, erythema nodosum leprosum and
a number of other cancers, Crohn's disease, sarcoidosis, graft-versus-host
disease , rheumatoid arthritis, & for some symptoms of HIV/AIDS.
e) Bacillus Calmette-Guerin (BCG)
• Live bacillus Calmette-Guerin (BCG) is an attenuated, live culture of the bacillus
of Calmette and Guerin strain of Mycobacterium bovis.
• The cytotoxic effect of BCG could result from the direct action of the CD4 cells
or from the cytotoxic effect of the released cytokines and the activation of other
cytotoxic cells [cytolytic T-lymphocytes, macrophages, natural killer or
lymphokine-activated killer cells].
Dosage
• Intralesional injection of 0.5 ml BCG-PSN every other day for 2 weeks can be
administered in cases of erosive lichen planus
Role of Immunomodulators

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Role of Immunomodulators

  • 1.  The word immunity is derived from the Latin word ‘immunes’ which means exempt from.  Immunity is usually defined as a state of relative resistance to an infection  Substances that are capable of stimulating immune mechanism are called as antigens  The oral cavity is a universe of various multiple diseases, which may be developmental, infective, inflammatory and immunological etc .  Immunology plays a very important role in homeostasis but it possesses two edge sword actions. Either hypo or hyperimmunity both can cause systemic diseases which will manifest in the oral cavity.  Immunomodulators are the agents which modulate the body immunity according to the need.  There are natural and synthetic immunomodulatory agents .
  • 2. Immunomodulators are natural or synthetic substances that help to regulate or normalize the immune system. Immunomodulators modulate the immune reaction and decrement inflammatory replication
  • 3. All drugs which modify immune response generally categorized as immunomodulators. These can either function as: 1.Immunosuppressants 2.Immunostimulants. Some of these can have both the properties depending on which component of immune response they affect. There is also an upcoming generation of immunosuppressants called tolerogens.
  • 7. a) Glucocorticoids Glucocorticoids have broad anti-inflammatory effects on multiple components of cellullar immunity. Mechanism of action To effect long term responses, steroids bind to receptors inside cells; either these receptors, glucocorticoid-induced proteins, or interacting proteins regulate the transcription of numerous other genes
  • 8. Therapeutic uses •Acute transplant rejection, •Graft-versus-host disease in bonemarrow transplantation •Rheumatoid and other arthritides •Systemic lupus erythematosus •Systemic dermatomyositis •Psoriasis and other skin conditions, •Asthma and other allergic disorders, •Inflammatory bowel disease, •Inflammatory ophthalmic diseases.
  • 9. Oral Indications • Oral Lichen Planus, • Oral submucous fibrosis, • Aphthous stomatitis, • Pemphigus, • Pemphigoid, • Erythema multiforme, • Epidermolysis bullosa, • Behcet’s Disease, • Orofacial Granulomatosis, • Sjogren syndrome.
  • 10. Adverse effects a) Side effects of systemic steroids: •Cushing's habitus, •Osteoporosis •Growth retardation: in children •Hyperglycemia •May be glycosuria •precipitation of diabetes •Glaucoma •Posterior Subcapsular cataract may also develop after long term use for several years, especially in children •Suppression of HPA axis- acute adrenal insufficiency, •Psychiatric disturbances •Peptic ulceration •Delayed healing: of wounds and surgical incisions •Susceptibility to infection •Fragile skin •Purple striae •Muscular weakness.
  • 11. b) Side effects of topical steroids i) Local adverse effects of topical steroids • Thinning of epidermis • Dermal changes- Atrophy • Telangiectasia • Striae • Easy bruising • Hypopigmentation • Delayed wound healing • Fungal & bacterial infections • Candidal infection (25-55%) • Burning mouth • Hypogeusia. ii) Systemic side effects of topical steroids- • Adrenal pituitary suppression– large amounts applied repeatedly.
  • 12. A. Tacrolimus B. Cyclosporine a) Tacrolimus Tacrolimus is a macrolide antibiotic produced by Streptomyces tsukubaensis Use Prophylaxis of solid- organ allograft rejection.
  • 13. Adverse drug reactions • Nephrotoxixity • Neurotoxixity • GI complaints • Hypertension • Hyperkalemia • Hyperglycemia and diabetes
  • 15. a) Levamisole Levamisole a heterocyclic compound was synthesized originally as an anthelmintic, but appears to restore depressed immune function of B lymphocytes, T lymphocytes, monocytes and macrophages.
  • 16. Adverse effects • Flu-like symptoms • GI disturbances • Headache • Dizziness • Insomnia • Thrombocytopenia • Granulocytopenia • Allergic manifestation • Muscle pain.
  • 17. b) Thalidomide • Thalidomide was first marketed in West Germany in the year 1957 with the trade-name Contergan. • A German drug company named Chemie Grunenthal developed and prescribed as a sedative or hypnotic and antiemetic for the treatment of morning sickness. • But now due to its immunomodulatory action it is used for a number of conditions including: ,multiple myeloma, erythema nodosum leprosum and a number of other cancers, Crohn's disease, sarcoidosis, graft-versus-host disease , rheumatoid arthritis, & for some symptoms of HIV/AIDS.
  • 18. e) Bacillus Calmette-Guerin (BCG) • Live bacillus Calmette-Guerin (BCG) is an attenuated, live culture of the bacillus of Calmette and Guerin strain of Mycobacterium bovis. • The cytotoxic effect of BCG could result from the direct action of the CD4 cells or from the cytotoxic effect of the released cytokines and the activation of other cytotoxic cells [cytolytic T-lymphocytes, macrophages, natural killer or lymphokine-activated killer cells]. Dosage • Intralesional injection of 0.5 ml BCG-PSN every other day for 2 weeks can be administered in cases of erosive lichen planus