Immunosuppression

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Immunosuppression
Intervention

Micrograph showing an opportunistic infection due to

immunosuppression - large (blue) cell below-centerleft infected with a polyomavirus. Urine cytology
specimen.
MeSH
D007165
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.
In general, deliberately induced immunosuppression is performed to prevent the body from rejecting an organ
transplant, treating graft-versus-host disease after a bone marrow transplant, or for the treatment of autoimmune 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 and HIV), is said to be immunocompromised. An immunosuppressant is any agent
that causes immunosuppression, including immunosuppressive drugs and some environmental toxins.

Contents

1 Deliberately induced
2 Non-deliberate immunosuppression
3 See also
4 References

Deliberately induced
Further information: Immunosuppressive drug
Administration of immunosuppressive drugs or immunosuppressants is the main method of deliberately
induced immunosuppression. In optimal circumstances, immunosuppressive drugs are targeted only at any
hyperactive component of the immune system, and in ideal circumstances would not cause any significant
immunodeficiency. However, in essence, all immunosuppressive drugs have the potential to cause
immunodeficiency. Immunodeficiency may manifest as increased susceptibility to opportunistic infections and
decreased cancer immunosurveillance. The term immunotoxin is also sometimes used (incorrectly) to label

undesirable immunosuppressants, such as various pollutants. Polychlorinated biphenyls (PCB) and the
insecticide DDT are immunosuppressants.[citation needed] Immunosuppressants may be prescribed when a normal
immune response is undesirable, such as in autoimmune diseases.
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.
After an organ transplantation, the body will nearly always reject the new organ(s) due to differences in human
leukocyte antigen haplotypes between the donor and recipient. As a result, the immune system detects the new
tissue as "hostile", and attempts to remove it by attacking it with recipient leukocytes, resulting in the death of
the tissue. Immunosuppressants are applied as a countermeasure; the side-effect is that the body becomes more
vulnerable to infections and malignancy, much like in an advanced HIV infection.
Throughout its history, radiation therapy has been 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 19721985 was awarded the Nobel Prize in Physiology or Medicine in 1990 for his work on immunosuppression.

Non-deliberate immunosuppression
Further information: Immunodeficiency
Non-deliberate immunosuppression can occur in, for example, malnutrition, aging, many types of cancer (such
as leukemia, lymphoma, multiple myeloma), and certain chronic infections such as Human Immunodeficiency
virus (HIV).[1] The unwanted effect in non-deliberate immunosuppression is immunodeficiency that results in
increased susceptibility to pathogens 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 in general includes both beneficial and potential adverse effects of
decreasing the function of the immune system, whereas the term immunodeficiency in general refers solely to
the adverse effect of increased risk for infection.