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Major classes of agents employed in immunosuppressive therapy: Corticosteroids Cytotoxic Agents T-cell suppressive agents Antibodies Mechanism of action: Cytotoxic Agents- suppress bone marrow function 1. Cyclophosphamide: a. Primarily suppresses B-cell production; lowers humoral immunity b. Used to treat severe rheumatoid arthritis c. Not normally used for graft rejection 2. Azathioprine a. Primarily suppresses T-cell production b. Used for graft rejection c. Normally used in combination with corticosteroids 3. Mycophenolate Mofetil (CELLCEPT) a. Mechanism of action: inhibits inosine monophosphate dehydrogenase; an enzyme required for de novo purine synthesis b. Selective because T and B cells rely on de novo pathway c. Suppresses lymphocyte proliferation and B-cell antibody production d. Can be used to inhibit transplant rejection T-Cell Suppressor Agents 1. Cyclosporine and Tacrolimus a. Mechanism of action: block proliferative response of T-cells to antigen by inhibiting calcineuri...

Infliximab is a chimeric IgG 1K monoclonal antibody. Its approximate molecular weight is 149,100 daltons. It is composed of human constant and murine variable regions. Infliximab binds specifically to human TNF-α. Biological effects of infliximab TNF-α induces proinflammatory cytokines that include IL-1 and IL-6. These cytokines enhance leukocyte migration by increasing endothelial layer permeability and expression of adhesion molecules by endothelial cells and leukocytes, activation of neutrophil and eosinophil functional activity, and induction of acute phase and other liver proteins. Infliximab neutralizes the biological activity of TNF-α by binding with high affinity to the soluble and transmembrane forms of TNF-α and inhibits binding of TNF-α with its receptors. A related cytokine that utilizes the same receptors as TNF-α, TNF-beta (lymphotoxin α) is not neutralized by infliximab. It has been found to downregulate IL-18 but not IL-12 and IL-13. It upregulates the expression of CX...