Editing Immunosuppression

{{Short description|Decreased resistance to infection}}
{{Infobox interventions |
  Name        = Immunosuppression |
  Image       = Polyomavirus.jpg |
  Caption     = [[Micrograph]] showing an opportunistic infection due to immunosuppression - large (blue) cell below-center-left infected with a [[polyomavirus]]. Urine cytology specimen. |
  ICD10       = D89.9|
  ICD9unlinked = |
  MeshID      = D007165 |
  OPS301      = |
  OtherCodes  = |
}}

'''Immunosuppression''' is a reduction of the activation or [[efficacy]] of the [[immune system]]. Some portions of the immune system itself have immunosuppressive effects on other parts of the immune system, and immunosuppression may occur as an adverse reaction to treatment of other conditions.<ref name="2nih">{{Cite web|url=https://medlineplus.gov/ency/article/000818.htm|title=Immunodeficiency disorders: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2017-05-06}}</ref><ref>{{Cite web|url=https://www.cancer.gov/publications/dictionaries/cancer-terms?cdrid=45727|title=NCI Dictionary of Cancer Terms|website=National Cancer Institute|language=en|access-date=2017-05-06|date=2011-02-02}}</ref>

In general, deliberately induced immunosuppression is performed to prevent the body from [[Transplant rejection|rejecting]] an [[organ transplant]].<ref name="emed1">{{Cite journal|date=2017-01-06|title=Immunosuppression: Overview, History, Drugs|url=http://emedicine.medscape.com/article/432316-overview}}</ref> Additionally, it is used for treating [[graft-versus-host disease]] after a [[bone marrow transplant]], or for the treatment of [[auto-immune disease]]s such as [[systemic lupus erythematosus]], [[rheumatoid arthritis]], [[Sjögren's syndrome]], or [[Crohn's disease]]. This is typically done using medications, but may involve surgery ([[splenectomy]]), [[plasmapheresis]], or radiation. A person who is undergoing immunosuppression, or whose immune system is weak for some other reasons (such as [[chemotherapy]] or [[HIV]]), is said to be ''[[immunocompromised]]''.<ref>{{Cite web|url=https://www.cancer.gov/publications/dictionaries/cancer-terms|title=NCI Dictionary of Cancer Terms|date=2011-02-02|website=National Cancer Institute|language=en|access-date=2019-11-28}}</ref>

==Deliberately induced==
{{further|Immunosuppressive drug}}
[[File:Azathioprine3Dan.gif|thumb|120 px|left|Azathioprine]]
[[File:SEM blood cells.jpg|thumb|White blood cells (and red blood cells)]]
Administration of [[immunosuppressive drug|immunosuppressive medications]] or immunosuppressants is the main method for deliberately inducing immunosuppression; in optimal circumstances, immunosuppressive drugs primarily target hyperactive components of the immune system.<ref>{{Cite journal|last=Wiseman|first=Alexander C.|date=2016-02-05|title=Immunosuppressive Medications|journal=Clinical Journal of the American Society of Nephrology|volume=11|issue=2|pages=332–343|doi=10.2215/CJN.08570814|issn=1555-9041|pmc=4741049|pmid=26170177}}</ref> People in remission from cancer who require immunosuppression are not more likely to experience a recurrence.<ref>{{cite journal|last1=Shelton|first1=Edward|last2=Laharie|first2=David|last3=Scott|first3=Frank I.|last4=Mamtani|first4=Ronac|last5=Lewis|first5=James D.|last6=Colombel|first6=Jean-Frederic|last7=Ananthakrishnan|first7=Ashwin N.|title=Cancer Recurrence Following Immune-Suppressive Therapies in Patients With Immune-Mediated Diseases: A Systematic Review and Meta-analysis|journal=Gastroenterology|date=July 2016|volume=151|issue=1|pages=97–109.e4|doi=10.1053/j.gastro.2016.03.037|pmid=27039969|pmc=4925196}}</ref> Throughout its history, [[radiation therapy]] has been used to decrease the strength of the immune system.<ref>{{Cite book|url=https://books.google.com/books?id=w5bBCwAAQBAJ&q=radiation+therapy+decreases+strength+of+immune+system&pg=PA28|title=Mosby's Guide to Nursing Diagnosis - E-Book|last1=Ladwig|first1=Gail B.|last2=Ackley|first2=Betty J.|last3=Makic|first3=Mary Beth Flynn|date=2016-03-15|publisher=Elsevier Health Sciences|page=28|isbn=9780323390279|language=en}}</ref>  Dr. Joseph Murray of Brigham and Women's Hospital was given the [[Nobel Prize in Physiology or Medicine]] in 1990 for work on immunosuppression.<ref>{{Cite web|url=https://www.nobelprize.org/nobel_prizes/medicine/laureates/1990/murray-facts.html|title=Joseph E. Murray - Facts|website=www.nobelprize.org|access-date=2017-05-12}}</ref>

Immunosuppressive drugs have the potential to cause [[immunodeficiency]], which can increase susceptibility to [[opportunistic infection]] and decrease [[cancer immunosurveillance]].<ref>{{Cite web|url=https://www.cancer.gov/about-cancer/causes-prevention/risk/immunosuppression|title=Immunosuppression|website=National Cancer Institute|language=en|access-date=2017-07-13|date=2015-04-29}}</ref> Immunosuppressants may be prescribed when a normal immune response is undesirable, such as in [[autoimmune diseases]].<ref>{{Cite journal|last=Chandrashekara|first=S.|date=2012|title=The treatment strategies of autoimmune disease may need a different approach from conventional protocol: A review|journal=Indian Journal of Pharmacology|volume=44|issue=6|pages=665–671|doi=10.4103/0253-7613.103235|issn=0253-7613|pmc=3523489|pmid=23248391 |doi-access=free }}</ref>

Steroids were the first class of immunosuppressant drugs identified, though side-effects of early compounds limited their use. The more specific{{Vague|date=March 2021}} [[azathioprine]] was identified in 1960, but it was the discovery of [[ciclosporin]] in 1980 (together with azathioprine) that allowed significant expansion of [[organ transplantation|transplantation]] to less well-matched donor-recipient pairs as well as broad application to  [[lung transplantation]], [[pancreas transplantation]], and [[heart transplantation]].<ref name=emed1/> After an [[organ transplantation]], the body will nearly always reject the new organ(s) due to differences in [[human leukocyte antigen]] between the donor and recipient. As a result, the immune system detects the new tissue as "foreign", and attempts to remove it by attacking it with  [[leukocytes|white blood cells]], resulting in the death of the donated tissue. Immunosuppressants are administered in order to help prevent rejection; however, the body becomes more vulnerable to infections and malignancy during the course of such treatment.<ref>{{Cite web|url=https://medlineplus.gov/ency/article/000815.htm|title=Transplant rejection: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2017-07-14}}</ref><ref>{{Cite journal|date=2017-03-09|title=Immunology of Transplant Rejection: Overview, History, Types of Grafts|url=http://emedicine.medscape.com/article/432209-overview#a7}}</ref><ref>{{Cite journal|last1=Charles A Janeway|first1=Jr|last2=Travers|first2=Paul|last3=Walport|first3=Mark|last4=Shlomchik|first4=Mark J.|date=2001|title=Responses to alloantigens and transplant rejection|publisher=Garland Science |url=https://www.ncbi.nlm.nih.gov/books/NBK27163/|language=en}}</ref>

==Non-deliberate immunosuppression==

[[File:Acute leukemia-ALL.jpg|thumb|260 px|Leukemia]]
{{Further|Immunodeficiency}}
Non-deliberate immunosuppression can occur in, for example, [[ataxia–telangiectasia]], [[complement deficiency|complement deficiencies]], many types of [[cancer]], and certain chronic infections such as [[HIV/AIDS|human immunodeficiency virus]] (HIV). The unwanted effect in non-deliberate immunosuppression is [[immunodeficiency]] that results in increased susceptibility to [[pathogen]]s, such as bacteria and viruses.<ref name=2nih/>

Immunodeficiency is also a potential adverse effect of many [[immunosuppressant drug]]s, 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.<ref>{{Cite journal|last1=Lallana|first1=Enrico C|last2=Fadul|first2=Camilo E|date=2011|title=Toxicities of Immunosuppressive Treatment of Autoimmune Neurologic Diseases|journal=Current Neuropharmacology|volume=9|issue=3|pages=468–477|doi=10.2174/157015911796557939|issn=1570-159X|pmc=3151601|pmid=22379461}}</ref>

[[B cell]] deficiency and [[T cell]] deficiency are immune impairment that individuals are born with or are acquired, which in turn can lead to immunodeficiency problems.<ref>{{Cite web|url=https://patient.info/doctor/immunodeficiency-primary-and-secondary|title=Immunodeficiency (Primary and Secondary). Information.|website=patient.info|language=en-GB|access-date=2017-07-13}}</ref> [[Nezelof syndrome]] is an example of an immunodeficiency of T-cells.<ref>{{cite book|last1=Disorders|first1=National Organization for Rare|title=NORD Guide to Rare Disorders|date=2003|publisher=Lippincott Williams & Wilkins|isbn=9780781730631|page=408|url=https://books.google.com/books?id=99YPDvFWBB0C&q=Nezelof+syndrome&pg=PA408|access-date=2 June 2017|language=en}}</ref>

==See also==
{{columns-list|colwidth=30em|
* [[Immunosuppressive drug]]
* [[Discovery and development of mTOR inhibitors]]
* [[BK virus]]
* [[Interleukin-2 immunotherapy]]
* [[B cell deficiency]]
* [[T cell deficiency]]
* [[Transplant rejection#Rejection treatment|Treatment methods for preventing organ rejection]]
}}

==References==
{{Reflist|32em}}

==Further reading==
* {{Cite book|url=https://books.google.com/books?id=ncwHBgAAQBAJ&q=immunosuppression|title=Immune Rebalancing: The Future of Immunosuppression|last1=Boraschi|first1=Diana|last2=Penton-Rol|first2=Giselle|date=2016-01-25|publisher=Academic Press|isbn=9780128033364|language=en}}Retrieved 6 May 2017.
* {{cite book|last1=Thomson|first1=A. W.|title=Therapeutic Immunosuppression|date=2001|publisher=Springer Science & Business Media|isbn=9789401007658|url=https://books.google.com/books?id=wXXvCAAAQBAJ&q=immunosuppression&pg=PA301|access-date=6 May 2017|language=en}}

==External links==
* [https://www.ncbi.nlm.nih.gov/pubmed/ PubMed]

{{Medicine|state=collapsed}}
{{Authority control}}

[[Category:Immune system]]
[[Category:Immunology]]
[[Category:Medical treatments]]

[[it:Immunodepressione]]