Administration of the hematopoietic stem and progenitor cells in the secondary immunodeficiencies.
Professor Vladimir V. Tsurko
Immunodeficiency (ID) is a genetic and/or laboratory sign of the deficiency of the component of immune system with or without clinical manifestations. It can be a primary or secondary manifestation of the damaged immunity as a complex of the protection factors of the body from foreign microorganisms. When the functional activity of the protection factors reduces, the state of ID develops. Accordingly, the ID is qualified as the primary or secondary depending on the initial cause.
Secondary immunodeficiency is an acquired condition when the local and systemic immunity reduce under the influence of the environment or internal factors. The regeneration of the immune system is depressed or absent. The secondary hypoimmune conditions can emerge anytime in anyone. The most typical manifestation of the secondary ID is frequent infectious diseases with increased resistance to the therapy.
The reasons for secondary ID include exogenous (external) factors of the environment, such as microwave and tonic radiation, prolonged administration of the pharmaceuticals and intoxication, deterioration of ecology, stress, fatigue) and many endogenous factors including physiologically conditioned decrease of immunity, endocrine disorders such as diabetes mellitus that change tolerance to infections, loss of protein components of immunity due to massive loss of blood or lymphorrhea, major burns, nephropathy, multiple trauma or extensive surgery, alimentary protein insufficiency, vitamin deficiency, cachexy, autoimmune pathologies, malignant tumors especially those that impair lymphoid growth of bone marrow cells, medicines and narcotics, mostly cytostatics, glucocorticoids and antimetabolites.
The special role in the development of the secondary ID is played by the infectious agents among which it is important to distinguish a) specific immunotropic infections: HIV, Epstein-Barr virus, T-lymphotropic virus; b) non-specific infections that induce ID without the damage of the immune cells: micobacteria of tuberculosis and lepra, measles and herpes viruses, protozoan infections, helminthes, tongue worms.
The diagnosis of the secondary ID is given by an immunologist after the examination of the case history and analysis of the immune status data (immunogram) of the patient. Monitoring of the data of the extended immunogram helps avoid mistakes in the therapy of the secondary IDs.
The people with confirmed ID need the therapy that simulates immunity. The growth factors that contribute to the production of the cells, the immune protection and recombinant bodies are used in the case of the severe ID, for example induced by radiation. Broad-spectrum antibiotics are prescribed to such patients if the bacterial process develops.
As related to the immunity of the healthy people who suffered from the unfavorable environmental factors, the non-medical methods are recommended: 8 hours sleep, no intellectual, physical and/or emotional stress, alternating intellectual and physical activity, aerobic exercises such as walking, jogging, cycling in the open air for no less than an hour; the city residents need a yearly rest in the country, resorts or sanatoriums; follow dietary pattern, prioritize balanced and healthy foods, cold exposure training, refuse from bad health habits.
Unfortunately, the plant extracts and biologically active substances that according to their manufacturers stimulate immunity and promote regeneration, have not gathered proper evidence of their effectiveness and safety. High regeneration capacity of the immunity supports the levels of the lymphocytes replenishing the pool of non-differentiated cells and controls the levels of the cells of memory. The therapy of the secondary IDs associated with the internal reasons starts from the treatment of the initial issue. The secondary IDs are transitory and the therapy of the secondary IDs is often easier and more effective.
The cancer associated IDs demand the combined treatment that involves surgical and non-invasive types of anti-cancer treatment. Surgeries and major burns require the complex of the restoring procedures that include specific diet, normalized pass of the food through intestines and bowels and prevention of the infectious complications.
The specific immunotropic infections demand anti-virus therapy including anti-retro-viral therapy for HIV. When the reduced levels of autologous immunoglobulins are confirmed (the element of humoral immune protection), it is possible to administer the human immunoglobulins. In the case of the pronounce leucopenia it is possible to infuse the donor white blood cells.
The regeneration after the chemotherapy should be mentioned separately. The restoration program has three directions that are adequate for other severe secondary IDs too: normalization of the digestion to prevent development of the pathogenic microorganisms and absorption of endotoxins, therapy of the liver and kidney dysfunction to improve the clearance of the nutrients’ cleavage products. Also the immunostimulants are prescribed to regenerate the immunity. Depending on the mechanism of actions we distinguish:
- Antigen pharmaceuticals that contain anti-bacterial antigens to stimulate the production of the antigens and differentiation of the naïve lymphocytes (Ribomunil, PSK and other)
- The preparations of thymus (Thymalin, Tactivin);
- T-lymphocytes stimulators (Cordyceps);
- The stimulators of the nucleic acids synthesis (Sodium nucleinate);
- Plant preparations to stimulate immunity and to normalize the work of immunity as a system (Echinacea purpurea extract and other).
The IDs can be treated with stem cell therapy. Transplantation of the hematopoietic stem cells (HSCs) is crucial for primary IDs or deleted bone marrow, as, for example, in the case of acute leucosis. However, the official medicine does not recommend this type of therapy to other groups of ID patients.
Immunotherapy to restore the white blood cells population with the allogeneic HSCs and HPCs can be of two types: as the hematopoiesis stimulation or blood components transfer. It is possible to use the colony-stimulating factors (Lenograstim) or macrophage stimulators (Licopid). So, in the complex therapy of the secondary IDs we widely use the HSCs and HPCs of the donor bone marrow for allogeneic immunotherapy.