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Fungi
Published in Harriet A. Burge, Bioaerosols, 2020
Infection rates following hip and knee replacement surgery can be as high as 10% (Lidwell et al., 1982), and infections can surface months or even years after the operation (Charnley, 1973). The increasing use of bone marrow transplants to treat patients with acute leukemia and other forms of cancer, severe aplastic anemia, and congenital and acquired immunodeficiencies, as well as other disorders, is associated with an increase of infections due to a variety of pathogens (Arlet et al., 1989). Prior to and following transplants, patients are given immunosuppressive drugs to prevent rejection. In addition, in the case of leukemia, the patient may also be given total body irradiation to destroy malignant cells. All during this time, but especially just following transplant, the patient is at high risk for many opportunistic infections (Streifel et al., 1989; Young et al., 1970). Epidemics of nosocomial opportunistic fungal infection have occurred that provide proof of airborne spread. The fungi involved are ubiquitous saprobes in the environment and are usually considered nonpathogenic. The normal method of dissemination of these fungi is through airborne spores. Aspergillus is the most frequently reported opportunistic pathogen, while Fusarium infections have only only recently been identified. Because of the widespread occurrence of these genera, the remainder of this discussion focuses on these opportunistic infections.
Hematopoietic Stem Cell Transplantation in Patients with Autoimmune Bullous Skin Disorders
Published in Richard K. Burt, Alberto M. Marmont, Stem Cell Therapy for Autoimmune Disease, 2019
Introduction of corticosteroids has greatly reduced mortality, but significant morbidity still remains. Many steroid regimens with or without immunosuppressive drugs have been tried. Patients with only oral lesions can be treated with topical steroids and oral hygiene. Patients with widespread disease need systemic corticosteroids. In general, the dosage recommended is prednisolone 1.0-1.5 mg/kg/day in combination with topical or intralesional steroids. Dosage will be adjusted based on clinical response, and the titer of circulating pemphigus antibody can be of help as an adjunctive tool for dosage adjustment. If disease is not controlled with this regimen, various dosage recommendations exist, such as higher daily dose or monthly pulse intravenous steroids. As an adjunctive treatment for steroids or as steroid-sparing agents, various immunosuppressive drugs are suggested including azathioprine, cyclophosphamide, gold, cyclosporin, methotrexate and mycophenolate mofetil. Plasmapheresis has been tried and showed variable responses. Intravenous immunoglobulin may also be a safe alternative modality for steroid-sparing effect in some recalcitrant cases.16
Bioartificial organs
Published in Ronald L. Fournier, Basic Transport Phenomena in Biomedical Engineering, 2017
Immunosuppressive drugs can be used to suppress the host’s immune system and prolong the function of transplanted cells that are a relatively close match to the host. However, immunosuppressive drugs have potent side effects, and in the case, e.g., of transplanting the islets of Langerhans, or their β cells, to treat insulin-dependent diabetes, these drugs may result in a situation where the cure is worse than the disease. Genetically engineered cell lines, in addition to their possibly being rejected by the host’s immune system, also pose additional risks that need to be considered. For example, the direct implantation of an immortal (usually of tumor origin) cell line can lead to the unchecked growth of the implanted cells. There is also the risk of these cells moving and proliferating at a site other than the desired site, and they can change to a potentially hazardous form with the loss of their original therapeutic function. In some applications, the full potential of tissue engineering and regenerative medicine will be limited unless techniques can be developed to either restrict the host’s immune response or somehow modify the transplanted cells to make them more acceptable to the host’s immune system, i.e., immunomodification (Lanza and Chick, 1994b).
Formulation development, optimization, and in vitro assessment of thermoresponsive ophthalmic pluronic F127-chitosan in situ tacrolimus gel
Published in Journal of Biomaterials Science, Polymer Edition, 2021
Deepika Modi, Musarrat H. Warsi, Vaidehi Garg, Meenakshi Bhatia, Prashant Kesharwani, Gaurav K. Jain
Tacrolimus (TCS) is an immunosuppressive drug used to treat various ocular diseases like allograft corneal rejection, Mooren’s ulcer, allergic conjunctivitis, immunogenic inflammatory ocular surface diseases [4, 5], posterior uveitis (intraocular inflammation) [6, 7], and refractory posterior blepharitis [8] when applied topically. Due to serious side effects associated with systemic administration, such as nephrotoxicity, neurotoxicity, weight loss, hyperglycemia, diarrhea, and liver dysfunction, topical administration of TCS is preferred [4]. Clinical studies have revealed that immunological rejection after corneal and limbal grafting can be inhibited by topical delivery of TCS [9]. Some of the clinically approved formulations of tacrolimus currently available in the market are Protopic ointment (0.1%, 0.3%, Fujisawa, Munich, Germany) for treating atopic dermatitis, which can also be used for atopic eyelid disease [10], Talymus ophthalmic suspension (0.1%, Senju Pharmaceutical Co., Ltd., Osaka, Japan) for severe allergic conjunctivitis [11] and Talimus ointment (0.1%, Ajanta Pharmaceuticals, India) for eczema as well as atopic keratoconjunctivitis and vernal keratoconjunctivitis [12].