[Immunosuppressive drugs--useful confusion of the 20th century?]

In the second part of the twentieth century, four categories of immunosuppressive agents have been developed: glucocorticosteroids, cytotoxic drugs, antibody reagents and agents interfering with the action or expression of cytokines. The emerging field of immunosuppression allows now to perform successfully organ transplantation and to control most of the immunologically mediated disease states during the acute, less so during the chronic phase. Unfortunately, all the immunosuppressive agents used today are nonspecific. As a consequence, opportunistic infections and the development of malignancies are expected side effects. Clinicians introduced these new agents with enthusiasm into practice. Immunosuppressive agents are mostly used for so-called autoimmune diseases, i.e. entities of unknown etiology. Considering the tremendous side effects of immunosuppressive agents, the question arises whether in the future research should focus more on the discovery of the cause of these immune-mediated disease states than on the development of further agents designed to relieve symptoms of autoimmune diseases. Two areas might be promising for future research in this field: 1. the definition of mechanisms accounting for the genetic predisposition and 2. the assessment of the triggers (infectious diseases and/or antigenes) causing so-called auto-immune diseases.