[Immunotherapy of inflammatory bowel diseases]

Inflammatory bowel diseases (IBD), namely ulcerative colitis (UC) and Crohn's disease (CD) are chronic disorders which appear to be immunologically related. The basic therapeutic agents used in IBD treatment are 5-aminosalicilates and corticoids. In cases when this treatment is insufficient, immunosuppressive therapy is recommended. During an acute phase of the illness most useful is cyclosporine A and in the maintenance therapy, azathioprine and 6-mercaptopurine. Because of insufficiency of this classic therapy in many cases, the new, more useful and safe methods of IBD treatment are wanted. Permanent researches have been focused on immunological reactions. The most useful appear to be TNFalpha antagonists (oxpentifilline, infliximab, entanercept, onercept and thalidomide), anti alpha-4 integrin antibodies (natalizumab), IL-10, anti-CD4, IL-6, IL-12, IL-18, IFNgamma, IL-2R antibodies and others. The best clinical experiences are connected with CD treatment using infliximab (monoclonal, chimeric anti TNFalpha antibodies). Its position in IBD therapy appears to be established now, whereas the other methods are still experimental. Most of clinical and experimental data indicate that it is possible to cure severe IBD using agents which affect metabolism of the cytokine playing key role in pathogenesis of the illness. The modern immunotherapy will probably play important role in the future IBD treatment.