From Big Medical Encyclopedia

SEROTHERAPY (Latin serum serum + Greek therapeia treatment) — the type of an immunotherapy based on introduction to the patient of homologous or heterological immune serum.

S.'s foundation was laid by discovery of bacterial toxins: diphtheritic — to E. R iyerseny (And. E. J. Yersin) in 1888, tetanic — S. Kitasato in 1890, and also specific antitoxins (see), possessing protective action, in blood serum of immunizirovanny animals — E. Beringom and S. Kitasato in 1890.

The antidiphtherial serum prepared in 1892 — 1894 was the first drug used for S. (see. Seroimmunity ). Antidiphtherial serum was successfully applied in Moscow in the clinic run by N. F. Filatov in 1894. Production of medical antidiphtherial horse serum in Russia was arranged by G. N. Gabrichevsky in 1895 in created by it Moscow bacteriological in-those.

Discovery of antitoxins against toxins of activators of some other inf. diseases (tetanus, botulism, staphylococcal infections, etc.), and also against poisons of snakes, spiders, etc. allowed to apply more widely to lay down. serums (see) at many patol. states to study the mechanism of their influence on an organism more deeply. Pages began to apply not only at inf. diseases and snake bites, but also at some other states, including for suppression of cellular immunity, napr, in transplantology, surgery, etc. (see. Immunotherapy , Immunoglobulins ). Treatment by the immunoglobulins received from hyperimmune serums of the person or animals, also belongs to S. and is widely applied at the inborn or acquired immunodeficiency (see. Immunological insufficiency ), allergies (see), burns (see), defeat by ionizing radiation. S.'s possibilities of patients are investigated leukoses (see), uses of antibodies as carriers of medicines, use of the monoclonal (gibridomny) antibodies which are synthesized in vitro free from impurity of other ballast proteins (see. Hybridoma ). Despite long history C., a lot of things in the mechanism of action to lay down. serums and serum globulins remains not studied. Perhaps, their influence on an organism is more difficult, than it was supposed earlier; e.g., in gamma-globulin of blood serum of the person the big antibody repertoire to various viruses and bacteria, and also presence, especially in placental gamma-globulin, a number of hormones, etc. is found.

Depending on the used immune drug its action is shown preferential either in anti-toxic, or in antimicrobic effect. In case of use of immunoglobulins for the replacing therapy at immunodeficiency are filled a missing one class (e.g., IgA) or several classes of immunoglobulins (e.g., IgG, IgA, IgM).

The philosophy of S. is the earliest use to lay down. serums since only in this case the positive effect is possible. The circulating toxin can be connected effectively only in line with blood; at its penetration into cells use of immune serums is insufficiently effective and it is possible to expect only the prevention of new defeats in an organism of the patient. At repeated administrations of serums (especially geterolo-gichny) the possibility of antibody formation to given to lay down increases. to drug, to-rye neutralize its action; at the same time also the sensitization of an organism to the entered serum develops. The effect of use of the same drug can be various at different patients; it depends on weight of defeats, the accompanying diseases, existence of the latent immunodeficiency, food, age etc. As K. V. Bunin (1963) emphasizes, the mechanism of effect of serums cannot be reduced only to simple binding of the pathogenic agent. Antibodies in structure to lay down. drugs as showed the last researches, can make also the immunoregulating impact on an organism.

Indications to S. are defined by weight of a disease and time which passed from the beginning of a disease. The unconditional indication to S.'s carrying out is botulism (see), tetanus (see), heavy current diphtherias (see), tick-borne encephalitis (see), malignant anthrax (see), stings a venomous snake (see. Snake poison ).

Contraindications to S. sharply expressed allergic reactions, life-threatening the patient (acute anaphylaxis), hypersensitivity of the patient to heterogeneous protein are. In these cases replacement, e.g., of horse antirabic immunoglobulin with homologous drug from blood sera of people, immunizirovanny against rage is possible.

Homologous, received from the had or immunizirovanny persons, and gete-rologichny, received from various large animals (horses, mules, donkeys), immunizirovanny anatoxins or microbic antigens distinguish serums. Homologous serums, despite the known difficulty of their receiving and quite often more low levels of antibodies, have undoubted advantage before geterologichny-m serums since at introduction of the first the probability of complications because of smaller allogeneity of protein considerably decreases. At nek-ry infections, napr, fever of JIacca, Ebola to hemorrhagic fever, practically still only way of treatment remains introduction by the patient of blood serum had these diseases.

In the USSR for S. release three basic groups of serums and gamma-globulins: anti-toxic (antitetanic, antidiphtherial, protivobotulinovy, antigangrenous serums, and also antistaphylococcal gamma-globulin), antimicrobic (anti-anthracic and protivoleptospirozny gamma-globulins) and anti-virus (antirabic, antismallpox, anti-influenza gamma-globulins and gamma-globulin against a tick-borne encephalitis). Besides, release to lay down. serums against poison of snakes and a spider of a karakurt (see. Serums ). From drugs of broader action, to-rye it is possible to apply to treatment of a number of infections, napr, measles, whooping cough, poliomyelitis, etc., and also allergic diseases, produce immunoglobulin normal human (see. Immunoglobulins ), polyglobulin of the person, hystoglobulin.

Due to the increase and the heavy course of the infections caused by opportunistic pathogenic bacteriums (a pyocyanic stick, proteas, colibacillus, etc.), in our country new serumal drugs, including new group of so-called anti-endotoxin serums against the toksoformny group of endotoxin of microbes causing endotoxic in patients are developed shock (see).

Before administration of serum define sensitivity of the patient to heterogeneous protein (see. Bezredki methods ).

To the most terrible to complications The page belongs acute anaphylaxis (see). During the use of heterologous serums it is possible to refer development to late complications serum disease (see). High extent of purification of serumal drugs and immunoglobulins, replacement regarding cases of heterological drugs with homologous allowed to lower complications at S. to a minimum.

Bibliography: Aleksevich Ya. I. About neutralization of a tetanin in an organism, Zhurn. mikr., epid. and immun., No. 2, page 15, 1980; The Guide to vaccinal and serumal business, under the editorship of P. N. Burgasov, page 254, M., 1978; The Guide to infectious diseases, under the editorship of A. F. Bilibin and G. P. Rudnev, page 81, M., 1962; Stanislavsky of E. S. Immunoprofilaktik and an immunotherapy of the diseases caused by gram-negative bacteria, Zhurn. mikr., epid. and immun., No. 12, page 91, 1980, bibliogr.; T and m p N of e r To. - And N about y-x and at with F. Immunological insufficiency at children, the lane with it., page 150, M., 1979; Amman A. J. and. lake of Use of intravenous Y-globulin in antibody immunodeficiency, Clin. Immunol., v. 22, p. 60, 1982; Behring E. A. Blutserumthe-rapie, Lpz., 1892; Biochemical clinical pharmacology, ed. by J. P. Tillement, p. 265, Oxford a. o., 1979; Schroder J. Monoclonal antibodies, Med. Biol., v. 58, p. 140, 1980.

I. V. Rubtsov.