Azathioprine (AZA) and Its Best Alternatives In Ayurveda
Abstract
Azathioprine is a prominent immunosuppressant. This drug acts as an anti purine by getting converted into 6-MP. Azathioprine shows immunosuppressant action because of its selective uptake into immune cells and hence its intracellular conversion to 6-MP. Azathioprine primarily suppresses cell mediated immunity. It is a drug of choice in ulcerative colitis because it helps in reducing symptoms and lowers the chances of flare ups. Use of azathioprine calms down your immune system and thus causes symptoms like recurrent infections resulting in high grade fever. In this article we will mainly discuss Azathioprine (AZA), how it works and what side effects it can cause. Along with these alternatives to Azathioprine in Ayurvedic herbs is also mentioned.
Introduction
Azathioprine is called a first line immunosuppressant with a steroid sparing effect in ulcerative colitis, rheumatoid arthritis, organ transplant patients and many more. Steroid sparing means reducing the need for steroid uptake as the side effects of steroids increases with dosage. On one hand azathioprine reduces the side effect of steroids but on the other side it too has its own side effects. We can also understand that immunosuppressants are making steroid functioning better even at small doses due to their suppressing action on the immune system working. Before coming on to the main discussion, it’s very necessary to understand the working of the normal immune system so as to understand the action of immunosuppressants.
Working Of Normal Immune System
Immune system is a complex network of cells and proteins that works together in strengthening the defences of the body against any kind of infection. Immune system keeps a record of each and every microbe it has ever detected. The white blood cells, especially B lymphocytes and T lymphocytes are called as memory cells, which means it can recognise and destroy the microorganisms when they reenter the body. If tried and understood in simple words then the immune system is a network of biological processes that protects our body from various infections. Immune system consists of two components:
- Innate Immune System
- Adaptive Immune System
1. Innate Immune System
The response of the innate immune system is non specific. Usually exposure to pathogens causes immediate maximal response. The components of the innate system are cell mediators and humoral components. Cell mediators are immune responses at cell level and do not have any antigen antibody response involvement. The innate immunity is something that is present from birth and does not have memory of pathogens stored in beta cells or T cells which means it does not depend on the previous exposure to an antigen.
2. Adaptive Immune system
Adaptive Immunity is something that builds with time. It is developed after the exposure to some antigen either from pathogens and a vaccination. This part of the immune system usually gets activated when the innate system fails to control an infection. The cells that are responsible for adaptive immunity are white blood cells also known as lymphocytes. B cells and T cells are two types of lymphocytes. These two types of lymphocytes are responsible for immune antibody responses and cell mediated immune responses. In case of antibody responses B cells are activated to secrete antibodies (protein known as immunoglobulins). These antibodies travel through the bloodstream and bind with the antigen (causative agent) turning it into an inactive stage.
Now after understanding the normal immunity system, let us understand how immunosuppressants work on our immunity system.
Immunosuppressants Functioning On Body’s Immune System
As mentioned earlier, immunosuppressants work by reducing the efficacy of the immune system. What we have to understand is how? In modern science Azathioprine is termed as a prodrug which is converted into the 6-mercaptopurine and then is metabolised to cytotoxic thioguanine nucleotides which are responsible for immune suppression and also inhibits DNA synthesis. This helps in suppression of both cell mediated and antibody mediated immune reactions, leading to decreased immunity. To understand in simple words the cytotoxic effect of Azathioprine is having a marked effect on T lymphocytes. It thus decreases the cell mediated immunity along with antibody response thus causing reduction in immune system working and hence preventing steroid resistance. The steroids thus can be used in low doses but can show enough effect over the ongoing pathology.
What side effects Azathioprine can have?
The toxicity of Azathioprine can reduce the count of white blood cells hence making your body prone to or easy targets for various infections. The white blood cell count can reduce below than 1000, visible in biochemistry reports. This drug can cause internal bleeding and total falling of hair. Gums and internal mucosa can also bleed due to reduced platelet count which is the ultimate result of bone marrow suppression taking place due to Azathioprine. The intestinal bleeding due to the toxicity of this drug is usually detected in occult stool test positivity (presence of invisible strings of blood seen in stool after examining under microscope). Bone marrow suppression and hematological toxicity are the two main side effects of this drug.
Symptoms arising in early stages of toxicity
- Increased in stomach irritation and abdominal pain
- Hair loss and hair color changes
- Blood in urine or stool
- Mouth ulcers or mouth sores
- Fatigue
- Decreased resistance to infections
- Bruising
- Bleeding gums
Ayurveda is a very vast ancient science that is having many effective and wonderful herbs explained by various acharyas. Some of these herbs can act best immunomodulator and hence act as an alternative to Azathioprine (AZA).
These immunomodulators are very much potent in protecting healthy cells of the body by modulating the response of impaired immune systems. Below discussed are some herbs and herbal extracts that can be potentially used as immunomodulators.
1. Curcumin
Curcumin is the effective extract of turmeric (Curcumin Longa). Turmeric finds mentions in almost every ayurvedic treatise- ancient, medieval or modern. It has been described as tikta and katu (bitter and pungent), laghu, rooksha and ushna (light, dry and hot). Sages supporting Ayurveda have extolled it as digestive, astringent, anti diabetic and useful in blood formation. It also has been described as varnaya for skin. Turmeric contains a wide range of volatile oils, vitamin A, protein, minerals and an overwhelming amount of carbohydrates. Now discussing its main extract curcumin, it is having a wide range of therapeutic properties. It is a known anti bacterial, anti allergic, carminative and antioxidant. Moreover recent studies have shown its effect as an immunomodulator. It stops the immune system from attacking its own healthy cells and also bears anti cancerous properties. It inhibits the impaired T cells attacking the body’s healthy cells.
2. Guggul
Guggul is a very much familiar name in Ayurvedic medications. Guggul happens to be an oleoresin excluded by an ordinary looking tree called in botanical terms as Commiphora mukul. This resinous mass undergoes a typical process of purification to make it fit for human consumption. Ancient acharyas have described guggul to be bitter in taste but hot in effect. It has qualities to pacify all three dosha in the body. It is described as light, dry, sharp, sticky and unctuous. The chemical composition of guggul despitcs a variety of organic compounds and inorganic ions. It also contains mineral matter mostly consisting of silicon dioxide, calcium, magnesium, iron and a volatile oil. It shows analgesic, anti inflammatory and immunostimulant as well as immunomodulator effects. It typically acts on the immune system and hence inhibits the process which results in the impairment of immune cells or constituents and then behaves as a stimulant.
3. Giloy
Giloy is a well known ayurvedic medicine. Almost all the ancient Ayurvedic texts have studied and analyzed its remarkable healing properties and is typically known by the name of amrita. Giloy is famous for its usefulness to man by its conduct of strengthening the immune system and keeping functioning of various body organs in a balanced state. Due to these unique properties it continues to get an exalted status, trust and respect from physicians and typically from patients. Its chemical constituents consist of various alkaloids, glucosides, fatty acids and volatile oils. Ayurvedic texts describe it as bitter and astringent in taste and heavy, unctuous and hot in effect. It pacifies tridosha and even being hot in potency it gives a cooling effect. It works on the immune system by strengthening its constituents and also modulates the imparied immune cells. It helps in reversing the autoimmune activity of immune cells.
Conclusion
Drugs like Azathioprine may be called as prodrugs in modern medicine but their adverse effects hit a person’s health real hard. The dosage of such drugs are too regulated from time to time and its reactions are to be noted. If a patient present with any of the mild symptoms even then toxicity is to be considered and immediate cessation of Azathioprine is to be done. On the other hand Ayurvedic herbs do not cause any kind of side effects and hence are quite safe to use. Patients can take it even for a long time and no toxicity will ever be noticed. In case of any query kindly visit www.planetayurveda.com
