How does neupogen work?

18 10 2012

Copied shamelessly from a post written by a biologist in the Yahoo e-group on repro immunology:

Neupogen (G-CSF) like any cytokine has numerous target cells and effects in the body.  It is used in chemotherapy patients and neutropenic patients to raise their white blood cell counts, but for our purposes we can think of that increase in cell numbers as basically a side effect.  It’s not possible at this point to say for sure exactly which of its effects are critical for preventing miscarriage, but it has several functions that could all play a role and it may be a combinatorial effect.  1) it has “tolerizing” effects antigen-presenting cells (APCs) (i.e., dendritic cells, macrophages) and T cells to prevent the activation of cytotoxic T cells and promote the formation of regulatory T cells (Tregs).   APCs can be thought of basically as “sentinals” that monitor what’s going on in the tissues and then direct the adaptive immune response.  How the APCs direct the adaptive immune response depends in part on what signals they are receiving from the local cytokine environment.  2) it directly inhibits the function of NK cells; 3) there are receptors for G-CSF directly on trophoblast cells of the embryo and G-CSF likely promotes their proliferation.  This in turn results in increased production of HCG by the embryo.  HCG and G-CSF have many overlapping functions in regulating cell functions at the maternal-fetal interface; 4) it promotes angiogenesis (formation of new blood vessels) and may have effects on decidual cells resulting in a “receptive” uterine lining.  5) G-CSF also promotes intestinal barrier function which may reduce inflammation originating from the gut in conditions such as celiac, IBD (Crohn’s and ulcerative colitis), etc.  So, basically it has a lot of effects that could be seen as positive for promoting a pregnancy and preventing miscarriage.  It’s not clear which of these effects is critical or if it is a combination of these.  I tend to think that it is probably a combination.   



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