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Chronic alcohol use has profound modulatory effects on the immune system. Both the innate and the acquired immunity are compromised. The use of pharmacotherapy is increasingly applied to enhance the percentage of success in maintaining alcoholic patients in remission. Disulfiram, naltrexone and gamma hydroxybutiric acid are the drugs used for this purpose in Italian Addiction Services. In this study we analyze the effect of pharmacotherapy of alcohol dependence on immune responses in alcoholics. Six groups were studied. Group A included 10 patients who were still using alcohol. Group B consisted of 10 patients abstinent from alcohol in treatment only with group therapy. Groups C, D and E were composed of 10 patients each, treated for at least 6 months with oral doses of gamma hydroxybutiric acid, naltrexone or disulfiram respectively. Ten age- and sex-matched healthy volunteers who never misused alcohol were included as a control group. Lymphoproliferation and peripheral mononuclear cell production of the Th1 cytokines IL-2 and IFN-gamma, the Th2 cytokine IL-4, and of the pro-inflammatory cytokines IL-1 and TNF-alpha were evaluated in all the patients and controls. The level of activity of the hypothalamus pituitary adrenal axis was assessed. Both ACTH and cortisol levels in plasma were elevated in alcoholic patients with no treatment. In this group a significant alteration of cytokine production was observed. TNF and IFN-gamma were lower than controls, while the Th2 cytokine IL-4 was increased. These altered levels state for a Th1/Th2 unbalance characterized by decreased Th1 response in the presence of Th2 predominance. In patients undergoing pharmacological treatment, none of the immune parameters were different from those observed in healthy controls, independently of the type of drug administered. These data indicate that pharmacotherapy more than group therapy treatment is able to ameliorate the immune system functioning in alcoholic patients.

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Neurocognitive disorders are devastating. In 2016, 43.8 million people were estimated to have Alzheimer' s disease worldwide. By 2050, this figure is expected to rise by 56%. Despite the extreme importance of the disease, the weapons available to us to combat it are very scarce. Natural substances may be a worthwhile option for the treatment and management of neurocognitive disorders. Some of these natural products have been shown to be capable of positively impacting memory, behavior, and functions of patients with Alzheimer' s disease. These substances act on the disease mainly through antioxidant properties, the ability to eliminate oxygen radicals, the capacity to influence cell survival and programmed cell death, and the potential to condition amyloidogenesis. This chapter provides an overview of our current knowledge on the potential of natural products to be effective neuroprotective agents for Alzheimer' s disease. Current evidence on Ginkgo biloba, bacopia, resveratol, curcumin, quercetin, kaempferol, capsaicin, and berberine, along with their adverse effects and drug interactions are discussed.

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