How do biologics work to treat autoimmune diseases. What are the different types of biologics available. How are biologics administered to patients. What are the potential side effects of biologic treatments.

The Mechanism of Action: How Biologics Target Inflammation

Biologics are a class of medications designed to treat autoimmune diseases by targeting specific components of the immune system. These drugs work by interfering with the inflammatory process at a molecular level, preventing the cascade of events that leads to tissue damage and symptoms.

At the heart of their mechanism lies the interaction between cytokines and cell receptors. Cytokines are proteins that act as messengers in the immune system, triggering inflammation when they attach to receptors on cell surfaces. This process can be likened to unlocking a door with a key – the cytokine being the key and the receptor being the lock.

Biologics employ various strategies to disrupt this interaction:

• Blocking receptors on cells, preventing cytokines from attaching
• Occupying receptors themselves, leaving no space for cytokines
• Neutralizing specific cytokines before they can reach their target cells

By interfering with these molecular interactions, biologics can effectively halt the inflammatory process before it gains momentum, potentially preventing tissue damage and alleviating symptoms.

The Precision of Biologic Treatments

One of the key advantages of biologics is their specificity. Each biologic targets a particular cytokine or cellular component involved in inflammation. This precision allows for more targeted treatment approaches compared to conventional medications that affect the immune system more broadly.

However, this specificity also presents challenges in treatment selection. As Dr. Frame notes, “We don’t really have an easy mechanism to say, ‘If I have four or five cytokines that commonly cause an autoimmune disorder…it’s absolutely this cytokine.'” Consequently, the choice of biologic often depends on clinical studies, physician experience, and sometimes insurance coverage.

Types of Biologics: Targeting Different Inflammatory Pathways

Biologics are categorized into several classes based on their specific targets within the inflammatory process. Understanding these classes can provide insight into how these medications work and which conditions they are most likely to treat effectively.

TNF Inhibitors

TNF inhibitors target tumor necrosis factor, a protein that plays a crucial role in inflammation. These biologics prevent TNF from binding to its receptors, effectively blocking its pro-inflammatory effects. TNF inhibitors are commonly used to treat conditions such as:

• Ankylosing spondylitis
• Crohn’s disease
• Ulcerative colitis
• Psoriatic arthritis
• Rheumatoid arthritis

Interleukin Inhibitors

Several classes of biologics target different interleukins, which are a family of cytokines involved in various inflammatory processes:

1. IL-1 inhibitors: Used primarily for juvenile idiopathic arthritis
2. IL-6 inhibitors: Effective for giant cell arteritis, juvenile idiopathic arthritis, and rheumatoid arthritis
3. IL-17 inhibitors: Commonly prescribed for psoriasis, psoriatic arthritis, and ankylosing spondylitis
4. IL-12 and IL-23 inhibitors: Used to treat psoriasis, psoriatic arthritis, and Crohn’s disease

B-cell and T-cell Inhibitors

These biologics target specific types of immune cells rather than cytokines:

• B-cell inhibitors: Used for rheumatoid arthritis and lupus
• T-cell inhibitors: Primarily prescribed for rheumatoid arthritis

The diversity of biologic classes allows for tailored treatment approaches, potentially improving outcomes for patients with various autoimmune conditions.

Administration of Biologics: Routes and Frequency

The administration of biologics differs significantly from traditional medications due to their molecular structure and sensitivity to stomach acid. Dr. Frame explains, “If you try to give most of these biologics orally, they will mostly be chewed up by the stomach acid.” As a result, biologics are typically administered through two main routes:

1. Intravenous (IV) infusion: Delivered directly into the bloodstream
2. Subcutaneous injection: Administered under the skin

The frequency of administration varies depending on the specific biologic and the condition being treated. Some regimens include:

• Weekly self-administered subcutaneous injections
• Monthly intravenous infusions
• Infusions every few months

This variability in administration schedules allows for personalized treatment plans that can accommodate patients’ lifestyles and disease management needs.

Potential Side Effects: Balancing Benefits and Risks

As with any medication, biologics can cause side effects. While these drugs are generally well-tolerated, patients should be aware of potential adverse reactions. Common side effects may include:

• Fatigue for a few days following infusion or injection
• Headaches
• Injection site reactions
• Mild sore throat
• Stomach discomfort

It’s important to note that more serious side effects can occur, particularly related to the immune system. Patients should discuss the potential risks and benefits with their healthcare provider before starting biologic therapy.

Combining Biologics with Traditional Treatments

Biologics are often used in conjunction with other medications to manage autoimmune diseases effectively. For conditions like rheumatoid arthritis or ankylosing spondylitis, biologics may be prescribed when traditional treatments prove insufficient.

Conventional treatments that may be used alongside biologics include:

• NSAIDs (Non-Steroidal Anti-Inflammatory Drugs) such as ibuprofen
• DMARDs (Disease-Modifying Antirheumatic Drugs) like methotrexate

This combinational approach allows for a more comprehensive management strategy, potentially improving symptom control and slowing disease progression.

The Future of Biologics: Advancing Autoimmune Disease Treatment

As research in immunology and molecular biology continues to advance, the field of biologics is likely to expand and evolve. Future developments may include:

• More targeted therapies with fewer side effects
• Improved delivery methods for enhanced patient convenience
• Combination biologics that target multiple inflammatory pathways simultaneously
• Personalized medicine approaches using genetic and biomarker data to select the most effective biologic for each patient

These advancements hold the promise of more effective and tailored treatments for individuals living with autoimmune diseases, potentially improving quality of life and long-term outcomes.

Making Informed Decisions: Biologics in Your Treatment Plan

When considering biologic therapy, patients should engage in thorough discussions with their healthcare providers. Important factors to consider include:

• The specific autoimmune condition and its severity
• Previous response to conventional treatments
• Potential benefits and risks of biologic therapy
• Administration methods and frequency
• Insurance coverage and cost considerations
• Lifestyle factors that may impact treatment adherence

By carefully weighing these factors, patients and their healthcare teams can make informed decisions about incorporating biologics into their treatment plans, potentially leading to better disease management and improved quality of life.

As the landscape of autoimmune disease treatment continues to evolve, biologics remain at the forefront of innovative therapies. Their ability to target specific components of the immune system offers hope for more effective and personalized treatment approaches. While challenges remain in selecting the most appropriate biologic for each patient, ongoing research and clinical experience continue to refine our understanding and use of these powerful medications.

For individuals living with autoimmune diseases, biologics represent a significant advancement in treatment options. As we look to the future, the continued development and refinement of biologic therapies promise to further transform the management of these complex conditions, offering new hope for improved outcomes and quality of life.

How Do Biologics Work to Treat Autoimmune Diseases?

Before cytokines can produce inflammation, they need to attach to receptors on the surface of your cells. Think of it as opening the lock on your front door with a key. You can’t turn on the lights until you unlock and open the door. Cytokines can’t affect your cells until they open the lock. Biologics prevent cytokines from unlocking your cells and causing inflammation and possible damage in a few ways. Some of these medications block¹¹ the receptors on cells so that cytokines can’t attach to them. Other drugs fill the receptor themselves, leaving no room for the cytokine.

Each biologic works against a specific cytokine. But some autoimmune diseases are fueled by more than one cytokine. So how does your doctor know which one to choose?

“We don’t really have an easy mechanism to say, ‘If I have four or five cytokines that commonly cause an autoimmune disorder…it’s absolutely this cytokine,’” Dr. Frame says. The decision comes down to which biologic most people with your condition responded well to in studies, and your doctor’s preference, he adds. Your insurance coverage, if you have it, can also factor into the decision, Dr. Husni says.

What types of biologics are there?

Biologics are divided up into groups, or classes, based on the inflammatory pathway they target⁷. Each works by preventing a particular cytokine from causing inflammation. Below are the common biologic classes used to treat autoimmune diseases:

TNF inhibitors

What they target: These prevent the tumor necrosis factor protein from binding to its corresponding receptors and causing inflammation⁸.

Autoimmune diseases they commonly treat: ankylosing spondylitis, Crohn’s disease, ulcerative colitis, psoriatic arthritis, rheumatoid arthritis

IL-1 inhibitors

What they target: interleukin-1, interleukin-6, interleukin-12, interleukin-23

Autoimmune diseases they commonly treat: juvenile idiopathic arthritis

IL-6 inhibitors

What they target: interleukin-6

Autoimmune diseases they commonly treat: giant cell arteritis, juvenile idiopathic arthritis, rheumatoid arthritis

IL-17 inhibitors

What they target: interleukin-17

Autoimmune diseases they commonly treat: psoriasis, psoriatic arthritis, ankylosing spondylitis 

IL-12 and IL-23 inhibitors

What they target: interleukin-12, interleukin-23

Autoimmune diseases they commonly treat: psoriasis, psoriatic arthritis, Crohn’s disease

B-cell inhibitors

What they target: B cells

Autoimmune diseases they commonly treat: rheumatoid arthritis, lupus

T-cell inhibitors

What they target: T cells

Autoimmune diseases they commonly treat: rheumatoid arthritis

How do I take biologics?

Biologics are very sensitive to the acid in your stomach and can’t be taken orally like many conventional medications. “If you try to give most of these biologics orally, they will mostly be chewed up by the stomach acid,” Dr. Frame says. “We have to give them either through an IV directly into the blood or injected under the skin,” he says.

How often you need treatment and the way you receive it depends on your type of autoimmune disease, and which biologic you take. For example, some medications can be self-administered through an injection under your skin weekly. Other drugs are given through an intravenous infusion monthly or every few months.

What about side effects?

Any drug you take can cause side effects, and biologics are no exception. It’s common to feel tired for a couple of days after your infusion or injection, or to have headaches. Other side effects of taking a biologic include reactions near your injection site, a mild sore throat, and stomach pains.

Biologics: Basic Facts for Patients

People with inflammatory autoimmune diseases, such as rheumatoid arthritis and ankylosing spondylitis, may be prescribed biologic drugs if traditional NSAIDs (e. g. ibuprofen) or DMARDs (e.g. methotrexate) are ineffective. Biologics can also be used in conjunction with these traditional medications.

See 5 Types of Medication That Treat Rheumatoid Arthritis (RA)

How Biologics Work

Before symptoms of inflammation can be seen or felt, a series of biochemical reactions takes place in the body. A biologic drug targets and prevents a specific reaction from happening, stopping the inflammatory process in its tracks.

In contrast to biologics, conventional drugs treat general inflammation (and resulting symptoms like joint pain) after it has begun.

See Pain Medications for Arthritis Pain Relief

One type of biologic: TNF inhibitors
Protein molecules called tumor necrosis factor (TNF) trigger unnecessary inflammation in people with autoimmune diseases such as rheumatoid arthritis. Biologics called TNF inhibitors contain special protein molecules that, when injected into a patient’s bloodstream, attach to the TNF molecules. When TNF inhibitors attach to TNF, the TNF cannot trigger inflammation.

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Biologics Take Time to Work

A patient may notice a decrease in symptoms as soon as 1 week or as long as 12 weeks after starting a biologic, and symptoms may continue to improve for months afterward. For example, many people who take TNF inhibitors feel symptom relief in 2 to 4 weeks, though the full effects of the drugs usually take 3 to 6 months.

It is not unusual for a biologic to become less effective over months or years, as a person’s immune system develops antibodies to the drug. When this happens, a person will notice symptoms gradually coming back. When a biologic loses its efficacy, a doctor may recommend switching to another biologic.

In This Article:

• Biologics: Basic Facts for Patients

• Risks and Side Effects of Biologics

How Biologics Are Given to Patients

Most biologics are liquid medicines administered to a patient by either:

• Injection under the skin. A patient may give him or herself injections at home. In some cases, a family member or other caregiver may give the injections.
• Infusion into the blood stream. This is typically done in a medical office and can take a few hours.

Pharmaceutical companies are working to develop biologics that can be administered with oral pills. The first of these is tofacitinib, sold as Xeljanz, which was approved by the FDA in 2012.

See The Science Behind Biologics

How often a person takes a biologic varies. In general, infusions may be needed once every 4 to 6 weeks. Injections are usually required every week or two.

Storing and Handling Biologics

Every biologic will have storage and handling instructions that must be followed, or the drug will lose some or all of its effectiveness. Most biologics should not be:

• Exposed to rapid temperature changes. For example, do not use a heat source to warm up a drug that has been stored in the refrigerator. Let it gradually warm to room temperature before injection.
• Exposed to multiple temperature changes. For example, people are advised against storing a biologic in a refrigerator, then warming it up to room temperature, and then putting it back into the refrigerator for later.
• Shaken. Rapid shaking is usually not necessary and may be harmful.

Why are guidelines like these necessary? Most medications are made up of small, stable molecules—aspirin molecules have just 21 atoms—but biologics are made up of huge molecules with thousands of atoms. The chemical bonds that hold those atoms together are relatively weak, and they can be broken by rapid temperature changes and other factors. A drug will not work as prescribed if too many if its molecules’ bonds are broken.

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Examples of Biologics Available Today

Biologics are categorized by what part of the inflammatory process they target.

See Biologics for RA and Other Autoimmune Conditions

TNF blockers are the most common type of modern biologic. TNF blockers include but are not necessarily limited to:

• certolizumab (Cimzia)
• etanercept (Enbrel)
• adalimumab (Humira)
• infliximab (Remicade)
• golimumab (Simponi)

Examples of other biologics (and their mode of action) include:

• tocilizumab (Actemra), targets the interleukin-6 pathway
• anakinra (Kineret), an interleukin-1 receptor antagonist
• rituximab (Rituxan), a CD20-directed cytolytic antibody
• tofacitinib (Xeljanz), first in a class of treatments RA called Janus kinase (JAK) inhibitors

These list change as the FDA approves new drugs and they are introduced to the US market.

See Biologics, Biosimilars, and Interchangeable Biosimilars—What is the Difference?

Cost

Biologics tend to be expensive. For example, a month’s supply of Humira (two doses) can cost around $2,000 without insurance. Some patients may be eligible for coupons and discounts through pharmaceutical companies.

Dr. Kathee de Falla is a licensed and certified pharmacist. She has more than a decade of experience providing medical advice and supplying prescription medications in a retail setting. Dr. de Falla spent several years developing drugs at Abbott Laboratories, a pharmaceutical company where she holds a patent for a drug formulation.

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what it is and how to apply it

Protection of cultivated plants on the site is one of the most important measures that have a direct impact on the future harvest. However, many gardeners fear for their own health. How to protect plants without harm to yourself?

What are biological products

Chemicals used to control diseases and pests can indeed be dangerous to humans if safety measures are not observed during work or when processed plants are used as food.

The protective period of such drugs can be up to 1 month. But sometimes pests and diseases attack crops just before harvest. It is no longer possible to treat them with chemical means, and ignoring them will lead to the loss of fruits.

In such cases, biological preparations come to the rescue. These are special compounds of natural (biological) origin that do not affect human health, but lead to the death of harmful insects and fungi.

They are obtained on the basis of the vital activity of living organisms – viruses, fungi, bacteria, plants. They are destructive only in relation to a certain list of pests and diseases.

Biological products have won the recognition of gardeners thanks to:

• Safety. The formulations are absolutely safe for humans and animals. Processed fruits are allowed to be eaten after a few days.
• Sustainability. Preparations are not dangerous for the environment, often do not affect the bees.
• Complex action. Most of the products combine a double action – they fight the “enemy” of the plant and strengthen its immunity.
• Economy. A small amount is sufficient for processing. Solutions do not require special conditions for preparation.
• Expiry date. Biological products can be used from spring to autumn frosts.
• Validity. Compounds are harmful to insects at all stages of their development.
• Not addictive. Insects and pathogens are not accustomed to natural remedies (versus chemical ones).

Varieties of biological preparations

Based on the active substance and purpose of use, biological preparations are classified into several main groups. The choice of means is carried out depending on the nature of the problem.

Ecological products are subdivided into:

• biofungicides – preparations against fungal or bacterial diseases;
• bioinsecticides – pesticides;
• stimulants – formulations based on plant extracts affecting crop growth; can be used both during the growing season and at the stage of preparing seeds for sowing.

Biofungicides

Popular biofungicides include:

1. Phytodoctor Leaf. Prevents the development of bacterial and fungal diseases. Used for processing plants, harvested fruits, storage containers.
2. Kazumin. Means for combating bacterial, fungal diseases. It can be used for both treatment and prevention.
3. Trichodermin. The drug is especially effective against rot, both plants during the growing season and seeds before sowing are subject to treatment.
4. Phytosporin. The most famous remedy for diseases of various origins. Non-addictive, works at any positive temperature.

Bioinsecticides

Biological insecticides include:

1. Kaput. A popular remedy based on the activity of soil fungi. Effective in the fight against ticks and insects – it affects their nervous system. Causes mass death of pests for 5-6 days.
2. Fitoverm. A common biological product that is effective against many pests of indoor and horticultural crops.
3. Aktofit. Remedy for harmful insects, which has a paralyzing effect on them. Can be used in hot weather.
4. Entocide. Soil insecticide developed on the basis of fungi that destroys pests living in the soil. Not dangerous for earthworms.
5. Aktarofit. A fungal-based agent that destroys harmful insects. The death of pests begins on the 2nd day, reaches a maximum on the 5th day.

Stimulants

Biological stimulants have a gentle effect on horticultural crops due to their natural composition – plant extracts.

Recommended stimulants are:

1. Amalgerol. Combines the action of a biostimulator and a soil bioactivator. Increases plant immunity, improves soil microflora, does not affect insects.
2. Replant. A unique drug that protects potatoes from pests, diseases, stimulates its development, and prevents stressful conditions of the plant.

Advantages of biological products over chemical plant protection products

Eating organic fruits and vegetables is beneficial for human health. And the widespread use of chemical plant protection products leads to their accumulation in soil, water and plant parts. In addition, useful organisms often die at the same time as harmful ones. They also note the formation of resistance of harmful microorganisms to chemicals during their intensive use. Therefore, the advantages of biological products are obvious. Their active substances are products of natural biocenoses. Thus, they are environmentally friendly and safe for the environment, humans, animals, insects. When used correctly, they are highly effective.

Application of biological preparations

Biological agents for the protection of garden plants can be used on any crops: fruit and berry, ornamental, vegetable, green. The use of biological products is an absolutely safe, fast and economical way to get rid of fungi or insects on cultivated plants. Despite the environmental friendliness of the products, dosages should be strictly observed. Deviation from the recommended norms can reduce the effectiveness of drugs.

To achieve maximum effectiveness, it is necessary to “awaken” the microorganisms that make up the biological products. This may take infusion for several hours.

Processing is only recommended in the evening as the preparations break down in direct sunlight. So biological products have a longer effect on diseases and pests.

They are more effective in cool (but not cold) weather, with high humidity (but not dampness). The action of the compositions is terminated with precipitation or a strong decrease in air temperature. Processing is subjected not only to the plants themselves, but also the soil under them. This reduces the likelihood of re-spreading of pests and fungi.

The death of insects does not occur instantly, as is the case with the use of chemicals, but after a couple of days. Multiple treatments recommended.

Biological products require special storage conditions. Best of all, they retain their properties at a temperature of about 5 degrees, in a dark place.

If the use of biological products or their choice causes you difficulties, please contact the managers of our online store. They will help you choose an effective remedy that will not harm the environment and the body. They will tell you about the procedure for preparing and using the solution.

Biological economy: how bio-based crops work

Biologization is a new trend in agriculture, the essence of which is to care for the environment and use biological products instead of conventional ones. This is an integrated approach that allows you to increase productivity while reducing production costs.

The main methods of improving soil fertility during biologization are the introduction of organic fertilizers and microbiological preparations into the soil. This also includes a reduction in the use of chemical agents and herbicidal treatments due to biological agents and cultivation with special equipment.

The so-called soil microbial activators have recently become very popular. European producers claim that their products are an innovative development, but farmers know that often the new is the well-forgotten old.

First steps

Scientists from the USSR were among the first to develop special preparations. In those days, farmers often faced a shortage of fertilizers. To solve the problem, the government actively sponsored scientific research in this area, which led to the creation in 1960s of fertilizers based on nitrogen-fixing microorganisms. After 20 years, plant protection products came into use, which are now also classified as biological products.

But their century turned out to be short-lived – they were soon supplanted by centralized chemicalization, which began in the 80s. In the 1990s, state sponsorship of scientific developments came to naught. Now interest in biologization in Russia is reviving, albeit slowly. On the market

again there are drugs that work not on chemical compounds, but on live bacteria.

Two ways

Doctor of Biological Sciences, Head. Laboratory of Biotechnology of Plants and Microorganisms of the Center of the North-East. Rudnitsky Irina Shirokikh notes that the management of biological processes in agrocenoses is possible through the introduction of agronomically valuable strains of microorganisms both into the soil and into the rhizosphere of plants. Numerous experiments carried out allow us to assert that the symbiosis of microorganisms with plants is the basis of the latter’s vital activity.

At the same time, in order to ensure optimal mineral nutrition of the crop, it is important not only the amount of nutrients in the soil, but also the degree of their availability. It is bacteria and microscopic fungi that are a kind of intermediaries between the soil and the plant, and therefore, the more active they are, and the wider their diversity, the better.

The development of biopreparations that activate microbiomes is going in two directions. The first option is the use of microbes directly, which, when the drug is introduced into the soil, have a positive effect on its fertility due to biological nitrogen fixation, more active decomposition of crop and other plant residues, the formation of humic substances and the suppression of phytopathogens.

The second option is the pre-sowing treatment of seeds or already vegetative plants with bacteria that stimulate growth and protect various crops from pathogens of harmful diseases.

– In both cases, most often we are talking about preparations containing microorganisms – cellulolytics, nitrogen-fixing and phosphate-mobilizing bacteria, – the specialist notes. – These include some bacilli, streptomycetes, Pseudomonas, and so on. When these beneficial bacteria are introduced into the agrocenosis, the plant begins to “feed” them with its secretions, in which there are tasty food sources for microbes. This is how a beneficial exchange occurs: microorganisms fix nitrogen for plants, supply phytohormones and vitamins, protect against stress and pathogens.

As a result, plants can actively develop even on soils poor in nitrogen.

Irina Gennadievna added that the situation is different with phosphorus: as a rule, there is quite a lot of it in soils, but it is in a form that is difficult to digest. And many microorganisms, such as mycorrhizal fungi, phosphate-mobilizing bacteria, produce acids outside, which dissolve hard-to-reach compounds, due to which the plant absorbs phosphorus.

Another option is humic preparations, the active ingredients of which are sodium, ammonium and potassium humates. It is known that humic substances are the products of vital activity of soil microorganisms. They activate the activity of soil microflora, increase the supply of nutrients to plants, stimulate the growth and development of plants, increase their resistance to low and high temperatures, moisture deficiency, increase yield and improve its quality.

Humic biopreparations have another useful property – they are able to bind toxic and radioactive elements into slow-moving or difficult-to-dissociate compounds. The introduction of such growth stimulants into the soil increases the number of ammonifying bacteria by an average of 3-5 times, nitrifying – by 3-7 times. The ability to fix molecular nitrogen also increases – about 10 times.

– Thus, biological products of both the first and second groups, at a relatively low cost and high environmental friendliness, effectively affect the soil, contributing to a more active life exchange between plants and microorganisms, increasing productivity and maintaining soil fertility, – adds Irina Shirokikh.

Experts note that biological preparations are distinguished by high payback. This is due to their low cost and high efficiency. In addition, one drug can be used throughout the entire growing season, and its effect will manifest itself in the long term.

Measure seven times

Proper use of drugs in modern agriculture has many advantages. However, a positive effect will be only in the case of thoughtful introduction of stimulants.

– It is possible to activate the soil microflora only up to certain limits, since excessive biological activity can have negative consequences for the soil: destruction of organic matter, dehumification and deflation processes. Therefore, the use of biological products, as well as any other agricultural technologies, should be targeted and take into account the peculiarities of crop rotations, tillage systems, regional natural and climatic conditions. Not a single biological product is universal: a differentiated approach is needed in this area, – says Irina Shirokikh.

For this reason, soil biologization, including the introduction of microbial activators, is more popular in small and medium-sized farms. Within the framework of a large enterprise, the lands can be very different from each other, and therefore it is necessary to select their own preparations for each type.

In addition, the use of such preparations requires not only attention to the condition of the soil, but also work with it, since the survival of bacteria depends on this. So, some of them may simply not survive if the soil is, for example, too acidic.

Prospects

But the prospects for biological products are great. This is also evidenced by statistics – the market volume over the past 5-6 years has grown more than three times due to an increase in demand from farmers who are faced with depletion and soil pollution due to excessive chemicalization.

Biologization is developing especially actively in regions where agrarians closely cooperate with scientific institutes: in the Krasnodar and Stavropol Territories, Bashkiria, Belgorod, Voronezh, Leningrad, Tomsk Regions and in the Moscow region.