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Mifamurtide is a synthetic immunomodulator and a derivative of muramyl dipeptide (MDP), formulated as a liposomal preparation. It acts by activating monocytes and macrophages, primarily through interaction with the nucleotide-binding oligomerization domain 2 (NOD2) receptor, leading to nuclear factor kappa B (NF-kB) activation. This results in the production of proinflammatory cytokines and enhances both bactericidal and tumoricidal immune responses. Mifamurtide is used as an adjuvant therapy in combination with postoperative multi-agent chemotherapy for high-grade, resectable, non-metastatic osteosarcoma after complete surgical resection in children, adolescents, and young adults. The drug has demonstrated improved overall survival when added to standard chemotherapy regimens[1][2][3][4][5][8].
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