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Most in vitro and animal experiments have suggested immunostimulatory effects; however, 1 study found a spirulina extract to be immunosuppressive. 61 Activation of monocytes and macrophages, 62 , 63 as well as augmentation of interleukin and interferon production, have been demonstrated. 64 Intestinal epithelial lymphocytes of aged mice treated with spirulina were increased compared with the control aged group. 65 A clinical study in healthy men found that oral administration of spirulina for 3 months resulted in enhanced interferon production and natural killer (NK) cell capacity. 25 An ex vivo study of NK cells from spirulina-treated healthy patients showed increased NK activity, which was confirmed by a second study in which NK cell and T-cell markers were increased by spirulina. 66 A clinical trial in elderly patients showed positive effects on anemia and immunosenescence after 6 and 12 weeks of supplementation. 67 The immunostimulatory effects appear to be largely mediated by spirulina polysaccharides. 62 , 63

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