Interferon gamma-1b in the treatment of compensatory anti-inflammatory response syndrome - A new approach: Proof of principle

被引:130
作者
Kox, WJ
Bone, RC
Krausch, D
Docke, WD
Kox, SN
Wauer, H
Egerer, K
Querner, S
Asadullah, K
vonBaehr, R
Volk, HD
机构
[1] HUMBOLDT UNIV BERLIN, UNIV HOSP CHARITE, INST MED IMMUNOL, D-10117 BERLIN, GERMANY
[2] RUSH PRESBYTERIAN ST LUKES MED CTR, CHICAGO, IL 60612 USA
[3] BOEHRINGER INGELHEIM GMBH, INGELHEIM, GERMANY
关键词
D O I
10.1001/archinte.157.4.389
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Immunoparalysis is defined as a decrease in the level of HLA-DR expression on monocytes during the course of sepsis. Objective: To evaluate whether interferon gamma-1b has an immunoregulatory effect in patients with immunoparalysis during the compensatory anti-inflammatory response syndrome. Methods: Of the patients admitted consecutively to the intensive care unit for the management of sepsis, 10 received interferon gamma-1b, 100 mu g per 0.5 mL, after confirmation of HLA-DR expression of less than 30% on 2 consecutive days. The therapy was continued until HLA-DR expression remained more than 50% for 3 days. Results: Interferon gamna-1b therapy resulted in the recovery of diminished levels of HLA-DR expression on monocytes. Of the 10 patients, 8 responded to treatment within 1 day. On the first day of interferon gamma-1b therapy, HLA-DR expression increased from mean (+/-SEM) pretreatment levels of 27%+/-6% to 62%+/-8% (P<.01) and remained high during the 28-day study period in 8 patients. The therapy was given to 2 patients a second time when HLA-DR expression on monocytes was less than 30%. The recovery of monocytic HLA-DR expression levels after administration of interferon gamma-1b was associated with restitution of monocytic function, reflected by a significant increase of plasma interleukin-6 (P<.05) and tumor necrosis factor alpha (P<.05) levels in 9 patients. Conclusions: This study shows that HLA-DR expression is a good marker of compensatory anti-inflammatory response syndrome. It also shows that interferon gamma-1b not only restored the levels of HLA-DR expression but also reestablished the ability of monocytes to secrete the cytokines interleukin-6 and tumor necrosis factor alpha.
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页码:389 / 393
页数:5
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