Avian Influenza
Chemotherapy may help bird flu victims
Mar 3, 2006 - 12:42:37 PM

Chemotherapy for an immune system disorder might also be effective in treating people infected with the H5N1 strain of bird flu, scientists say.

With the possibility of resistance to antiviral treatments, absence of human vaccines and the spread of this flu across the globe, new treatments are urgently required, argues a team from the Karolinska University Hospital in Stockholm.

Jan-Inge Henter, a paediatric clinical oncologist, noticed that the symptoms of patients infected with H5N1 were very similar to those with an often-fatal immune disease called haemophagocytic lymphohitiocytosis (HLH), reported.

Indeed, three papers on patients with H5N1 note that its symptoms include a profound over-response of the immune system, which also occurs in HLH patients.

The over-production of certain immune messengers, such as interleukin 6, is seen in H5N1 patients and cause of death is often linked to sepsis with multi-organ failure - all symptoms also associated with HLH.

But HLH, both in its inherited form and in response to the Epstein-Barr virus, can be treated with drugs, including a key chemotherapy called etoposide, which kills excess immune cells.

When the chemotherapy is given immediately, the treatments increased survival rates from 56 percent to 90 percent in comparison with giving treatment at four weeks or not at all, according to one retrospective study of patients with Epstein-Barr-virus-associated HLH.

"Etoposide is an excellent trigger of programmed cell death in immune cells," says Henter.

"So we think that the immune regulation of patients with severe (H5N1) infection is out of control. We are down-regulating things to kill off some of the cells to get some kind of balance - there is some logic to how this could work."

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