Treatment of Mycobacterium fortuitum pulmonary infection with "transfer factor" (TF): new methodology for evaluating TF potency and predicting clinical response

Transfer Factor: Myths and Facts

Transfer factor (TF), also called "Lawrence transfer factor", or dialyzable leukocyte extract (DLE), has been used since the mid-twentieth century to transfer specific skin hypersensitivity through the injection of leukocytes from immunized donors to animals and humans. The main mechanism of action of TF has been suggested at the level of cell-mediated immunity, as it induces the production of migration inhibitory factor (MIF) and interferon gamma (IFN-γ). Otherwise, TF can inhibit nuclear factor κ-light-chain-enhancer of activated B cells (NF-κB), and decrease tumoral necrosis factor α (TNF-α) and IL-4 levels. Given these biological effects, TF has been prescribed for a wide variety of conditions including infections, allergies, autoimmunity, and cancer, with inconsistent results. The exact nature of TF, however, remains unknown, so it has been impossible to accurately define its pharmacokinetics or dosage. This is further complicated because researchers have used TF in a variety of ways across the different studies: antigen-specific or non-antigen-specific, orally or subcutaneously administered, human and non-human origin. In this review we summarize the most important data about what TF is, its mechanism of action, how it is produced, its biological effects, and the available clinical trials using it, in order to establish its role and potential clinical applications in modern medicine.

CpG and transfer factor assembled on nanoparticles reduce tumor burden in mice glioma model

This work describes the use of a transfer factor, a low molecular protein that can transfer cell mediated immunity from donor to recipient, and CpG, a clinically relevant toll-like receptor agonist, for treating glioma.

Transfer factors as immunotherapy and supplement of chemotherapy in experimental pulmonary tuberculosis

Problems of logistics, compliance and drug resistance point to an urgent need for immunotherapeutic strategies capable of shortening the current six month antibiotic regimens used to treat tuberculosis. One potential immunotherapeutic agent is transfer factors. Transfer factors (TF) are low molecular weight dialysable products from immune cells which transmit the ability to express delayed-type hypersensitivity (DTH) and cell mediated immunity from sensitized donors to nonimmune recipients. In this study we determined the efficiency of TF as immunotherapy to treat experimental tuberculosis. When BALB/c mice are infected via the trachea with Mycobacterium tuberculosis H37Rv there is an initial phase of partial resistance dominated by Th-1 type cytokines plus tumour necrosis factor-alpha (TNFalpha) and the inducible isoform of nitric oxide synthase (iNOS), followed by a phase of progressive disease characterized by increasing expression of IL-4, diminished expression of TNFalpha and iNOS, and low DTH. Animals in this late progressive phase of the disease (day 60) were treated with different doses of TF (one injection per week) obtained from spleen cells when the peak of immune protection in this animal model is reached (day 21), or with different doses of TF from peripheral leucocytes of PPD + healthy subjects. We show here that the treatment with murine or human TF restored the expression of Th-1 cytokines, TNFalpha and iNOS provoking inhibition of bacterial proliferation and significant increase of DTH and survival. This beneficial effect was dose dependent. Interestingly, murine TF in combination with conventional chemotherapy had a synergistic effect producing significant faster elimination of lung bacteria loads than chemotherapy alone.

In vitro studies during long-term oral administration of specific transfer factor

153 patients suffering from recurrent pathologies, i.e. viral infections (keratitis, keratouveitis, genital and labial herpes) uveitis, cystitis, and candidiasis were treated with in vitro produced transfer factor (TF) specific for HSV-1/2, CMV and Candida albicans. The cell-mediated immunity of seropositive patients to HSV-1/2 and/or CMV viruses was assessed using the leucocyte migration inhibition test (LMT) and lymphocyte stimulation test (LST) in presence of the corresponding antigens, and the frequency of positive tests before, during and after TF administration was studied. The data were stratified per type of test, antigen and the recipients' pathology, and statistically evaluated. For the LMT, a total of 960 tests were carried out for each antigen dilution, 3 different antigen dilutions were used per test. 240/960 tests (25.4%) were found positive during non-treatment or treatment with unspecific TF, whereas 147/346 tests (42.5%) were found positive when the antigen corresponding to the specificity of the TF administered to the patient was used (P < 0.001). When the data were stratified following pathology, a significant increased incidence of positive tests during specific treatment was also observed (0.0001 < P < 0.05). In the LST (1174 tests), a significant increase of thymidine uptake was observed in the absence of antigen (control cultures), during treatment with both specific and unspecific TF, but also in the presence of antigen and/or autologous serum during specific TF administration (P < 0.0001). TF administration also significantly increased the soluble HLA class I antigens level in 40 patients studied to this effect.

Stabilization of Salmonella-specific dialyzable leukocyte extracts

Activity of Salmonella-specific dialyzable leukocyte extracts (DLE) prepared from mesenteric lymphatic nodes of calves and stabilized with bovine albumin was studied in this work. The effect of ambient temperature and storage period on the activity of DLE was evaluated. Testing for DLE activity by means of capillary leukocyte migration inhibition (LMI) assay showed that DLE stabilized with albumin retained 60% of its activity for 12 months of storage at 4 degrees C. This level of activity was retained in the native DLE (without albumin) kept at -20 degrees C. DLE stabilized with albumin and stored for 12 months at 4 degrees C inhibited the penetration of salmonellae into the liver and spleen, and their colonization in the gastrointestinal tract was significantly reduced.

Dialyzable leukocyte extract used in the prevention of Salmonella infection in calves

The protective effect of dialyzable leukocyte extract (DLE) was investigated in the experimental model of Salmonella infection in calves. DLE was obtained from the lymphatic nodes and spleens of fattening bulls immunized with whole-cell Salmonella vaccine (designated DLEs-im), from the same organs of calves immunized and subsequently infected with Salmonella typhimurium (DLEs-inf), and from non-immunized fattening bulls (DLEn). Three doses of DLEs-inf and DLEs-im applied intravenously at 3-day intervals induced protection in all calves against infection. There were statistically significant differences in the immunological, clinical and microbiological parameters. Three doses of DLEs-inf injected intramuscularly at 3-day intervals provided a protective effect; however, one calf died. The intravenous application of DLEn induced low protection against experimental Salmonella infection and two calves died. The results indicate that the preparation of antigen-specific DLE may be possible via immunization of fattening bulls.

The experimental and clinical use of immune-modulating drugs in the prophylaxis and treatment of infections

Therapeutic agents capable of stimulating immune responses could be of great value in the prophylaxis and treatment of infectious diseases. Three classes of compounds, each representing a separate approach to the goal of immune stimulation, are discussed with respect to recent experimental and clinical findings. The action of microbial structures and their derivatives can be understood on the basis of "acquired cellular immunity", a phenomenon first described in connection with infections by mycobacteria and other intracellular organisms. In contrast, there is hardly a common denominator for synthetic compounds which are currently used as immune-stimulatory agents. Substances which influence purine metabolism in lymphocytes on the one hand and histamine H2 blockers such as cimetidine on the other hand seem to represent the most promising developments in this field to date. Products of immune cells such as transfer factor and lymphokines form the third and possibly most important group of immune-stimulating agents. Current experimental and clinical trends in this field are briefly described. It is suggested that the delineation of the mechanism of action of lymphokines will open the door to the identification or synthesis of artificial agonists and antagonists as has been the case in the pharmacology of the endocrine and nervous systems.

Transfer factor and repeated otitis media

The effect of transfer factor (TF) was investigated in 12 children with repeated otitis media. These patients were immunologically compared to a control group of 23 age-matched healthy children. Levels of immunoglobulins, total and "active" T-cells, and phagocytic activity of granulocytes and monocytes were evaluated in the 12 children prior to, during, and after TF therapy. Percentages of "active" T cells and absolute numbers of "active" T and total T cells, which were initially low in the patient group, increased significantly after TF therapy to statistically match those of the healthy control group. The percentage of phagocytic monocytes in patients after therapy did not differ from healthy children; however, the percentage of phagocytic granulocytes remained depressed significantly. The levels of IgG, IgA, and IgM were unaffected by the therapy although the IgA and IgM were higher in the patient population throughout the study. After therapy, one-half of the patient population remained asymptomatic for a 1-year period and the others had markedly reduced attack rates.

The experimental and clinical use of immune-modulating drugs in the prophylaxis and treatment of infections

Therapeutic agents capable of stimulating immune responses could be of great value in the prophylaxis and treatment of infectious diseases. Three classes of compounds, each representing a separate approach to the goal of immune stimulation, are discussed with respect to recent experimental and clinical findings. The action of microbial structures and their derivatives can be understood on the basis of "acquired cellular immunity", a phenomenon first described in connection with infections by mycobacteria and other intracellular organisms. In contrast, there is hardly a common denominator for synthetic compounds which are currently used as immune-stimulatory agents. Substances which influence purine metabolism in lymphocytes on the one hand and histamine H2 blockers such as cimetidine on the other hand seem to represent the most promising developments in this field to date. Products of immune cells such as transfer factor and lymphokines form the third and possibly most important group of immune-stimulating agents. Current experimental and clinical trends in this field are briefly described. It is suggested that the delineation of the mechanism of action of lymphokines will open the door to the identification or synthesis of artificial agonists and antagonists as has been the case in the pharmacology of the endocrine and nervous systems.