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Yndart Arias A, Kolishetti N, Vashist A, Madepalli L, Llaguno L, Nair M. Anti-inflammatory effects of CBD in human microglial cell line infected with HIV-1. Sci Rep 2023; 13:7376. [PMID: 37147420 PMCID: PMC10162654 DOI: 10.1038/s41598-023-32927-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/04/2023] [Indexed: 05/07/2023] Open
Abstract
Human immunodeficiency virus (HIV) infection is associated with a chronic inflammatory stage and continuous activation of inflammasome pathway. We studied the anti-inflammatory effects of the compound cannabidiol (CBD) in comparison with Δ (9)-tetrahydrocannabinol [Δ(9)-THC] in human microglial cells (HC69.5) infected with HIV. Our results showed that CBD reduced the production of various inflammatory cytokines and chemokines such as MIF, SERPIN E1, IL-6, IL-8, GM-CSF, MCP-1, CXCL1, CXCL10, and IL-1 β compared to Δ(9)-THC treatment. In addition, CBD led to the deactivation of caspase 1, reduced NLRP3 gene expression which play a crucial role in the inflammasome cascade. Furthermore, CBD significantly reduced the expression of HIV. Our study demonstrated that CBD has anti-inflammatory properties and exhibits significant therapeutic potential against HIV-1 infections and neuroinflammation.
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Affiliation(s)
- Adriana Yndart Arias
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
- Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
| | - Nagesh Kolishetti
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
- Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Arti Vashist
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
- Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Lakshmana Madepalli
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
- Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Lorgeleys Llaguno
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA
| | - Madhavan Nair
- Department of Immunology and Nano-Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
- Institute of Neuroimmune Pharmacology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, 33199, USA.
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Aggarwal S, Mishra S. Differential role of segments of α-mating factor secretion signal in Pichia pastoris towards granulocyte colony-stimulating factor emerging from a wild type or codon optimized copy of the gene. Microb Cell Fact 2020; 19:199. [PMID: 33121493 PMCID: PMC7597063 DOI: 10.1186/s12934-020-01460-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The methylotrophic yeast, Pichia pastoris has been widely used for the production of human therapeutics, but production of granulocyte colony-stimulating factor (G-CSF) in this yeast is low.The work reported here aimed to improve the extracellular production of G-CSF by introducing mutations in the leader sequence and using a codon optimized copy of G-CSF. Bioinformatic analysis was carried out to propose an explanation for observed effect of mutations on extracellular G-CSF production. RESULTS Mutations in the pro-region of the α-mating type (MAT) secretory signal, when placed next to a codon optimized (CO)-GCSF copy, specifically, the Δ57-70 type, led to highest G-CSF titre of 39.4 ± 1.4 mg/L. The enhanced effect of this deletion was also observed when it preceded the WT copy of the gene. Deletion of the 30-43 amino acids in the pro-peptide, fused with the wild type (WT)-GCSF copy, completely diminished G-CSF secretion, while no effect was observed when this deletion was in front of the CO-GCSF construct. Also, Matα:Δ47-49 deletion preceding the WT-GCSF dampened the secretion of this protein, while no effect was seen when this deletion preceded the CO-GCSF copy of the gene. This indicated that faster rates of translation (as achieved through codon optimization) could overcome the control exercised by these segments. The loss of secretion occurring due to Δ30-43 in the WT-GCSF was partially restored (by 60%) when the Δ57-70 was added. The effect of Δ47-49 segment in the WT-GCSF could also be partially restored (by 60%) by addition of Δ57-70 indicating the importance of the 47-49 region. A stimulatory effect of Δ57-70 was confirmed in the double deletion (Matα:Δ57-70;47-49) construct preceding the CO-GCSF. Secondary and tertiary structures, when predicted using I-TASSER, allowed to understand the relationship between structural changes and their impact on G-CSF secretion. The Δ57-70 amino acids form a major part of 3rd alpha-helix in the pre-pro peptide and its distortion increased the flexibility of the loop, thereby promoting its interaction with the cargo protein. A minimum loop length was found to be necessary for secretion. The strict control in the process of secretion appeared to be overcome by changing the secondary structures in the signal peptides. Such fine tuning can allow enhanced secretion of other therapeutics in this expression system. CONCLUSIONS Among the different truncations (Matα:Δ57-70, Matα:Δ47-49, Matα:Δ30-43, Matα:Δ57-70;30-43, Matα:Δ57-70;47-49) in pro-peptide of α-MAT secretion signal, Matα:Δ57-70 fused to CO-GCSF, led to highest G-CSF titre as compared to other Matα truncations. On the other hand, Matα:Δ30-43 and Matα:Δ47-49 fused to the WT-GCSF dampened the secretion of this protein indicating important role of these segments in the secretion of the cargo protein.
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Affiliation(s)
- Sakshi Aggarwal
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, Hauz-Khas, New-Delhi, 110016, India
| | - Saroj Mishra
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi, Hauz-Khas, New-Delhi, 110016, India.
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Plasma concentration of injectable contraceptive correlates with reduced cervicovaginal growth factor expression in South African women. Mucosal Immunol 2020; 13:449-459. [PMID: 31896762 DOI: 10.1038/s41385-019-0249-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 11/10/2019] [Accepted: 12/15/2019] [Indexed: 02/06/2023]
Abstract
Long-acting injectable contraceptives have been associated with mucosal immune changes and increased HIV acquisition, but studies have often been hampered by the inaccuracy of self-reported data, unknown timing of injection, and interactions with mucosal transmission co-factors. We used mass spectrometry to quantify the plasma concentrations of injectable contraceptives in women from the CAPRISA004 study (n = 664), with parallel quantification of 48 cytokines and >500 host proteins in cervicovaginal lavage. Higher DMPA levels were associated with reduced CVL concentrations of GCSF, MCSF, IL-16, CTACK, LIF, IL-1α, and SCGF-β in adjusted linear mixed models. Dose-dependent relationships between DMPA concentration and genital cytokines were frequently observed. Unsupervised clustering of host proteins by DMPA concentration suggest that women with low DMPA had increases in proteins associated with mucosal fluid function, growth factors, and keratinization. Although DMPA was not broadly pro-inflammatory, DMPA was associated with increased IP-10 in HSV-2 seropositive and older women. DMPA-cytokine associations frequently differed by vaginal microbiome; in non-Lactobacillus-dominant women, DMPA was associated with elevated IL-8, MCP-1, and IP-10 concentrations. These data confirm a direct, concentration-dependant effect of DMPA on functionally important immune factors within the vaginal compartment. The biological effects of DMPA may vary depending on age, HSV-2 status, and vaginal microbiome composition.
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Samadi DS, Goldberg AN, Orlandi RR. Granulocyte Transfusion in the Management of Fulminant Invasive Fungal Rhinosinusitis. ACTA ACUST UNITED AC 2018. [DOI: 10.1177/194589240101500408] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Usually, fulminant, invasive fungal rhinosinusitis is observed in the immunocompromised patient and is associated with significant morbidity and mortality. A high index of suspicion and early diagnosis is imperative for optimizing outcome. Mainstays of treatment include antifungal agents and radical resection of necrotic tissue. Reversal of the underlying medical condition, when possible, is a critical part of the management. In the neutropenic population, granulocyte transfusion may represent an adjunct to current therapy. We provide the first report of a case of invasive fungal rhinosinusitis in which this intervention was used.
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Affiliation(s)
- Daniel S. Samadi
- Department of Otorhinolaryngology–Head and Neck Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Andrew N. Goldberg
- Department of Otolaryngology–Head and Neck Surgery, University of California–San Francisco, San Francisco, California
| | - Richard R. Orlandi
- Department of Otolaryngology, University of Utah School of Medicine, Salt Lake City, Utah
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Yaseen MM, Abuharfeil NM, Yaseen MM, Shabsoug BM. The role of polymorphonuclear neutrophils during HIV-1 infection. Arch Virol 2017; 163:1-21. [PMID: 28980078 DOI: 10.1007/s00705-017-3569-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/14/2017] [Indexed: 12/23/2022]
Abstract
It is well-recognized that human immunodeficiency virus type-1 (HIV-1) mainly targets CD4+ T cells and macrophages. Nonetheless, during the past three decades, a huge number of studies have reported that HIV-1 can directly or indirectly target other cellular components of the immune system including CD8+ T cells, B cells, dendritic cells, natural killer cells, and polymorphonuclear neutrophils (PMNs), among others. PMNs are the most abundant leukocytes in the human circulation, and are known to play principal roles in the elimination of invading pathogens, regulating different immune responses, healing of injured tissues, and maintaining mucosal homeostasis. Until recently, little was known about the impact of HIV-1 infection on PMNs as well as the impact of PMNs on HIV-1 disease progression. This is because early studies focused on neutropenia and recurrent microbial infections, particularly, during advanced disease. However, recent studies have extended the investigation area to cover new aspects of the interactions between HIV-1 and PMNs. This review aims to summarize these advances and address the impact of HIV-1 infection on PMNs as well as the impact of PMNs on HIV-1 disease progression to better understand the pathophysiology of HIV-1 infection.
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Affiliation(s)
- Mahmoud Mohammad Yaseen
- Medical Laboratory Sciences, College of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, 22110, Jordan.
| | - Nizar Mohammad Abuharfeil
- Applied Biological Sciences, College of Science and Arts, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Mohammad Mahmoud Yaseen
- Public Health, College of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
| | - Barakat Mohammad Shabsoug
- Chemical Sciences, College of Science and Arts, Jordan University of Science and Technology, Irbid, 22110, Jordan
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Brumann M, Bogner V, Völkl A, Sotlar K, Euler E, Mutschler W. Necrotizing fasciitis in a young patient with acute myeloid leukemia - a diagnostic challenge. Patient Saf Surg 2014; 8:28. [PMID: 25002906 PMCID: PMC4084793 DOI: 10.1186/1754-9493-8-28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 06/18/2014] [Indexed: 11/16/2022] Open
Abstract
Background Necrotizing fasciitis is characterized by a fulminant destruction of the soft tissue with an alarmingly high mortality rate. One of the main reasons for the continued high mortality is due to the challenge to punctual recognize and diagnose this disease, as specific cutaneous signs can vary or even be missing early in its evolution – especially in case of simultaneous first manifestation of an acute leukemia. Case presentation An untypical case of necrotizing fasciitis disease in a young patient with the first diagnosis of acute myeloid leukemia is presented. After her induction chemotherapy the only presenting clinical sign was fever in the presence of severe neutropenia without an evident infectious focus. After a few days a painless confluent, erythematous, pustular skin rash with a central necrosis on lateral thigh appeared. Escherichia coli was isolated from blood cultures. Surgical debridement was performed and showed subcutaneous tissue, fascia and underlying muscle around the site of initial cutaneous manifestation with typical necrosis on exploration. But, initially taken skin biopsy did not show any typical histopathological findings like bacteria or inflammatory cells confirming necrotizing fasciitis. Nevertheless, the intraoperative findings were impressive and highly indicative for a necrotizing soft tissue infection, so that the patient was treated according to clinical guidelines with extensive recurrent surgical debridement, broad-spectrum antibiotics and intensive care therapy. After recovering from NF, she successfully underwent further chemotherapy and stem cell transplantation. Conclusion The presented case highlights the risk of potential misinterpretation, delayed diagnosis and treatment of necrotizing fasciitis in patients presenting with an untypical clinical and histopathological manifestation of necrotizing fasciitis as a result of severe neutropenia following chemotherapy for acute myeloid leukemia.
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Affiliation(s)
- Mareen Brumann
- Department of Trauma Surgery, University Hospital Munich, Ludwig-Maximilians-University, Nussbaumstr. 20, Munich 80336, Germany
| | - Viktoria Bogner
- Department of Trauma Surgery, University Hospital Munich, Ludwig-Maximilians-University, Nussbaumstr. 20, Munich 80336, Germany
| | - Andreas Völkl
- Department of Hematology and Oncology, University Hospital Munich, Ludwig-Maximilians-University, Ziemsenstr. 1, Munich 80336, Germany
| | - Karl Sotlar
- Institute of Pathology, University Hospital Munich, Ludwig-Maximilians-University, Thalkirchnerstr. 36, Munich 80337, Germany
| | - Ekkehard Euler
- Department of Trauma Surgery, University Hospital Munich, Ludwig-Maximilians-University, Nussbaumstr. 20, Munich 80336, Germany
| | - Wolf Mutschler
- Department of Trauma Surgery, University Hospital Munich, Ludwig-Maximilians-University, Nussbaumstr. 20, Munich 80336, Germany
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Shi X, Sims MD, Hanna MM, Xie M, Gulick PG, Zheng YH, Basson MD, Zhang P. Neutropenia during HIV infection: adverse consequences and remedies. Int Rev Immunol 2014; 33:511-36. [PMID: 24654626 DOI: 10.3109/08830185.2014.893301] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neutropenia frequently occurs in patients with Human immunodeficiency virus (HIV) infection. Causes for neutropenia during HIV infection are multifactoral, including the viral toxicity to hematopoietic tissue, the use of myelotoxic agents for treatment, complication with secondary infections and malignancies, as well as the patient's association with confounding factors which impair myelopoiesis. An increased prevalence and severity of neutropenia is commonly seen in advanced stages of HIV disease. Decline of neutrophil phagocytic defense in combination with the failure of adaptive immunity renders the host highly susceptible to developing fatal secondary infections. Neutropenia and myelosuppression also restrict the use of many antimicrobial agents for treatment of infections caused by HIV and opportunistic pathogens. In recent years, HIV infection has increasingly become a chronic disease because of progress in antiretroviral therapy (ART). Prevention and treatment of severe neutropenia becomes critical for improving the survival of HIV-infected patients.
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Abstract
The development of an infection involves interplay between the host's immune system and the virulence of the infecting microorganism. The traditional treatment of an infection involves antimicrobial chemotherapy to kill the organism. The use of immunotherapies in infections includes treatment options that modulate the immune response and can lead to control of infections. These therapies are expected to become more important therapeutic options with the increase in infections due to multidrug-resistant organisms and the increasing number of immunocompromised patients.
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Affiliation(s)
- Vivek Kak
- Allegiance Health, 1100 East Michigan Avenue, #305, Jackson, MI 49201, USA.
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Molineux G, Foote M, Arvedson T. Use of Filgrastim (r-metHuG-CSF) in Human Immunodeficiency Virus Infection. TWENTY YEARS OF G-CSF 2012. [PMCID: PMC7123730 DOI: 10.1007/978-3-0348-0218-5_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In 2008, an estimated 33.4 million individuals worldwide were infected with the human immunodeficiency virus (HIV) [1]. Only a few years ago, infection with HIV almost invariably culminated in the development of the acquired immunodeficiency syndrome (AIDS), characterized by severe depletion of CD4+ lymphocytes leading to derangements predominantly affecting cell-mediated immunity, but affecting humoral immunity as well [2]. In the later stages of AIDS, neutropenia and neutrophil functional deficits were common sequelae of HIV infection, other opportunistic infections, or HIV- or opportunistic infection-related treatment [3]. The care of the HIV-infected patient was palliative in nature, and the possibility that use of filgrastim (rHuG-CSF) might extend survival in late-stage AIDS patients with severe neutropenia or severe opportunistic infections, or might be a treatment for HIV infection itself, was explored [4]. Subsequently, however, the development of protease inhibitors and the widespread adoption of their use in multidrug regimens of highly active antiretroviral therapy (HAART) revolutionized the care of HIV-infected patients, and the number of patients dying from HIV decreased dramatically [5].
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Affiliation(s)
- Graham Molineux
- Amgen Inc., One Amgen Center Drive, Thousand Oaks, 91320 California USA
| | - MaryAnn Foote
- MA Foote Associates, Par Five Court 4284, Westlake Village, 91362 California USA
| | - Tara Arvedson
- Amgen, Inc., One Amgen Center Dr. 1, Thousand Oaks, 91320 California USA
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Page AV, Liles WC. Colony-stimulating factors in the prevention and management of infectious diseases. Infect Dis Clin North Am 2011; 25:803-17. [PMID: 22054757 DOI: 10.1016/j.idc.2011.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Colony-stimulating factors (CSFs) are attractive adjunctive anti-infective therapies. Used to enhance innate host defenses against microbial pathogens, the myeloid CSFs increase absolute numbers of circulating innate immune effector cells by accelerating bone marrow production and maturation, or augment the function of those cells through diverse effects on chemotaxis, phagocytosis, and microbicidal functions. This article summarizes the evidence supporting the accepted clinical uses of the myeloid CSFs in patients with congenital or chemotherapy-induced neutropenia, and presents an overview of proposed and emerging uses of the CSFs for the prevention and treatment of infectious diseases in other immunosuppressed and immunocompetent patient populations.
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Affiliation(s)
- Andrea V Page
- Division of Infectious Diseases, Department of Medicine and SA Rotman Laboratories, McLaughlin-Rotman Centre for Global Health, Toronto General Hospital, University Health Network, University of Toronto, 13 Eaton North, Room 208, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada
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Abstract
It is firmly established that interferon-gamma (IFN-gamma) plays a mandatory role in acquired protective immunity to pathogenic mycobacteria and other intracellular pathogens. Therefore, it seems conceivable that application of recombinant IFN-gamma could be exploited for the treatment of tuberculosis. However, the results of experimental studies and clinical trials, conducted mostly in patients with multidrug resistant (MDR) disease, have thus far been only moderately encouraging. Further studies are now needed to determine if a greater clinical benefit from IFN-gamma could be obtained for the prophylactic treatment of latent tuberculosis infection and for shortening of the protracted standard chemotherapy regimen. Thus, aerosolized IFN-gamma treatment could be particularly beneficial to AIDS patients at high risk of developing mycobacterial infections, that is, those with significantly declined CD4(+) T cell counts. This review describes the current state of research on IFN-gamma interventions in tuberculosis and related infections and highlights some of the future opportunities.
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Affiliation(s)
- Rajko Reljic
- Department of Cellular and Molecular Medicine, St George's Hospital Medical School, University of London, 43 Cranmer Terrace, London, England.
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van Walraven C, Davis D, Forster AJ, Wells GA. Time-dependent bias was common in survival analyses published in leading clinical journals. J Clin Epidemiol 2004; 57:672-82. [PMID: 15358395 DOI: 10.1016/j.jclinepi.2003.12.008] [Citation(s) in RCA: 242] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2003] [Indexed: 10/25/2022]
Abstract
OBJECTIVE In survival analysis, "baseline immeasurable" time-dependent factors cannot be recorded at baseline, and change value after patient observation starts. Time-dependent bias can occur if such variables are not analyzed appropriately. This study sought to determine the prevalence of such time-dependent bias in highly-cited medical journals. STUDY DESIGN AND SETTING We searched Medline databases to identify all observational studies that used a survival analysis in American Journal of Medicine, Annals of Internal Medicine, Archives of Internal Medicine, British Medical Journal, Chest, Circulation, Journal of the American Medical Association, Lancet, and New England Journal of Medicine between 1998 and 2002. Studies with "baseline immeasurable" time-dependent factors were susceptible to time-dependent bias if a time-dependent covariate analysis was not used. RESULTS Of 682 eligible studies, 127 (18.6%, 95% CI 15.8-21.8%) contained a "baseline immeasurable" time-dependent factor and 52 (7.6% [5.8-9.9%] of all survival analyses/40.9% [32.3-50.0%] of studies with a time-dependent factor) were susceptible to time-dependent bias. In 35 studies (5.1% [3.7-7.1%]/27.6% [20.5-35.9%]), the bias affected a variable highlighted in the study abstract and correction of the bias could have qualitatively changed the study's conclusion in over half of studies. CONCLUSION In medical journals, time-dependent bias is concerningly common and frequently affects key factors and the study's conclusion.
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Affiliation(s)
- Carl van Walraven
- Department of Medicine, University of Ottawa, Ottawa Hospital, Civic Campus, 1053 Carling Avenue, F-660, Ottawa, ON K1Y 4E9, Canada.
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Moyle G, Sawyer W, Law M, Amin J, Hill A. Changes in hematologic parameters and efficacy of thymidine analogue-based, highly active antiretroviral therapy: a meta-analysis of six prospective, randomized, comparative studies. Clin Ther 2004; 26:92-7. [PMID: 14996521 DOI: 10.1016/s0149-2918(04)90009-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2003] [Indexed: 10/26/2022]
Abstract
BACKGROUND Hematologic changes that occur with HIV infection and antiretroviral therapy may impact the quality of life of patients and have been associated with morbidity and mortality. The management of anemia and neutropenia has improved survival in persons with HIV. OBJECTIVES This meta-analysis was performed to assess the changes in hemoglobin (Hb) levels and neutrophil counts that occur during thymidine analogue-based triple therapy and to establish whether different regimens of triple therapy are similar in efficacy based on CD4(+) T-cell count and viral load changes. METHODS This was a meta-analysis of the impact of zidovudine (AZT) compared with stavudine (d4T) in triple therapy regimens in HIV patients with regard to hematologic parameters and efficacy markers. The peer-reviewed literature was searched with use of MEDLINE, PubMed, EMBASE, and the Cochrane database of systematic reviews (key terms: HIV, antiretroviral therapy, CD4, viral load, three, triple, and highly active antiretroviral therapy [HAART]). Searches were initially not limited by publication type, study design, date, or language but subsequently were sorted to include only studies performed in treatment-naive adult patients; randomized; and comparative of a regimen that included d4T with a regimen that included AZT; to involve regimens that included a minimum of 3 drugs each; and to include hematologic outcomes data. Outcomes were CD4(+), viral load, and hematologic parameters. RESULTS This meta-analysis included 6 studies. Treatment efficacy as measured by changes in CD4(+) T-cell counts and viral load did not differ significantly between regimens. Hb levels decreased with AZT treatment by a mean (SE) 0.4 (0.05) g/dL and 0.2 (0.06) g/dL at weeks 24 and 48, respectively, but increased with d4T treatment by 0.45 (0.03) g/dL and 0.58 (0.04) g/dL, respectively. All grades of anemia and neutropenia events were consistently more common with AZT-based regimens relative to d4T-based therapy. CONCLUSIONS AZT-based HAART has a greater negative impact on hematologic parameters relative to d4T-based regimens. AZT recipients are more likely than d4T recipients to experience anemia and neutropenia events of any grade, and AZT is associated with a net decrease in Hb level relative to a net increase with d4T. These factors may influence the choice of drug used in the treatment of certain patient populations.
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Jaworowski A, Maslin CLV, Wesselingh SL. The use of growth factors and cytokines to treat opportunistic infections in HIV-1 disease. Sex Health 2004; 1:161-74. [PMID: 16335304 DOI: 10.1071/sh03022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The success of highly active antiretroviral therapy (HAART) in reducing AIDS-related mortality means that in regions where HAART is available, HIV infection may now be regarded as a chronic disease. However the inability of HAART to eliminate HIV-1 from various anatomical and cellular reservoirs within the body means that HIV-infected individuals require life-long treatment with therapy that can have significant side effects. Management of HIV disease is therefore increasingly focused on drug-related toxicities and the improvement of current HAART regimens. Here we review the potential use of immunomodulatory cytokines to directly or indirectly stimulate the mononuclear phagocyte system as adjuncts to current HIV treatment as well as their use in the management of opportunistic infections in individuals who develop immunodeficiency. We argue that cytokines, which stimulate mononuclear phagocyte activity against opportunistic pathogens, may be useful for the treatment of individuals who develop recurrent opportunistic infections. Cytokines may act synergistically with antimicrobial agents to improve outcomes, which is of particular importance since recurrent infections frequently result in resistance to standard antimicrobial treatments. Before their use can be advocated however, given their toxicity and significant cost, the potential benefits of cytokines must be demonstrated in larger clinical trials.
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Affiliation(s)
- Anthony Jaworowski
- AIDS Pathogenesis and Clinical Research Program, The Burnet Institute for Medical Research and Public Health, Melbourne, Australia.
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Azoulay E, Delclaux C. Is there a place for granulocyte colony-stimulating factor in non-neutropenic critically ill patients? Intensive Care Med 2004; 30:10-7. [PMID: 14593456 PMCID: PMC7095052 DOI: 10.1007/s00134-003-2049-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2003] [Accepted: 09/29/2003] [Indexed: 11/22/2022]
Abstract
Immunoparalysis, characterised by impairments in neutrophil and monocyte/macrophage function, is common in critically ill patients. The theoretical ability of granulocyte colony-stimulating factor (G-CSF) to improve the functions of both neutrophils and monocytes/macrophages provides a rationale for G-CSF therapy in non-neutropenic critically ill patients with infection or a high risk of nosocomial infection. The expression of the receptors that mediate G-CSF effects in neutrophils and monocytes/macrophages is regulated by bacterial products, cytokines and endogenous G-CSF levels, accounting for the variables effects of G-CSF on the neutrophil functions of critically ill patients. This variability should be taken into account when designing studies on the use of G-CSF in ICU-patients. Studies are still needed to identify the subset of patients who may benefit from G-CSF therapy.
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Affiliation(s)
- Elie Azoulay
- Intensive Care Unit, Saint Louis Teaching Hospital, 1 Avenue Claude Vellefaux, 75010 Paris, France.
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16
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Hareng L, Hartung T. Induction and regulation of endogenous granulocyte colony-stimulating factor formation. Biol Chem 2002; 383:1501-17. [PMID: 12452428 DOI: 10.1515/bc.2002.172] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Granulocyte colony-stimulating factor (G-CSF) is one of the most prominent endogenous proteins in broad clinical use. While its biological and clinical effects are relatively well studied, little is known about its endogenous formation in health and disease. However, such knowledge is crucial to decide in which situations G-CSF should be applied efficiently in the clinic, ie. when endogenous production does not suffice. The dramatic changes induced by G-CSF in the differential blood cell count are directly immunomodulatory, strengthening the innate defence by multiplying neutrophilic granulocytes. A multitude of further immunomodulatory effects contribute to the regulation of the concerted host defence. In this review, following a short introduction into the biology of G-CSF, the available data on endogenous formation in a number of animal models and human diseases is compiled. The cellular sources and inducers of G-CSF formation are reviewed and the regulation of G-CSF expression on both the transcriptional and translational level are discussed. The emerging understanding of the role and regulation of endogenous G-CSF formation opens up possibilities to define therapeutic windows as well as targets for diagnostics or drug development. Lastly, the modulation of G-CSF formation by various pharmacological agents alerts to putative side effects of these drug treatments.
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Affiliation(s)
- Lars Hareng
- Biochemical Pharmacology, University of Konstanz, PO Box 655, D-78457 Konstanz, Germany
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Levine AM, Scadden DT, Zaia JA, Krishnan A. Hematologic Aspects of HIV/AIDS. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2002:463-78. [PMID: 11722999 DOI: 10.1182/asheducation-2001.1.463] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review addresses various aspects of HIV infection pertinent to hematology, including the consequences of HIV infection on specific aspects of hematopoiesis and an update on the current biologic, epidemiologic and therapeutic aspects of AIDS-related lymphoma and Hodgkin's disease. The results of the expanding use of progenitor cell transplantation in HIV infected patients are also reviewed. In Section I, Dr. Scadden reviews the basis for HIV dysregulation of blood cell production, focusing on the role of the stem cell in HIV disease. T cell production and thymic function are discussed, with emphasis placed upon the mechanisms of immune restoration in HIV infected individuals. Results of clinical and correlative laboratory studies are presented. In Section II, Dr. Levine reviews the recent epidemiologic trends in the incidence of lymphoma, since the widespread availability of highly active anti-retroviral therapy (HAART). The biologic aspects of AIDS-lymphoma and Hodgkin's disease are discussed in terms of pathogenesis of disease. Various treatment options for these disorders and the role of concomitant anti-retroviral and chemotherapeutic intervention are addressed. Drs. Zaia and Krishnan will review the area of stem cell transplantation in patients with AIDS related lymphoma, presenting updated information on clinical results of this procedure. Additionally, they report on the use of gene therapy, with peripheral blood CD34+ cells genetically modified using a murine retrovirus, as a means to treat underlying HIV infection. Results of gene transfer experiments and subsequent gene marking in HIV infected patients are reviewed.
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Affiliation(s)
- A M Levine
- University of Southern California, Norris Cancer Hospital, Los Angeles, CA 90033, USA
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Davidson M, Min YI, Holbrook JT, Van Natta ML, Murphy R, Jabs DA, Welch W, Meinert CL. Use of filgrastim as adjuvant therapy in patients with AIDS-related cytomegalovirus retinitis. AIDS 2002; 16:757-65. [PMID: 11964532 DOI: 10.1097/00002030-200203290-00011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neutropenia in AIDS predisposes to bacterial infection. Granulocyte colony-stimulating factor (filgrastim) can reverse neutropenia. OBJECTIVE To determine the effects of filgrastim on bacterial infections, hospitalization, and mortality in patients with cytomegalovirus retinitis and AIDS. METHODS Using a person-time analysis, a retrospective cohort study of filgrastim adjuvant therapy in three multicenter clinical trials of anti-cytomegalovirus therapy during the period 1990-1997 measured filgrastim use, bacterial infections, and mortality. RESULTS Of 719 patients, 379 patients used filgrastim for 31% of the follow-up time. There was an inverse relationship between the 389 confirmed bacterial infections, including 186 bacteremias, and absolute neutrophil counts. Before adjustment for CD4 T-cells counts and antibiotic/antiretroviral therapy, filgrastim was associated with reduced risk of catheter-related bacteremia [relative risk (RR), 0.52; P = 0.02] and repeat bacterial infection (RR, 0.41; P = < 0.01). After adjustment, the RR of catheter-related bacteremia with filgrastim use was decreased (RRadj, 0.69; P = 0.16) and the RR of repeat bacterial infection with filgrastim use was of marginal significance (RRadj, 0.57; P = 0.07), possibly due to the confounding effect of trimethoprim-sulfamethoxazole on all bacteremia (RRadj, 0.55; P = < 0.01). Unrelated to bacteremia, filgrastim use was associated with a 56% reduction in mortality (P < 0.01). CONCLUSIONS There was a large survival benefit associated with filgrastim use in this study but the reasons for this benefit are unclear. Although a reduction in crude risk of some bacterial infections with filgrastim use was detected, after adjustment for potentially confounding factors these risks were smaller and no longer statistically significant.
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Affiliation(s)
- Michael Davidson
- Center for Clinical Trials, The Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Jaing TH, Huang CS, Chiu CH, Huang YC, Kong MS, Liu WM. Surgical implications of pseudomonas aeruginosa necrotizing fasciitis in a child with acute lymphoblastic leukemia. J Pediatr Surg 2001; 36:948-50. [PMID: 11381435 DOI: 10.1053/jpsu.2001.23998] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Necrotizing fasciitis caused by Pseudomonas aeruginosa is extremely rare. Only 4 cases were reported in the literature. The authors report the occurrence of P aeruginosa necrotizing fasciitis starting out as a vulval abscess in a girl before induction chemotherapy for acute lymphoblastic leukemia. To our knowledge, this is the second case described in association with leukemia. In this case, the outcome was favorable because of early surgical intervention, confirming the diagnosis. J Pediatr Surg 36:948-950.
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Affiliation(s)
- T H Jaing
- Division of Pediatric Hematology and Oncology, Department of Medicine, Chang Gung Children's Hospital, Taoyuan, Taiwan
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20
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Sereti I, Lane HC. Immunopathogenesis of human immunodeficiency virus: implications for immune-based therapies. Clin Infect Dis 2001; 32:1738-55. [PMID: 11360217 DOI: 10.1086/320758] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2000] [Revised: 01/12/2001] [Indexed: 11/03/2022] Open
Abstract
Human immunodeficiency virus (HIV) infection leads to a state of CD4 lymphopenia and generalized immune activation with subsequent development of opportunistic infections and neoplasms. The use of highly active antiretroviral treatment has dramatically improved the clinical outcome for HIV-infected patients, but the associated cost and toxicity and the eventual development of drug resistance have underscored the need for additional therapeutic strategies. Immune-based therapies, such as treatment with cytokines or immunosuppressants, adoptive immunotherapy, and therapeutic immunizations, are being intensely investigated as potential supplements to antiretroviral therapy. Although much data have been generated as a result of these efforts, to date there has been little evidence of the clinical efficacy of these strategies. Randomized clinical studies remain critical in evaluating the clinical significance and the role of immune-based therapies in the therapeutic armamentarium against HIV.
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Affiliation(s)
- I Sereti
- Cellular and Molecular Retrovirology Section, Laboratory of Immunoregulation, National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA
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21
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Gonçalves AS, Appelberg R. Effects of recombinant granulocyte-colony stimulating factor administration during Mycobacterium avium infection in mice. Clin Exp Immunol 2001; 124:239-47. [PMID: 11422200 PMCID: PMC1906052 DOI: 10.1046/j.1365-2249.2001.01552.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2000] [Indexed: 11/20/2022] Open
Abstract
Granulocyte colony-stimulating factor (G-CSF) administration in vivo has been shown to improve the defence mechanisms against infection by different microbes. Here we evaluated a possible protective role of this molecule in a mouse model of mycobacterial infection. The administration of recombinant G-CSF promoted an extensive blood neutrophilia but failed to improve the course of Mycobacterium avium infection in C57Bl/6 or beige mice. G-CSF administration also failed to improve the efficacy of a triple chemotherapeutic regimen (clarithromycin + ethambutol + rifabutin). G-CSF treatment did not protect interleukin-10 gene disrupted mice infected with M. avium. Spleen cells from infected mice treated with G-CSF had a decreased priming for antigen-specific production of interferon gamma compared to control infected mice. Our data do not substantiate previous reports on the protective activity of G-CSF in antimycobacterial immunity using mouse models.
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Affiliation(s)
- A S Gonçalves
- Laboratory of Microbiology and Immunology of Infection, Institute for Molecular and Cell Biology, University of Porto, Portugal
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22
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Incidence and Determinants of Bacterial Infections in HIV-Positive Patients Receiving Anti-Pneumocystis carinii/ Toxoplasma gondii Primary Prophylaxis Within a Randomized Clinical Trial. J Acquir Immune Defic Syndr 2001. [DOI: 10.1097/00042560-200105010-00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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23
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Murri R, Ammassari A, Pezzotti P, Cingolani A, De Luca A, Pallavicini F, Grillo R, Antinori A. Incidence and determinants of bacterial infections in HIV-positive patients receiving anti-Pneumocystis carinii/Toxoplasma gondii primary prophylaxis within a randomized clinical trial. J Acquir Immune Defic Syndr 2001; 27:49-55. [PMID: 11404520 DOI: 10.1097/00126334-200105010-00009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We assessed the incidence and determinants of bacteremia, pneumonia, and sinusitis/otitis in HIV-positive people receiving cotrimoxazole (CTX) or dapsone-pyrimethamine (DP) for primary prophylaxis of Pneumocystis carinii pneumonia (PCP) and toxoplasmic encephalitis (TE) within a randomized clinical trial. In total, 244 patients were randomized: 122 were assigned to CTX and 122 to DP. In the cohort, 22 bacteremia, 63 pneumonia, and 39 sinusitis/otitis cases were observed. Incidence rates of bacteremia, pneumonia, and sinusitis/otitis as well as the 2-year probability of remaining free from any bacterial infection were not significantly different between the two groups. At multivariate analysis, the risks of developing bacteremia and pneumonia were found to be independently increased by the use of a central venous catheter (hazard ratio [HR], 4.48; p <.05 and HR, 4.13; p <.01, respectively) and by hospitalization (HR, 28.82; p <.05 and HR, 10.15; p <.05, respectively). In conclusion, CTX at the dosage employed for primary PCP/TE prophylaxis does not seem to protect against bacterial infections more than second-line DP.
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Affiliation(s)
- R Murri
- Department of Infectious Diseases, Catholic University, Rome, Italy.
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25
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Ángel von Wichmann M, Camino X, Arrizabalaga J, Rodríguez-Arrondo F, Antonio Iribarren J, Txoperena G. Administración de factor estimulante de colonias de granulocitos en pacientes con infección por el virus de la inmunodeficiencia humana y neutropenia prolongada. Enferm Infecc Microbiol Clin 2001. [DOI: 10.1016/s0213-005x(01)72557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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26
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Ángel von Wichmann M, Camino X, Arrizabalaga J, Rodríguez-Arrondo F, Antonio Iribarren J, Txoperena G. Administración de factor estimulante de colonias de granulocitos en pacientes con infección por el virus de la inmunodeficiencia humana y neutropenia prolongada. Enferm Infecc Microbiol Clin 2001. [DOI: 10.1016/s0213-005x(01)72543-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Levine AM, Li P, Cheung T, Tulpule A, Von Roenn J, Nathwani BN, Ratner L. Chemotherapy consisting of doxorubicin, bleomycin, vinblastine, and dacarbazine with granulocyte-colony-stimulating factor in HIV-infected patients with newly diagnosed Hodgkin's disease: a prospective, multi-institutional AIDS clinical trials group study (ACTG 149). J Acquir Immune Defic Syndr 2000; 24:444-50. [PMID: 11035615 DOI: 10.1097/00126334-200008150-00009] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
To ascertain the results of standard ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, dacarbazine) in HIV-infected patients with newly diagnosed Hodgkin's disease (HD), a nonrandomized, prospective, multiinstitutional clinical trial was conducted by the AIDS Clinical Trials Group (ACTG), in HIV-infected patients with Hodgkin's disease. All patients received the standard ABVD regimen, with granulocyte-colony-stimulating factor (G-CSF). Antiretroviral therapy was not used. Between May, 1992 and August, 1996, 21 patients were added to the study and treated. The median CD4 count was 113 cells/mm3, and 29% had a history of a clinical AIDS-defining condition before diagnosis of HD. Systemic "B" symptoms were present in 90% at diagnosis. Stage IV HD was present in 67%, with bone marrow involvement in 12 (57%). Nodular sclerosis HD was present in 38%, with mixed cellular disease in 31%. Among all patients entered and treated, complete remission (CR) was attained in 9 (43%; 90% confidence interval [CI], 24%-63%), whereas partial response occurred in 4 (19%), leading to an overall objective response rate of 62% (90% CI, 42%-79%). Despite routine use of G-CSF, 10 patients (47.6%) experienced life-threatening neutropenia, with absolute neutrophil counts <500 cells/mm3. In all, nine opportunistic infections occurred in 6 patients (29%) during the study or shortly thereafter. Median survival was 1.5 years. Results of this study suggest that alternative treatment strategies should be explored, including use of chemotherapy together with antiretroviral therapy.
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Affiliation(s)
- A M Levine
- Divisions of Hematology and Hematopathology, University of Southern California School of Medicine, Los Angeles, California 90033, USA
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Chemotherapy Consisting of Doxorubicin, Bleomycin, Vinblastine, and Dacarbazine With Granulocyte–Colony-Stimulating Factor in HIV-Infected Patients With Newly Diagnosed Hodgkin's Disease: A Prospective, Multi-institutional AIDS Clinical Trials Group Study (ACTG 149). J Acquir Immune Defic Syndr 2000. [DOI: 10.1097/00042560-200008150-00009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hermans P, Sommereijns B, Van Cutsem N, Clumeck N. Neutropenia in patients with HIV infection: a case control study in a cohort of 1403 patients between 1982 and 1993. JOURNAL OF HEMATOTHERAPY & STEM CELL RESEARCH 1999; 8 Suppl 1:S23-32. [PMID: 10596033 DOI: 10.1089/152581699319894] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The relationship between neutropenia and increased risks of severe infections in patients with HIV infection and the factors associated with neutropenia-induced infections was studied by a retrospective comparative study using matched case-control analysis. A database (1982-1993) of 1870 patients with HIV infection was searched, and from 484 patients with neutropenia, 177 patients were paired with 177 nonneutropenic control subjects. Descriptive analysis and development of logistic models were used to determine factors associated with the risk of developing bacterial infections and major fungal infections. The occurrence of severe bacterial and fungal infections was significantly higher in neutropenic patients (p < or = 0.001). Bacteremia was more common in neutropenic patients than in nonneutropenic patients (p < or = 0.02) in the matched case-control analysis. Risk of severe infections was strongly associated with the neutrophil count (p < or = 0.05), clinical stage, and hemoglobin level (p < 0.005) when paired patients were compared. More neutropenic episodes occurred between 1991 to 1993, possibly due to prolonged survival and the increasing use of concomitant myelosuppressive therapies. Neutropenic HIV-infected patients are significantly at risk of developing severe infections at the end-stage of HIV disease, and this may have a major impact on hospitalization and death. Preventing neutropenia could dramatically improve the quality of life of these patients.
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Affiliation(s)
- P Hermans
- Division of Infectious Diseases, C.H.U. Saint-Pierre, Brussels, Belgium
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Welch W, Foote M. The use of Filgrastim in AIDS-related neutropenia. JOURNAL OF HEMATOTHERAPY & STEM CELL RESEARCH 1999; 8 Suppl 1:S9-16. [PMID: 10596030 DOI: 10.1089/152581699319867] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neutropenic individuals are at high risk for bacterial and fungal infections. Filgrastim (r-metHuG-CSF, NEUPOGEN) has been shown to improve chemotherapy-induced neutropenia significantly. Because a high incidence of HIV-infected patients have neutropenia, often associated with myelosuppressive antiretroviral medication, Filgrastim is frequently used as a treatment strategy for this HIV-associated neutropenia. This review summarizes published work related to the use of Filgrastim in HIV-infected patients. Literature bases (EMBASE, MEDLINE, Int. Pharm. Abs., SciSearch, and Aidsline) from 1970 to 1998 were searched for articles describing the relationship of Filgrastim and ANC to bacterial infection rates, bacterial infection outcome, and overall survival. Thirty-five related articles were identified during this search. Filgrastim appears to have a significant role in increasing peripheral ANC and enhancing neutrophil function in patients with HIV infection and AIDS. This may translate into a clinical benefit of delivery of full-dose myelosuppressive antiretroviral therapy and decreased susceptibility to infections and increased survival in this patient population.
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Affiliation(s)
- W Welch
- Amgen Inc., Thousand Oaks, CA 91320-1799, USA
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31
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Colony-Stimulating Factors in the Therapeutic Approach to Sepsis. Curr Infect Dis Rep 1999; 1:218-223. [PMID: 11095791 DOI: 10.1007/s11908-999-0022-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sepsis and its complications continue to be a leading cause of death in the United States despite availability of potent broad-spectrum antimicrobial agents. Current in vitro, ex vivo, animal, and human data are reviewed. Present data shows that colony-stimulating factors (CSFs), granulocyte CSFs, and granulocyte-macrophage CSFs are very effective in raising the leukocyte count and shortening the number of neutropenic days. CSFs in some studies improved outcome of neutropenic septic patients especially when given very early. However, there are studies that do not show any benefit. CSFs appear to be safe and should be limited to septic, neutropenic patients whose duration of neutropenia is anticipated to be prolonged, or to patients who are seriously ill.
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Ambati BK, Perlman DC, Salomon N. Outcomes of granulocyte colony-stimulating factor or granulocyte-macrophage colony-stimulating factor use in neutropenic patients infected with human immunodeficiency virus. Int J Infect Dis 1999; 3:70-5. [PMID: 10225983 DOI: 10.1016/s1201-9712(99)90012-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE To characterize the effects of granulocyte colony-stimulating factor (G-CSF) or granulocyte-macrophage colony-stimulating factor (GM-CSF) on clinical outcomes in neutropenic HIV-infected patients, by means of a retrospective cohort study at an urban teaching hospital. METHOD Data were reviewed from all patients discharged between January 1, 1996, and August 31, 1997, with human immunodeficiency virus and neutropenia (absolute neutrophil count (ANC) <1000 cells/mL), with outcome measures of length of stay, infectious complications, and survival to discharge. RESULTS Of the 228 discharged patients who met selection criteria, 71 had received G-CSF or GM-CSF; 157 controls had not. Cases had lower CD4+ cell counts (30 vs. 54 cells/mL; P = 0. 017) and lower nadir ANCs (372 vs. 579 cells/mL; P < 0.001). Granulocyte-CSF or GM-CSF usage was not associated with the frequency of site-related infections, fever, or sepsis (all P > 0. 20). No difference was found in duration of hospitalization (23 vs. 21 days; P > 0.20). In a logistic regression model for survival to discharge, higher nadir ANC and CSF use were independently associated with improved survival (P = 0.034 and P = 0.026, respectively). CONCLUSION Use of G-CSF or GM-CSF was associated with improved survival to discharge among hospitalized HIV-infected patients with neutropenia.
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Affiliation(s)
- B K Ambati
- Department of Medicine, Beth Israel Medical Center, New York, New York 10003, USA
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Stoltz DA, Zhang P, Nelson S, Bohm RP, Murphey-Corb M, Bagby GJ. Ethanol Suppression of the Functional State of Polymorphonuclear Leukocytes Obtained From Uninfected and Simian Immunodeficiency Virus Infected Rhesus Macaques. Alcohol Clin Exp Res 1999. [DOI: 10.1111/j.1530-0277.1999.tb04197.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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