Immunomodulation with diethyldithiocarbamate in patients with AIDS-related complex

Role of oxidant stress in cytokine-induced activation of NF-kappaB in human aortic smooth muscle cells

The transcription factor nuclear factor-kappaB (NF-kappaB) has been implicated in inflammatory and proliferative vascular mechanisms. Activated NF-kappaB has been documented in human atherosclerotic lesions, and its activation in human vascular smooth muscle cells (SMC) by cytokines has been reported. However, intracellular mechanisms mediating NF-kappaB activation in human SMC are poorly understood. The aim of this study was to explore the potential role of reactive oxygen species and oxidant stress as signaling events in cytokine-induced NF-kappaB activation. Western blot analysis revealed the presence of inhibitory protein I-kappaBalpha in resting human aortic SMC, which was rapidly phosphorylated and degraded on exposure to interleukin-1beta (IL-1beta) followed by NF-kappaB translocation to the nucleus. IL-1beta had no effect on two measures of intracellular oxidant stress, fluorescence generated by the oxidation of 2',7'-dichlorodihydrofluorescin to dichlorofluorescein (DCF) or changes in intracellular sulfhydryl content. N-acetylcysteine (NAC) a membrane-permeant antioxidant, which augmented intracellular sulfhydryl content and inhibited H(2)O(2)-induced DCF fluorescence, had no effect on cytokine-induced NF-kappaB activation. In contrast to NAC, the metal chelators pyrrolidine dithiocarbamate and diethyldithiocarbamate attenuated IL-1beta-induced NF-kappaB activation but had no effect on intracellular sulfhydryl content. Treatment of the cells with the oxidant H(2)O(2) caused an increase in DCF fluorescence and decreased intracellular sulfhydryl content but had no effect on I-kappaBalpha or NF-kappaB. In conclusion, this study suggests that oxidant stress may not play a major role in cytokine-induced activation of NF-kappaB in human aortic SMC and that oxidants may not be primary activators of NF-kappaB in these cells.

Potent antioxidant activity of a dithiocarbamate-related compound from a marine hydroid

Recently, we discovered a novel class of natural products, named the tridentatols, in a marine hydroid. Close examination of their molecular structures suggested that they may have antioxidant activity. This observation prompted us to evaluate in vitro the capacity of one of these tridentatols, viz. tridentatol A, to inhibit lipid peroxidation using human low density lipoprotein (LDL) as an experimental model. LDL was incubated with 5 microM cupric chloride (Cu2+) in the absence and presence of tridentatol A or a reference antioxidant standard, i.e. vitamin E. The onset of rapid formation of conjugated lipid hydroperoxides was delayed in a concentration-dependent manner by tridentatol A. More specifically, LDL incubated with Cu2+ had a lag-phase time (the elapsed time before the onset of rapid formation of conjugated lipid hydroperoxides) of 150 min. However, when 0.5 microM tridentatol A was present during incubation, the lag phase time was extended to 225 min. With 1 microM tridentatol A, the lag phase time was 300 min. The same concentrations of vitamin E produced noticeably lower lag phase times. Thus, compared with vitamin E, tridentatol A better protected against the formation of conjugated lipid hydroperoxides in LDL. Direct colorimetric measurements of both lipid hydroperoxides and thiobarbituric acid-reactive substances confirmed the greater potency of tridentatol A relative to vitamin E. Furthermore, tridentatol A negated the Cu2+-induced increase in electrophoretic mobility of LDL to a greater extent than vitamin E. In conclusion, tridentatol A is a powerful antioxidant against lipid peroxidation of LDL and is significantly more potent than vitamin E in this regard.

Dithiocarbamates trigger differentiation and induction of CD11c gene through AP-1 in the myeloid lineage

It has recently been shown that the alteration of the cell-redox status affects the transcription factor expression and activity. Dithiocarbamates (DTCs) are potent antioxidant agents that can switch the expression of genes dependent on the activation of the transcription factors AP-1 and NF kappa B. In this study, we show that these agents triggered the expression of genes involved in myeloid differentiation of the promonocytic U-937 cell line. DTCs promoted differentiation-associated changes that included the surface up-regulation of beta 2-integrins (CD11a-c/CD18), cell growth arrest concomitant with transferrin receptor (CD71) down-modulation, induction of the nonspecific esterase enzyme, and a rapid drop in the mRNA levels of c-myc. A further analysis, focused on the molecular mechanisms leading to the activation of CD11c expression, revealed that the pyrrolidine derivative of DTC (PDTC) increased CD11c mRNA levels and augmented its gene promoter activity. Transfection experiments with reporter constructs harboring different promoter regions of CD11c gene, indicated the presence of a functional DTC-responsive region located between positions -160 and +40 of the promoter. Gel retardation assays revealed that the PDTC-induced DNA-protein complexes were restricted to members of the Fos and Jun families that bound to an AP-1 site located at position -60 from the transcription start site. A role for this site was confirmed by in vitro mutagenesis experiments that indicated the functional importance of this site for the CD11c gene transcriptional activation in response to PDTC. The effect of DTCs on myeloid cell differentiation supports a possible role for these agents in the therapy of some bone marrow-derived malignancies.

Dose response and timing effects in the therapy of the LP-BM5 murine retrovirus-induced lymphoproliferative immunodeficiency disease with diethyldithiocarbamate

Diethyldithiocarbamate (DTC) was used to treat the murine, retrovirus-induced, immunodeficiency disease (MAIDS). Once-weekly treatment was not effective and 800 mg/kg was toxic. When 200, 400 and 600 mg/kg were given i.p., 5 days per week, starting either on the day of virus inoculation or 14 days later, a dose-response and time-response relationship was noted. Higher doses and a 2-week delayed onset of treatment were generally more effective in reducing the development of lymphadenopathy, hypergammaglobulinemia and in prolonging survival than treatment started on the day of virus inoculation. When treatment was delayed until 10 weeks after virus inoculation existing lymphadenopathy was abrogated (treated node area 0 mm2 compared to control 175 mm2, P < 0.0001) and survival was improved (treated 100% compared to control 12.5%, P < 0.0001). However, when therapy was stopped animals died at the same rate as the untreated controls. These data indicate that DTC is active in MAIDS in a dose-responsive and time-dependent manner.

Multicenter, randomized, placebo-controlled study of ditiocarb (Imuthiol) in human immunodeficiency virus-infected asymptomatic and minimally symptomatic patients. The HIV87 Study Group

Ditiocarb sodium has been reported to reduce the progression of human immunodeficiency virus (HIV) infection. To confirm this therapeutic activity and to evaluate the effect of ditiocarb sodium in the early stages of HIV infection, we conducted a randomized, double-blind, placebo-controlled trial in asymptomatic or minimally symptomatic adults with HIV infection. Patients were followed during a 24 mo period, with a clinical and laboratory evaluation every 4 mo. Of 1333 patients who continued therapy after day 1, 669 were randomized to ditiocarb and 664 to placebo. The two treatment groups were comparable at entry, except for the CD4+ cell count, which was lower in the ditiocarb (median 416/mm3) than in the placebo group (median 458/mm3). Acquired immunodeficiency syndrome (AIDS) developed in 106 patients in the ditiocarb group as compared with 68 in the placebo group; 285 patients progressed to AIDS-related complex (157 ditiocarb, 128 placebo); 55 patients died (34 ditiocarb; 21 placebo). The risk of progression to AIDS, after adjustment for baseline CD4+ cell count, was significantly higher in the ditiocarb than in the placebo group (adjusted relative risk = 1.41; p = 0.027). A decrease in CD4+ cell counts was observed, with no significant difference between the ditiocarb and the placebo group. A positive effect of ditiocarb given in the condition of this study can be excluded. Although previous studies have shown opposite results, this study suggests that the use of ditiocarb in HIV-infected patients should be discontinued.

Dithiocarbamates as potent inhibitors of nuclear factor kappa B activation in intact cells

Dithiocarbamates and iron chelators were recently considered for the treatment of AIDS and neurodegenerative diseases. In this study, we show that dithiocarbamates and metal chelators can potently block the activation of nuclear factor kappa B (NF-kappa B), a transcription factor involved in human immunodeficiency virus type 1 (HIV-1) expression, signaling, and immediate early gene activation during inflammatory processes. Using cell cultures, the pyrrolidine derivative of dithiocarbamate (PDTC) was investigated in detail. Micromolar amounts of PDTC reversibly suppressed the release of the inhibitory subunit I kappa B from the latent cytoplasmic form of NF-kappa B in cells treated with phorbol ester, interleukin 1, and tumor necrosis factor alpha. Other DNA binding activities and the induction of AP-1 by phorbol ester were not affected. The antioxidant PDTC also blocked the activation of NF-kappa B by bacterial lipopolysaccharide (LPS), suggesting a role of oxygen radicals in the intracellular signaling of LPS. This idea was supported by demonstrating that treatment of pre-B and B cells with LPS induced the production of O2- and H2O2. PDTC prevented specifically the kappa B-dependent transactivation of reporter genes under the control of the HIV-1 long terminal repeat and simian virus 40 enhancer. The results from this study lend further support to the idea that oxygen radicals play an important role in the activation of NF-kappa B and HIV-1.

Effective therapy of the LP-BM5 murine retrovirus-induced lymphoproliferative immunodeficiency disease with diethyldithiocarbamate

The effects of therapy with the immunomodulator diethyldithiocarbamate (DTC) on the manifestation and natural history of LP-BM5 murine retrovirus infection in adult C57 Black 6 mice was investigated. DTC itself, had limited effects on the spleen weight, serum IgM, or mitogen responses of the non-virus-infected control mice when evaluated over a 9-week period. The virus inoculum administered was such that there was approximately a twofold increase in serum IgM and a halving of phytohemagglutinin (PHA) and lipopolysaccharide (LPS) responses in about two weeks and death of all animals by about 26 weeks postinfection. Doses of DTC of 20 and 200 mg/kg weekly or 5 days per week (intraperitoneally) in mice with LP-BM5 infection did not alter the manifestations or course of the disease. Doses of 400 or 600 mg/kg given 5 days per week, starting either 2 weeks before or the day of virus inoculation significantly reduced hypergammaglobulinemia, spleen weight, lymphadenopathy, and also prolonged survival. A dose of 400 mg/kg started 2 weeks after virus inoculation resulted in partial prevention of hypergammaglobulinemia, splenomegaly, and lymphadenopathy as well as 100% survival compared with 12.5% in non-drug-treated controls at 23 weeks after virus inoculation. The 9 surviving animals in the treated group were then allocated to continue treatment or stop treatment. In the animals without further treatment, lymphadenopathy and mortality occurred starting within 6 weeks after cessation of therapy while the animals with continued treatment remained in good condition for 40 weeks. There was only a very limited and transient effect of DTC therapy on the decline of the proliferative responses to phytohemagglutinin or lipopolysaccharide in any of the treated groups in the above described experiments.(ABSTRACT TRUNCATED AT 250 WORDS)

Current status of immunotherapy of patients with HIV-infection

Immunotherapy is receiving increasing attention as an approach to managing HIV-infection and its complications. As the immune response to HIV becomes better understood, new approaches to HIV immunotherapy are possible. Approaches under development include, first and foremost, the use of vaccines, not only for prophylaxis but also for therapy of established disease. Other approaches being studied include passive serotherapy, use of synthetic HIV-binding molecules such as CD4, immunorestoration and immunomodulation with immunomodulatory drugs, thymic hormones, cytokines and anti-infective immunotherapy directed against the opportunistic infecting organisms of HIV. The current role of these modalities as single agents and in combination and their potential role in the future is discussed.

Clinical and immunologic effects of combination therapy with intravenous immunoglobulins and AZT in HIV-infected patients

30 patients with HIV infection were enrolled to evaluate the clinical efficacy and toxicity of zidovudine (AZT), 0.5 g/day p.o. (Group A) vs. AZT 0.5 g/day p.o. plus intravenous immunoglobulins (IVIG), 0.4 g/kg of body weight for three consecutive days, followed by one treatment of 0.6 g/kg of body weight every fourth week (Group B), over a period of one year. The study was open and randomized. The treatment groups were compared using the following study variables: 1) type of infections, recurrences and severity; 2) change in CD4+ T and CD8+ T cell count; 3) change in platelet count; 4) change in TNF alpha serum levels; 5) the probability of not developing an opportunistic infection over a period of 12 months. Patients from Group B developed less pathological events in comparison to Group A. No significative differences were evident with regard to values of T cell subsets obtained before and after treatment in each group and between the two groups. On the contrary, in 12 out of 15 patients from Group B there was a significant increase in platelet count. In both groups there was a significant decrease of mean serum levels of TNF alpha when a comparison was made between time 12 vs. time 6. However, when data were expressed as single values, in three subjects from Group B TNF alpha was still detectable by time 12 vs. 9 individuals in Group A. The cumulative probabilities of developing an opportunistic infection over the 12 months of treatment in the Group A subjects were significantly higher than in the Group B subjects (p less than 0.01). Adverse effects--nausea and gastric pain--were reported for 3 individuals (20%) from Group A and 4 patients (26%) from Group B. In conclusion, patients treated with AZT are especially likely to benefit from IVIG prophylaxis.

Inhibition of HIV progression by dithiocarb. German DTC Study Group

60 patients with HIV-1 infection in Walter Reed stages 2-4 were randomised to treatment with intravenous or oral dithiocarb (diethyldithiocarbamate, DTC) or placebo for 24 weeks in a paired double-blind design. 55 patients were evaluable at the end of the study: no patient who had received DTC but 6 placebo patients had AIDS, a significant difference. Significantly delayed disease progression was observed in the intravenous DTC group compared with its matching placebo. The benefit in the oral DTC group was not statistically significant. During an 18-month follow-up 3 deaths occurred in the original placebo groups, whereas no patient who had initially received DTC died. A significant delay in progression to AIDS was observed in the DTC groups.

Report of the symposium on the use of intravenous gammaglobulin in adults infected with the human immunodeficiency virus

On July 27, 1989, the International Conference on Molecular Aspects of Immune Response and Infectious Diseases devoted a symposium to the subject of the use of intravenous gamma globulin (IVIG) in acquired immunodeficiency syndrome (AIDS). The information presented confirmed that IVIG benefits human immunodeficiency virus (HIV)-infected children with recurrent infections and that much remains to be learned about the influence of IVIG in adult AIDS. The symposium participants recognized the urgent need to develop randomized clinical trials using a control group to assess the efficacy of a treatment with IVIG in PGL (persistent generalized lymphadenopathy), ARC (AIDS-related complex), and AIDS. To prepare this report, a committee was established, including individuals with expertise in immunology, immunopharmacology, microbiology, virology, infectious diseases, general medicine, and pediatrics and representing research experience in academia and hospitals. After an introduction to the report with a summary of immunotherapeutic agents under evaluation to treat HIV infection, section 1 lays out the present understanding of the disease pathogenesis. Section 2 then outlines the treatment of HIV-seropositive individuals, discussing the uncertainties that any treatment entails. Section 3 discusses the rationale for treating HIV-infected individuals with IVIG, and Section 4 examines the major differences between IVIG and hyperimmunoglobulins for the treatment of HIV infection. Section 5 looks at IVIG as a mean to delay the emergence of opportunistic infections and restore immunocompetence in AIDS and related illnesses, and Sections 6 and 7 suggest a pilot protocol on the use of IVIG in association with low-dose or standard-dose zidovudine (AZT).(ABSTRACT TRUNCATED AT 250 WORDS)

A pilot study of diethyldithiocarbamate in patients with acquired immune deficiency syndrome (AIDS) and the AIDS-related complex

We investigated the use of diethyldithiocarbamate (DTC, or Imuthiolr, Merieux Institute) as a therapeutic agent in patients with Acquired Immune Deficiency Syndrome (AIDS) and AIDS-Related Complex (ARC). Patients were prospectively stratified and randomized to receive DTC 200 mg/m2 intravenously weekly for 16 weeks or no therapy, followed by crossover to the opposite arm for an equal period. Forty-four patients were entered and forty were evaluable. There was a statistically significant decrease in symptoms in the DTC treated patients compared to the controls (p = .002). There was a significant improvement in lymphadenopathy in the treated patients compared to the controls (p = .005). One patient showed disappearance of splenomegaly, one clearing of antifungal agent-resistant perianal moniliasis, and one clearing of hairy leukoplakia. No significant differences in progression were noted. No changes were seen in any of the immunological parameters measured. There was no significant toxicity. Because of the changes in symptoms and in lymphadenopathy, we suggest that further study of DTC, both alone and in combination with other agents, may be indicated.

Thymostimulin treatment in AIDS-related complex

Thirty-four patients with AIDS-related complex (ARC) were treated for 6 months with thymostimulin, a thymic hormone. Clinical and immunological findings after a 1-year follow-up were compared with those in 24 age- and sex-matched controls receiving no immunotherapy. Statistical evaluation after 6 and 12 months showed significant differences in the two groups. The thymostimulin-treated group had higher leukocyte and lymphocyte counts, more positivity in intradermal tests with multiple recall antigens, and less lymphadenopathy and weight loss. The number of OKT3+ and OKT4+ lymphocytes decreased significantly in the control group, but did not change in the thymostimulin-treated patients. Finally, after 18 months of follow-up, no progression to AIDS was seen among the treated subjects, whereas 3 of the controls developed the disease. We conclude that thymostimulin, alone or in combination with antiviral drugs, may be helpful in the management of ARC patients.

A calf thymus acid lysate improves clinical symptoms and T-cell defects in the early stages of HIV infection: second report

Thymomodulin is a calf thymus acid lysate capable of inducing T lymphocyte maturation. Fifteen patients with HIV infection at different stages according to the Walter Reed classification were treated with 60 mg/day of thymomodulin syrup for more than 50 days. Two WR6B subjects had clinical and immunological parameters unchanged and died, while the patient suffering from Kaposi's sarcoma presented an evident clinical and laboratory improvement with remission of the neoplasia. The other 12 patients ranging from WR2 to WR5B showed an improvement of clinical symptoms after thymomodulin therapy accompanied by the normalization of CD4/CD8 ratio (P less than 0.001). This helpers/suppressors increase was due to a significant increase of CD4 cells (P less than 0.01) and also to a decrease of the CD8 lymphocytes (P less than 0.05). Thymomodulin administration did not cause an enhancement of the urinary levels of neopterin, a marker of T-cell activation.