Clinicoimmunological monitoring of therapy in patients with associated forms of yersiniosis

Characteristics of the clinical process and immunological profile in children with yersiniosis as a monoinfection or in association with acute intenstinal infections and virus hepatitis A are presented. The efficacy of the immunotropic therapy with cycloferon, an interferon inductor, and recombinant interferon in the patients with the viral and bacterial association of the disease (yersiniosis + hepatitis A) and initial disbalance of the serum cytokines was estimated. Dependence of the interferon clinicolaboratory efficacy on the initial levels of serum y-interferon, IL2 and IIA, promoting shorter terms of hyperthermia, diarrhea syndrome and cytolysis syndrome was shown. It allowed to optimize the scheme of the pathogenetic therapy of Yersinia mixed infection.     

Level of natural autoantibodies to interferon-alpha and characteristics of interferon status during chronic hepatitis and liver cirrhosis

Level of autoantibodies to interferon-alpha and characteristics of interferon status were studied in 118 patients with chronic diffuse liver diseases (CDLD). During formation of liver cirrhosis in patients with CDLD level of natural autoantibodies to endogenous interferon-alpha increased. During progression of CDLD, decrease of interferon-alpha level and its functional activity were observed as well as change in the ratio between active fraction of interferon-alpha and its inactivated forms towards increase of the latter. One cause of observed decrease in biological functional activity of interferon-alpha in patients with chronic hepatitis and liver cirrhosis was increased titer of interferon-alpha neutralizing autoantibodies in blood. Level of natural autoantibodies to interferon-alpha, its antiviral activity and concentration during chronic hepatitis and liver cirrhosis can be used as markers of disease severity and predictors of its outcome.     

Clinical efficacy of cycloferon in complex therapy of infectious mononucleosis in pediatrics

The results of the cycloferon use in therapy of 80 children at the age of 1 to 15 years with infectious mononucleosis are presented. The children were divided by chance sampling into two comparable groups of 40 subjects each. In the first group the children in addition to the standard therapy were treated with cycloferon for 10 days, intramuscularly or orally depending on the age. The reference group included the patients under the standard therapy alone. The efficacy of the drug was evaluated by reduction and more rapid disappearance of the main clinical symptoms of the disease. The improvement of certain laboratory indices, including those of the liver protein synthesis function were recorded, that allowed to reduce the hospitalization term. No side effects of the cycloferon use were observed.     

Induction of indoleamine dioxygenase by interferon in mice: a study with different recombinant interferons and various cytokines

Since it is important the availability of a specific marker for interferon induction in vivo, we investigated the effect of different recombinant interferons and various cytokines on indoleamine 2,3-dioxygenase activity. Although with different magnitude, recombinant interferon-alpha A/D (Bgl II) hybrid, interferon-gamma and tumor necrosis factor, all increase the activity of this enzyme, whereas interleukin-1, recombinant interferon-alpha A and interferon-alpha D do not induce this activity in mice lung tissue. Dexamethasone is able to inhibit indoleamine 2,3-dioxygenase induction by lipopolysaccharide or by interferon-alpha A/D but it fails to prevent the induction by interferon-gamma.     

Apoptosis of the hypothalamus neurosecretory cells in stress and ageing: the role of immune modulators

There is assumption about active role of immune modulators in cell death process. The involvement of interferon-alpha and cycloferon in apoptosis regulation of hypothalamic neurons of mice during stress and aging was studied. We determined the expression of apoptosis markers (Bcl-2, Mcl-1, Bax) in comparison with apoptosis level. We have found that immune modulators suppress activity of nonapeptidergic neurons. Thus, interferon-alpha treatment reduces synthesis of Bcl-2; cycloferon treatment inhibits expression of Bax and Bcl-2. So the role of immune modulators in neuron apoptosis depends on the stage of ontogenesis and type of immune modulator. Cycloferon is able to reduce the level of age-dependent apoptosis of neurons in aging, but under stress condition both interferon-alpha and cycloferon act as protectors of cell death.     

Interferon-alpha and interferon-gamma reduce excessive collagen synthesis and procollagen mRNA levels of scleroderma fibroblasts in culture

The effects of interferon-alpha and interferon-gamma on collagen synthesis and mRNA levels of type I and type III procollagens were studied in skin fibroblasts cultured from affected and unaffected skin sites of two patients with localized scleroderma (morphea). Both scleroderma cell lines exhibited elevated type I and type III procollagen mRNA levels to account for the increased procollagen synthesis, when compared to the unaffected controls. Interferon-gamma treatment resulted in a dose-dependent reduction in collagen synthesis and procollagen mRNA levels in scleroderma fibroblasts. A 72-h exposure to interferon-gamma reduced procollagen mRNA levels in the scleroderma fibroblast lines to the levels exhibited by the unaffected control fibroblasts. The suppressive effect of interferon-alpha on procollagen mRNA levels was somewhat weaker than that of interferon-gamma. The results suggest potential use of interferon-gamma in treatment and prevention of human fibrotic conditions.     

Advances in therapy for hepatitis C infection

The first approved therapy for chronic hepatitis C virus (HCV) infection was recombinant interferon. Subsequently, controlled studies demonstrated that the combination of interferon-alpha and ribavirin leads to significantly higher virologic sustained responses in patients with chronic hepatitis C. A novel modification of the interferon molecule resulted in the formulation of pegylated interferons, which have a longer half-life than standard interferon. Two recent trials have established the superiority of pegylated interferons compared with interferon-alpha in inducing sustained virologic responses in patients with chronic HCV infection, with or without cirrhosis. Presumably, pegylated interferons will replace standard interferon in treating HCV infection. Phase 3 trials of pegylated interferons in combination with ribavirin are currently under way. Noninterferon-based therapies for the treatment of HCV infection are also in the developmental and experimental phases. Our aims in this review are to present the currently available therapeutic options for HCV infection and the evidence supporting their use in typical patients with chronic hepatitis C or in patients with special circumstances. We also briefly review novel therapeutic approaches, including noninterferon-based therapies.     

Immunologic effects of interferon-alpha in man: treatment with human recombinant interferon-alpha suppresses in vitro immunoglobulin production in patients with chronic type B hepatitis

The effect of human recombinant interferon-alpha on lymphocyte proliferation and differentiation was studied in 18 patients with chronic type B hepatitis who were participating in a randomized controlled trial of interferon-alpha therapy. Peripheral blood mononuclear cells (PBMC) were obtained by lymphopheresis before and during a 4 mo course of interferon. Pokeweed mitogen-induced immunoglobulin synthesis by PBMC obtained from patients before therapy was similar to that of PBMC from normal individuals. However, after 2 wk treatment with human recombinant interferon-alpha mitogen-induced immunoglobulin production was decreased by an average of 50%. Staining for cytoplasmic immunoglobulin revealed decreases that paralleled secreted immunoglobulin, indicating that interferon-alpha treatment inhibited immunoglobulin synthesis. Mixing autologous T and B cell enriched populations from before and during interferon treatment revealed that the decrease in immunoglobulin synthesis involved a defect in the B cell-enriched population. In contrast to immunoglobulin synthesis, pokeweed mitogen-induced lymphocyte proliferation was not significantly affected by in vivo administration of interferon-alpha. Thus a major effect of in vivo interferon-alpha on immunoregulation in patients with chronic type B hepatitis appears to be an inhibition of the late stages of B cell differentiation into immunoglobulin producing and secreting plasma cells.     

Interferons and bone. A comparison of the effects of interferon-alpha and interferon-gamma in cultures of human bone-derived cells and an osteosarcoma cell line

Recombinant human interferon-alpha 2C and recombinant human interferon-gamma (5-1000 U/ml) inhibit the proliferation of normal human bone-derived cells and a human osteosarcoma cell line. In the bone-derived cells the inhibitory effect of interferon-gamma was significantly greater than that of interferon-alpha, whereas in the osteosarcoma cell line the inhibitory effects of both interferons were quantitatively similar. Interferon-alpha did not affect the alkaline phosphatase activity of either type of cells. In contrast, interferon-gamma affected the activity of the enzyme in both cell types: in the bone-derived cells the effect of interferon-gamma was stimulatory whereas in the osteosarcoma cells the effect was inhibitory. In both cell types interferon-gamma selectively inhibited the incorporation of radiolabelled proline into type I collagen. In the osteosarcoma cells, the effects of both interferons on collagen synthesis were quantitatively similar. In the bone-derived cells, however, interferon-alpha decreased proline incorporation into collagen and non-collagen proteins to a similar extent and thus did not affect collagen synthesis when expressed as a percentage of total protein synthesis. Two-dimensional polyacrylamide gel electrophoresis of the radiolabelled proteins of the cell layer synthesised by both cell types in the presence of either interferon demonstrated that this treatment enhanced or induced the synthesis of a total of 21 individual proteins (19 in bone cells, 14 in osteosarcoma), ranging in apparent molecular mass over 14-87 kDa. The set of proteins induced was different in all four combinations of cells and interferon. A tentative identification of several of the proteins was possible based upon estimation of molecular mass, preferential induction by interferon-alpha or interferon-gamma and differential induction in normal and transformed bone-derived cells. The results of this study demonstrate that interferons have complex effects upon the proliferative and biosynthetic activities of human bone-derived cells and demonstrate significant differences between the responses of normal cells and transformed bone-derived cell line. Further investigations will be required in order to determine whether or not these differences are unique to the osteosarcoma cell line or are a characteristic of the effects of interferons on bone-derived cells in general.     

Cycloferon efficacy of therapy of chronic hepatitis B (results of randomized multicentre study)

The best therapeutic effect in the treatment of patients with chronic hepatitis B was observed with the use of cycloferon in the scheme of the antiviral therapy. The combination of cycloferon with lamivudine provided complete stable remission in 54.1% of the patients, whereas the use of a-interferon in combination with cycloferon provided remission in 44.1% of the lamivudine-resistant patients. The use of cycloferon in the therapy of chronic hepatitis B made it possible to lower the frequency and manifestation level of the side effects and prevented the lamivudine resistance development and generation of the virus mutants.     

Recombinant interferon-alpha, but not interferon-gamma is effective therapy for essential thrombocythemia

Recombinant interferon-gamma with a starting dose of 0.5 mg 3x/week subcutaneously, was administered to 6 patients with essential thrombocythemia (median platelet count 1172 X 10(9)/l, range 602-1564). Four of the patients had received alkylating agents previously. Hematological remission, defined as a decrease in platelet counts to less than or equal to 350 X 10(9)/l, was observed in none of these patients. Subsequently 4 of these 6 patients, supplemented by 2 others were treated with interferon-alpha 2c at a dose of 5 X 10(6) U daily subcutaneously. Five patients showed hematological remission. In case of hematological remission the interferon-alpha doses was reduced to 5 X an thereafter to 3 X weekly 5 X 10(6) U. During an observation period ranging from 12-41 weeks platelet counts remained normal in all patients. Side-effects were mild and consisted of fever, myalgias, malaise and itching occurring mainly during the first month of treatment. No dose adaptation was required. The patients treated previously with interferon-gamma experienced the side effects from this drug less tolerably than those from the alpha-compound. These observations suggest that recombinant interferon-alpha may be an effective drug in treating essential thrombocythemia resulting in a sustained response.     

Cytokinin inducing and antiviral activity of cycloferon on experimental herpetic infection

Experimental data on the protective activity and the capacity for inducing the biosynthesis of some cytokins, the low molecular inductors of cycloferon, endogenic interferon of the acridanon group, in herpetic infection are presented. The herpes infection was modelled by intraperitoneal injection of herpes simplex virus, type 1 into BALB/c mice. In the animals with normal immune status cycloferon induced the formation of serum interferon (INF) in high titers (up to 1:20,000) with the peak achieved 4-8 hours after the injection of the preparation. In addition, cycloferon stimulated the synthesis of IL-2 and gamma INF, but decreased the concentration of IL-1b. Following immunosuppression caused by gamma-radiation or cyclophosphamide the titers of serum interferon decreased 4-8 times. In generalized herpes infection in non-inbred white mice with undamaged immune status cycloferon increased survival rate by 30-100% in comparison with the controls (untreated mice), while in case of immunosuppression the protective effect of this preparation was considerably lower. In infected mice the concentrations of gamma INF, IL-2, IL-1b were found to be elevated in comparison with their concentrations in healthy animals. In the course of the infectious process cycloferon suppressed the production of IL-2 and IL-1b, but did not influence the synthesis of gamma INF.     

Identification of proteins regulated by interferon-alpha in resistant and sensitive malignant melanoma cell lines

Treatment of patients with malignant melanoma with interferon-alpha achieves a response in a small but significant subset of patients. Currently, although much is known about interferon biology, little is known about either the particular mechanisms of interferon-alpha activity that are crucial for response or why only some patients respond to interferon-alpha therapy. Two melanoma cell lines (MeWo and MM418) that are known to differ in their response to the antiproliferative activity of interferon-alpha, have been used as a model system to investigate interferon-alpha action. Using a proteomics approach based on two-dimensional polyacrylamide gel electrophoresis and mass spectrometry, several proteins induced in response to interferon-alpha have been identified. These include a number of gene products previously known to be type I interferon responsive (tryptophanyl tRNA synthetase, leucine aminopeptidase, ubiquitin cross-reactive protein, gelsolin, FUSE binding protein 2 and hPNPase) as well as a number of proteins not previously reported to be induced by type I interferon (cathepsin B, proteasomal activator 28alpha and alpha-SNAP). Although the proteins upregulated by interferon-alpha were common between the cell lines when examined at the level of Western blotting, the disparity in the basal level of cathepsin B was striking, raising the possibility that the higher level in MM418 may contribute to the sensitivity of this cell line to interferon-alpha treatment.     

Interferon inductors in treatment of associative forms of tick-borne infection in children

Thirty three children with associative forms of thick-borne infection (thick-borne encephalitis with ixodic borreliosis) were clinically observed. The disease was characterized by subfebrile temperature, moderate intoxication, rare erythema (39.5%) and frequent cardiovascular disorders with development of Lyme carditis (32.6 +/- 7.2%) and further rise of hepatomegalia in the diseases dynamics and development of meningeal symptoms. There were observed changes in the cytokine spectrum, characterized by INF-gamma high levels, and hypersecretion of the whole spectrum cytokines in the dynamics, that provided the Th2 type immune response. High clinicoimmunological efficacy of the complex therapy with cycloferon as an immunomodulator providing more balanced production of pro- and anti-inflammatory cytokines (IL-1alpha, INF-gamma and IL-10) was shown.     

Cycloferon efficacy in viral and bacterial diseases of children (clinical review)

The authors' findings and literature data on the pharmacotherapeut efficacy of cycloferon, an interferon inductor (immunomodulators) are described. The drug effect in the treatment of various socially significant children' diseases, including acute respiratory tract viral infection, bronchial asthma, allergic conditions with infection protection disturbances, mycoplasmic infection, bronchopulmonary complications of acute respiratory tract viral infection with low intensity of free radical oxidation is indicated. The use of cycloferon at the background of vaccination was shown to provide inhibition of the autoimmune processes causing postvaccinal complications in frequently ill children. The results of the use of cycloferon in the treatment of gastrointestinal tract and intestinal infections of both the viral and bacterial genesis are discussed. Cycferon is recommended to be used for correction of the intestine dysbiosis (the microflora level came to normal in 95% of the children). The use of the drug in surgical pathology and in particular in appendicular peritonitis for decreasing the postoperative complications and correction of the immune disturbances due to chronic viral hepatitis C and B in children under the complex therapy is described. The cycloferon safety and efficacy were confirmed by the postmarketing randomized trials.     

Tumour necrosis factor-alpha and lipopolysaccharide enhance interferon-induced tryptophan degradation and pteridine synthesis in human cells

The capacity of recombinant interferon-alpha, -beta and -gamma, of bacterial lipopolysaccharide and of recombinant tumour necrosis factor-alpha to induce indoleamine 2,3-dioxygenase and synthesis of pteridines was studied in human peripheral blood mononuclear cells, human macrophages and normal dermal fibroblasts. The action of interferon-alpha and -beta on macrophages was supported by lymphocyte factors as indicated by the effect of these mediators in the absence or presence of lymphocytes. Tumour necrosis factor-alpha alone was ineffective in peripheral blood mononuclear cells and macrophages, but it significantly increased the action of all three interferon species on macrophages and fibroblasts. Lipopolysaccharide directly affected macrophages or dermal fibroblasts and enhanced the effect of interferon-gamma. However, in the presence of lymphocytes, the action of lipopolysaccharide was mediated via interferon-gamma.     

Rational pharmacotherapy and correction of immunity disorders in children with chronic hepatitis (clinical review)

The data on the efficacy of antivirals and their impact on the virologic and immunologic indices in HCV- and HBV-infected children are presented. The best therapeutic effect in the management of children with chronic virus hepatitis was provided by combined antiviral therapy of different action. In the treatment of babies the drugs of choice could be viferon or cycloferon, for the 2-year older children with chronic hepatitis B the combination of viferon + cycloferon should be recommended and for those with chronic hepatitis C the combination of interal + cycloferon could be used. The cycloferon combination with interferons-a makes it possible to generate the Th1 cellular immune response, to minimize the side effects of interferons and chemotherapeutics and to improve their tolerability. The complex therapy of patients with chronic hepatitis B and lambliasis, using cycloferon and macmiror, provided stable effect, less frequent relapses oflambliasis and minimum side effects of the specific therapy. The repeated isolation of lamblia within a 1-year observation period was recorded only in 16.6% of the children treated with cycloferon vs. the control (40.0%).     

Rational approach to treatment of patients with polytrauma complicated by urinary tract infection

Development of secondary immune dysbalance in patients with polytrauma complicated by urinary tract infection (acute pyelonephritis) was observed. In such cases bacterial complications were highly possible, that required the use of immunotropic drugs (cycloferon) increasing the host nonspecific resistance, responsible for Th1 immune response. The cycloferon therapy of the patients with chronic pyelonephritis normalized the lymphocyte electrophoretic mobility promoting efficient recovery of the immune homeostasis. Cycloferon was shown to be effective in the prophylaxis and therapy of infective inflammation in the patients with polytrauma, that was evident of the antibacterial therapy efficacy increasing and more rapid healing of the infective inflammation.     

Interferons as modulators of human monocyte-macrophage differentiation. I. Interferon-gamma increases HLA-DR expression and inhibits phagocytosis of zymosan

The development of HLA-DR (Ia) expression in the presence and absence of interferon-gamma was monitored in monocyte-macrophage cultures. Overnight incubation with doses as low as 5 U/ml gave elevated values for Ia expression and the maximum increase was obtained with 200 U/ml. In contrast interferon-alpha had only a slight effect on the expression of Ia at doses as high as 2000 U/ml. The increase seen at 24 hr was maintained during the first 2 days of culture. The interferon-gamma-treated cells expressed four to five times more Ia than fresh monocytes. During the same time, monocytes cultured in the absence of interferon expressed approximately two times the amount of fresh monocytes. When the surface density of Ia was calculated, the interferon-gamma-treated monocytes expressed twice that of the untreated cells. Major changes in morphology and size occurred between days 3 and 4 of monocyte to macrophage development. Consequently a rapid increase in Ia expression took place; however, when the surface density was calculated this value increased only slightly when the monocytes matured to macrophages. The interferon-gamma-treated cells continued to express more total Ia as well as having increased surface density of this antigen. Interferon-gamma was also added to monocyte-macrophages several days after culture initiation (days 3, 4, and 5). Despite being in different stages of maturation, the cells responded to the interferon with increased Ia expression and surface density. The phagocytic activity of opsonized zymosans was also monitored. In contrast to Ia expression, this activity was downregulated by interferon-gamma, and the lower levels of phagocytosis were maintained through the 7 days of observation. Thus, interferon-gamma appears to change the differentiation pathway of the monocyte. The signal stimulates an increased level of Ia that may assist in the initiation of immune responses, and at the same time downregulates the scavenger role of removing opsonized particles. Once the monocyte has received this specific signal it continues to develop in a pathway different from that of the nontreated monocytes.