The effect of antibody against TNF alpha on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever

QJM. 1997 Mar;90(3):213-21. doi: 10.1093/qjmed/90.3.213.

Abstract

Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotic treatment of louse-borne relapsing fever (LBRF) is associated with a transient, marked rise in circulating tumour necrosis factor alpha (TNF alpha), interleukin 6 (IL-6) and interleukin 8 (IL-8). Ovine polyclonal anti-TNF alpha antibody fragments (Fab) were used in a randomized double blind placebo controlled trial in an attempt to prevent this reaction. Within 4 h after penicillin, in controls (n = 29), a several-fold rise in cytokines occurred, concomitant with a fall in spirochaetes and maximal clinical manifestations of the J-HR. An intravenous infusion of anti-TNF alpha Fab, 30 min before penicillin in 20 patients reduced peak plasma levels of IL-6 and IL-8 (but not IL-1 beta) compared with controls (p = 0.01 and < 0.001, respectively) and the incidence of the J-HR, indicating some neutralization of TNF alpha. An apparent fall in TNF alpha reflected interference of anti-TNF alpha in the immunoassay.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Cytokines / metabolism*
  • Double-Blind Method
  • Female
  • Humans
  • Immunoglobulin Fragments / therapeutic use*
  • Immunoradiometric Assay
  • Infusions, Intravenous
  • Interleukin-1 / blood
  • Interleukin-6 / blood
  • Interleukin-8 / blood
  • Male
  • Middle Aged
  • Penicillins / therapeutic use*
  • Relapsing Fever / complications
  • Relapsing Fever / drug therapy*
  • Systemic Inflammatory Response Syndrome / etiology
  • Systemic Inflammatory Response Syndrome / prevention & control*
  • Tumor Necrosis Factor-alpha / immunology*

Substances

  • Cytokines
  • Immunoglobulin Fragments
  • Interleukin-1
  • Interleukin-6
  • Interleukin-8
  • Penicillins
  • Tumor Necrosis Factor-alpha