Bird flu

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Wanderer - 14 Nov 2005 03:41 GMT

If Avian flu is killing by causing an immune storm of cytokines leading
to pulmonary oedema would it be worthwhile using steroids under
antibiotic covers?

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David Rind - 14 Nov 2005 04:00 GMT

> If Avian flu is killing by causing an immune storm of cytokines leading
> to pulmonary oedema would it be worthwhile using steroids under
> antibiotic covers?

Interesting question. I've been wondering as well, if there are
inadequate supplies of neuraminidase inhibitors, whether we could treat
people with prednisone early in the course of infection and improve
outcomes. I haven't looked to see if anyone has tried this in animals.

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David Rind
drind@caregroup.harvard.edu

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bae@cs.toronto.no-uce.edu - 14 Nov 2005 14:35 GMT

>> If Avian flu is killing by causing an immune storm of cytokines leading
>> to pulmonary oedema would it be worthwhile using steroids under
[quoted text clipped - 4 lines]
>people with prednisone early in the course of infection and improve
>outcomes. I haven't looked to see if anyone has tried this in animals.

During the SARS epidemic in Hong Kong, steroids were used with the same
rationale (the worst effects of SARS are due to actions of the patient's
immune system). Many patients experienced significant permanent(?)
injury due to the high doses of steroids.

I expect that there is some literature by now discussing the risk/benefit
ratio of the use of steroids in this context that might generalize to
treatment of avian influenza.

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ziggittes@yahoo.com - 14 Nov 2005 15:42 GMT

Unlikely to work. What needs to be done is to specifically target the
cytokines themselves. For example, IL-10 and TGFbeta directly suppress
the production of TNF, a potent inflammatory cytokine. TNF apparently
is not expressed in significant amounts in influenza-infected patients
(at least not with the 1918 HA recombinant - see Nature, October 7 2004
issue). There are a host of cytokines known to be expressed, but
unfortunately, their mechanisms of control have not yet been worked out.

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