title: Serum neopterin, interleukin-4, and interleukin-6 concentrations in cerebral malaria patients and the effect of iron chelation therapy.
abstract: To determine if iron chelation therapy alters immune responses in children with cerebral malaria, we retrospectively measured mean serum levels of neopterin, interleukin-4 (IL-4), and IL-6 in children who received desferrioxamine B or placebo for three days in addition to quinine-based therapy. Mean levels of neopterin, IL-4, and IL-6 were elevated above the expected normal range on admission. Neopterin correlated significantly with the degree of anemia, IL-4 with the duration of fever prior to admission, and IL-6 with parasite density. Serial measurements of cytokines and neopterin were performed over four days in 39 children, 21 randomized to receive desferrioxamine B and 18 to receive placebo. Mean concentrations of neopterin did not change significantly in either group while levels of IL-4 increased significantly in the placebo group (P = 0.04) but remained unchanged in the desferrioxamine B group. Interleukin-6 concentrations decreased markedly in both groups (P < 0.025). Stable IL-4 levels in children given desferrioxamine B may represent an inhibition of the T helper lymphocyte-2 (TH-2) response resulting from a strengthened TH-1 response associated with iron chelation therapy. Any effect of iron chelation on immunity in the setting of severe malaria will have to be confirmed in future prospective investigations.
authors.affiliation: Department of Pediatrics, Pennsylvania State University, Hershey Medical Center, USA.
authors.forename: P E
authors.initials: PE
authors.lastname: Thuma
authors.forename: G
authors.initials: G
authors.lastname: Weiss
authors.forename: M
authors.initials: M
authors.lastname: Herold
authors.forename: V R
authors.initials: VR
authors.lastname: Gordeuk
mesh_terms: D001708:Biopterins / Q000031:analogs & derivatives* / Q000097:blood; D002675:Child, Preschool; D003676:Deferoxamine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D015847:Interleukin-4 / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D016779:Malaria, Cerebral / Q000188:drug therapy / Q000276:immunology*; D008297:Male; D019798:Neopterin; D011446:Prospective Studies; D017262:Siderophores / Q000627:therapeutic use*
chemical_list: D015850:Interleukin-6; D017262:Siderophores; D015847:Interleukin-4; D001708:Biopterins; D019798:Neopterin; D003676:Deferoxamine