title: The effect of antibody against TNF alpha on cytokine response in Jarisch-Herxheimer reactions of louse-borne relapsing fever.
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.
authors.affiliation: Department of Chemical Pathology, Medical College of Saint Bartholomew's Hospital, London, UK.
authors.forename: R E
authors.initials: RE
authors.lastname: Coxon
authors.forename: D
authors.initials: D
authors.lastname: Fekade
authors.forename: K
authors.initials: K
authors.lastname: Knox
authors.forename: K
authors.initials: K
authors.lastname: Hussein
authors.forename: A
authors.initials: A
authors.lastname: Melka
authors.forename: A
authors.initials: A
authors.lastname: Daniel
authors.forename: G G
authors.initials: GG
authors.lastname: Griffin
authors.forename: D A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D016207:Cytokines / Q000378:metabolism*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007128:Immunoglobulin Fragments / Q000627:therapeutic use*; D015592:Immunoradiometric Assay; D007262:Infusions, Intravenous; D007375:Interleukin-1 / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000627:therapeutic use*; D012061:Relapsing Fever / Q000150:complications / Q000188:drug therapy*; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000517:prevention & control*; D014409:Tumor Necrosis Factor-alpha / Q000276:immunology*
chemical_list: D016207:Cytokines; D007128:Immunoglobulin Fragments; D007375:Interleukin-1; D015850:Interleukin-6; D016209:Interleukin-8; D010406:Penicillins; D014409:Tumor Necrosis Factor-alpha