title: Use of granulocyte-macrophage colony-stimulating factor to reverse anergy in otherwise immunologically healthy children.
abstract: BACKGROUND
  T-cell anergy, as measured by delayed hypersensitivity skin testing, is associated with increased susceptibility to infection. Because the repertoire of effects of granulocyte-macrophage colony-stimulating factor (GM-CSF) includes enhancement of antigen processing and presentation by antigen-presenting cells, GM-CSF has been used to augment immune function in human immunodeficiency virus-induced and other viral illness-induced immune dysfunction and to affect positively immune function in a wide variety of disorders.
  
  
  OBJECTIVE
  To attempt reversal of T-cell anergy using GM-CSF in 3 otherwise immunologically healthy children with severe recurrent and persistent viral respiratory tract infections and in one child with recurrent bacterial sepsis.
  
  
  METHODS
  After written informed consent and baseline data were obtained, the study participants were administered 3 two-week cycles of GM-CSF. Delayed hypersensitivity skin testing and laboratory tests were repeated 2 weeks after the third cycle and subsequently as clinically indicated.
  
  
  RESULTS
  All 4 children developed delayed hypersensitivity by skin testing, and all demonstrated markedly decreased number and severity of infection. Improvement persisted in all patients for at least 1 year. A single cycle of additional treatment in 2 patients reestablished delayed hypersensitivity and decreased infection, both of which persisted throughout the follow-up period of 4 or more years.
  
  
  CONCLUSIONS
  GM-CSF treatment reversed T-cell anergy in 4 children. Reestablishment of delayed hypersensitivity was associated with a significant decrease in infection. Although further studies will be needed, use of GM-CSF should be considered as an immune modulator in patients with T-cell anergy and recurrent infections.
authors: Department of Pediatrics, Medical University of Ohio, Toledo, Ohio 43608, USA. lois.nelson@utoledo.edu
authors: Lois A
authors: LA
authors: Nelson
mesh_terms: D001424:Bacterial Infections / Q000276:immunology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000008:administration & dosage* / Q000276:immunology; D006801:Humans; D006968:Hypersensitivity, Delayed / Q000139:chemically induced / Q000276:immunology; D007111:Immunity, Cellular / Q000187:drug effects / Q000276:immunology; D008213:Lymphocyte Activation / Q000276:immunology; D011994:Recombinant Proteins; D012882:Skin Tests; D013601:T-Lymphocytes / Q000276:immunology; D014777:Virus Diseases / Q000276:immunology / Q000628:therapy
chemical_list: D011994:Recombinant Proteins; D016178:Granulocyte-Macrophage Colony-Stimulating Factor