A new protocol for multiple inhalation of IFN-gamma successfully treats MDR-TB: a case study.
METHODS
Aerosolized interferon-gamma (IFN-gamma) leads to transient conversion of sputum smears in multidrug-resistant pulmonary tuberculosis (MDR-TB).


OBJECTIVE
To test long-term conversion of sputum smears using the new Jena protocol.


METHODS
Four MDR-TB patients were treated with aerosolized recombinant IFN-gamma (rIFN-gamma) twice weekly for 8 weeks and anti-tuberculosis drugs. Patients were monitored clinically and T-cell subpopulations were analyzed.


RESULTS
The treatment was well tolerated. All sputum smears cleared within 6-8 weeks, and radiological signs of recovery lasted in all patients for 73-106 months (the entire follow-up period). Before treatment, a patient with a 20+ year history of TB showed no gammadelta T-cells; these cells appeared during treatment. The proportion of natural killer (NK) cells was enhanced during treatment and remained elevated. The proportion of CD4+/CD25+ T-cells in the blood rose after treatment and remained elevated at 2 and 10 months afterwards. No significant change in T-cell levels appeared in patients with a shorter history of TB, except for a tendency toward a slight increase in gammadelta T-cells during treatment.


CONCLUSIONS
We invite further confirmation, but aerosolized rIFN-gamma plus anti-microbial treatment cured MDR-TB in this case study. The optimal dosing schedule needs to be determined.
Grahmann
P R
PR
Medical Clinics I, Department of Pneumology and Allergology/Immunology, Friedrich-Schiller University, Jena, Germany. PR.Grahmann@t-online.de
Braun
R K
RK
D000293:Adolescent; D000328:Adult; D000336:Aerosols; D000995:Antitubercular Agents / Q000008:administration & dosage*; D002985:Clinical Protocols; D005260:Female; D005434:Flow Cytometry; D006801:Humans; D007371:Interferon-gamma / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013183:Sputum / Q000382:microbiology; D016176:T-Lymphocyte Subsets; D018088:Tuberculosis, Multidrug-Resistant / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy*
D000336:Aerosols; D000995:Antitubercular Agents; D007371:Interferon-gamma