Radical Therapy Chemotherapy May Help Some Human Bird Flu Victims
September 6th, 2008

An exciting and radical new treatment is being proposed for victims of the bird flu. Chemotherapy, usually used to treat immune system disorders, might also be effective in treating people infected with the H5N1 strain of the avian influenza virus.

A team from the Karolinska University Hospital in Stockholm, Sweden, is arguing that new forms of treatment and a new way of thinking are urgently needed. Currently the bird flu has a 50% mortality rate in humans and the virus has the possibility to become resistant to antiviral treatments. This scary reality is coupled with the fact that there are currently no vaccines that have been developed for humans and the bird flu is rapidly spreading across the world. These researchers have published their reasoning for the suggestion of the use of chemotherapy in The Lancet, to suggest to the scientific community that the use of this radical new therapy may be the answer some have been looking for.

The symptoms of patients who have the H5N1 avian flu virus were found to be very similar to patients who have an often fatal immune disease called haemophagocytic lymphohitiocytosis (HLH), discovered Jan-Inge Henter, a pediatric clinical oncologist. Patients with H5N1 have symptoms that include a major over-response of their immune system, which also is the case with HLH patients. The cause of death in patients with H5N1 is linked to sepsis and multi-organ failure, which is caused by the over-production of certain immune messengers. These same symptoms are seen with HLH patients, but HLH can be treated with a mix of drugs including a chemotherapy drug called etoposide, whose job is to kill excess immune cells. This treatment increases the survival rates of patients from 56% to 90% when given immediately, compared to giving the treatment at four weeks, or not giving it at all according to a study of Epstein-Barr HLH patients.

Henter suggests that the World Health Organization should recommend to scientists that they conduct research to support this hypothesis. He is hoping that they could bypass testing in animals and move directly to humans infected with the h5N1 virus that have secondary HLH. “So our thinking is that these patients with severe (H5N1) infection, their immune regulation is out of control. We are down-regulating things to kill off some of the cells, to get some kind of balance-there is some logic to how this could work,” states Henter. He also told New Scientist that, “Etoposide is licensed for this indication, and it is well known. The treatment protocol has been used successfully in humans affected by severe virus infections for more than 10 years,” and also adds that the drug is widely available and inexpensive.

The risks may be high for individuals who are seriously ill, but Henter points out that people with virus associated HLH are already at a dangerously high risk of death if their condition is left untreated. While scientists discuss the best treatment options of this virus, significant risks to patients need to be taken into account. The WHO is inviting clinicians from all countries with human cases of the H5N1 avian influenza virus to discuss the best possible treatment options at the end of March. Obviously, Henter is hopeful that scientists will begin research and testing of etoposide in patients in time to help prevent the pandemic that some officials say is inevitable.

This radical new treatment will not be the answer to preventing the disease, but instead may be able to offer a low cost and easily accessible option for those who are unfortunate enough to contract this illness. Many hope that there will be options like this one available in the case of a world-wide pandemic because currently it seems that there are no tools in place to prevent, treat, or contain this illness.

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