Prolonged disturbances of in vitro cytokine production in patients with severe acute respiratory syndrome (SARS) treated with ribavirin and steroids

• Published in: Clinical and experimental immunology 2004-03, Vol.135 (3), p.467-473
• Main Authors: JONES, B. M., MA, E. S. K., PEIRIS, J. S. M., WONG, P. C., HO, J. C. M., LAM, B., LAI, K. N., TSANG, K. W. T.
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Anti-Inflammatory Agents - therapeutic use; Antiviral Agents - therapeutic use; Biological and medical sciences; Cells, Cultured; Clinical Studies; corticosteroids; cytokines; Cytokines - biosynthesis; Drug Therapy, Combination; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; inflammation; Leukocyte Count; Leukocytes - drug effects; Leukocytes - immunology; Lymphocyte Activation; Lymphocyte Subsets - drug effects; Lymphocyte Subsets - immunology; Male; Medical sciences; Middle Aged; Phytohemagglutinins - immunology; pneumonia; Ribavirin - therapeutic use; SARS; Severe Acute Respiratory Syndrome - drug therapy; Severe Acute Respiratory Syndrome - immunology
• ISSN: 0009-9104; 1365-2249
• DOI: 10.1111/j.1365-2249.2003.02391.x

SUMMARY Severe acute respiratory syndrome (SARS) is a new disease which has spread rapidly and widely. We wished to know whether evaluation of in vitro cytokine production could contribute to improved understanding of disease pathogenesis and to better patient management. Numbers of unstimulated and mitogen‐stimulated cytokine‐secreting peripheral blood mononuclear cells were measured repeatedly during and after hospitalization in 13 patients with SARS using enzyme‐linked immunospot technology. Numbers of interferon‐gamma, interleukin (IL)‐2, IL‐4, IL‐10 and IL‐12 secreting cells induced by T cell activators were below normal in many or most patients before and during treatment with corticosteroids and ribavirin but returned essentially to normal after completion of treatment. Staphylococcus aureus Cowan 1 (SAC)‐stimulated IL‐10 secreting cells were increased in early SARS but fell during treatment. SAC‐induced IL‐12 secreting cells were deficient before, during and long after treatment. Numbers of cells induced to produce IL‐6 and tumour necrosis factor‐alpha by T cell or monocyte activators were higher than normal in many early SARS patients and were still increased in some during and after treatment. We conclude that prolonged dysregulated cytokine production occurs in SARS and that future studies should be directed at improving anti‐inflammatory and antiviral therapies in order to limit cytokine impairment.