Immunotherapy for Infectious Diseases

Immunotherapy for Infectious Diseases Immunotherapy for Infectious Diseases

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Fungal Infections 317 modalities in patients with fungal infection. In the next few years, one can anticipate that dozens of compounds in the form of cytokines, interleukins, growth factors, vaccines, and antibodies may become available, providing physicians with powerful options for enhancing immune function. In fact, the biologic revolution may deliver potential immune therapeutic agents to the bedside at a rate faster than the medical mycology community can evaluate them. Biologic response modifiers and immune therapies are complex modalities that require a sophisticated understanding of immune function and microbial pathogenesis for optimal use. Considering the diversity of fungal pathogens, the complexity of the immune system, the variety of immune modulators available, and the heterogeneity of patients with immune deficiencies at risk for fungal infection, the current challenge is to design systems for the expedient testing of immune therapy. REFERENCES 1. Kullberg BJ. Trends in immunotherapy of fungal infections. Eur J Clin Microbiol Infect Dis 1997; 16:51–55. 2. Wingard JR, Elfenbein GJ. Host immunologic augmentation for the control of infection. Infect Dis Clin North Am 1996; 10:345–364. 3. Anaissie EJ. Immunomodulation in the treatment of invasive fungal infections: present and future directions. Clin Infect Dis 1998; 26:1264–1265. 4. Walsh TJ, Hiemenz J, Anaissie EJ. Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients. Infect Dis Clin North Am 1996; 10:365–400. 5. Stevens DA. Combination immunotherapy and antifungal therapy. Clin Infect Dis 1998; 26:1266–1269. 6. Rodriguez-Adrian LJ, Grazziutti ML, Rex JH, Anaissie EJ. The potential role of cytokine therapy for fungal infections in patients with cancer: is recovery from neutropenia all that is needed? Clin Infect Dis 1998; 26:1270–1278. 7. Roilides E, Dignani MC, Anaissie EJ, Rex JH. The role of immunoreconstitution in the management of refractory opportunistic fungal infections. Med Mycol 1998; 36(suppl 1):12–25. 8. Han Y, Cutler JE. Assessment of a mouse model of neutropenia and the effect of an anticandidiasis monoclonal antibody in these animals. J Infect Dis 1997; 175:1169–1175. 9. DiNubile MJ. Therapeutic role of granulocyte transfusions. Rev Infect Dis 1985; 7:232–243. 10. Chanock SJ, Gorlin JB. Granulocyte transfusions. Time for a second look. Infect Dis Clin North Am 1996; 10:327–343. 11. Wright DG. Leukocyte transfusions: thinking twice. Am J Med 1984; 76:637–644. 12. Dale DC, Liles WC, Llewellyn C, Rodger E, Price TH. Neutrophil transfusions: kinetics and functions of neutrophils mobilized with granulocyte-colony-stimulating factor and dexamethasone. Transfusion 1998; 38:713–721. 13. Rex JH, Bhalla SC, Cohen DM, Hester JP, Vartivarian SE, Anaissie EJ. Protection of human polymorphonuclear leukocyte function from the deleterious effects of isolation, irradiation, and storage by interferon-� and granulocyte-colony-stimulating factor. Transfusion 1995; 35:605–611. 14. Strauss RG. Neutrophil (granulocyte) transfusions in the new millennium. Transfusion 1998; 38:710–712. 15. Clarke K, Szer J, Shelton M, Coghlan D, Grigg A. Multiple granulocyte transfusions facilitating successful unrelated bone marrow transplantation in a patient with very severe aplastic anemia complicated by suspected fungal infection. Bone Marrow Transplant 1995; 16:723–726.

318 Casadevall 16. Boutati EI, Anaissie EJ. Fusarium, a significant emerging pathogen in patients with hematologic malignancy: ten years’ experience at a cancer center and implications for management. Blood 1998; 90:999–1008. 17. Verschraegen CF, Van Besiern KW, Dignani C, Hester JP, Anderson BS, Anaissie EJ. Invasive aspergillus sinusitis during bone marrow transplantation. Scand J Infect Dis 1997; 29:436–438. 18. Di Mario A, Sica S, Salutari P, Ortu-La Barbera E, Marra R, Leone G. Granulocyte colony-stimulating factor-primed leukocyte transfusions in Candida tropicalis fungemia in neutropenic patients. Haematologica 1997; 82:362–363. 19. Catalano M, Fontana R, Scarpato N, Picardi M, Rocco S, Rotoli B. Combined treatment with amphotericin-B and granulocyte transfusion from G-CSF-stimulated donors in an aplastic patient with invasive aspergillosis undergoing bone marrow transplantation. Haematologica 1997; 82:71–72. 20. Mabry RL, Mabry CS. Immunotherapy for allergic fungal sinusitis: the second year. Otolaryngol Head Neck Surg 1997; 117:367–371. 21. Wright DG, Robichaud KJ, Pizzo PA, Deisseroth AB. Lethal pulmonary reactions associated with the combined use of amphotericin B and leukocyte transfusions. N Engl J Med 1981; 304:1185–1189. 22. Boxer LA, Ingraham LM, Allen J, Oseas RS, Baehner RL. Amphotericin-B promotes leukocyte aggregation of nylon-wool-fiber-treated polymophonuclear leukocytes. Blood 1981; 58:518–523. 23. Dana BW, Durie BGM, White RF, Huestis DW. Concomitant administration of granulocyte transfusions and amphotericin B in neutropenic patients: absence of significant pulmonary toxicity. Blood 1998; 57:90–93. 24. Burch WM, Snyderman R. Induction of cellular immunity to Coccidioides immitis after sensitization with dinitrochlorobenzene. Ann Intern Med 1992; 96:329–331. 25. Newman SL, Gootee L, Brunner G, Deepe GS Jr. Chloroquine induces human macrophage killing of Histoplasma capsulatum by limiting the availability of intracellular iron and is therapeutic in a murine model of histoplasmosis. J Clin Invest 1994; 93:1422–1429. 26. Levitz SM, Harrison TS, Tabuni A, Liu X. Chloroquine induces human mononuclear phagocytes to inhibit and kill Cryptococcus neoformans by a mechanism independent of iron deprivation. J Clin Invest 1997; 100:1640–1646. 27. Mazzola R, Barluzzi R, Brozzetti A, et al. Enhanced resistance to Cryptococcus neoformans infection induced by chloroquine in a murine model of meningoencephalitis. Antimicrob Agents Chemother. 1997; 41:802–807. 28. Kitchen LW. Adjunctive immunologic therapy for Cryptococcus neoformans infections. Clin Infect Dis 1996; 23:209–210. 29. Kitchen LW, Ross JA, Turner BS, Hernandez JE, Mather FJ. Diethylcarbamazine enhances blood microbicidal activity. Adv Ther 1995; 12:22–29. 30. Kitchen LW, Ross JA, Hernandez JE, Zarraga AL, Mather FJ. Effect of administration of diethylcarbamazine on experimental bacterial and fungal infections in mice. Int J Antimicrob Agents 1992; 1:259–268. 31. Nemunitis J. A comparative review of colonly-stimulating factors. Drugs 1997; 54:709–729. 32. Lieschke GJ, Burgess AW. Granulocyte colony-stimulating factor and granulocytemacrophage colony-stimulating factor. N Engl J Med 1992; 327:28–35. 33. Enelow RI, Sullivan GW, Carper HT, Mandell GL. Cytokine-induced human multinucleated giant cells have enhanced candidacidal activity and oxidative capacity compared with macrophages. J Infect Dis 1992; 166:664–668. 34. Offner F. Hematopoietic growth factors in cancer patients with invasive fungal infections. Eur J Clin Microbiol Infect Dis 1997; 16:50–63.

Fungal Infections 317<br />

modalities in patients with fungal infection. In the next few years, one can anticipate<br />

that dozens of compounds in the <strong>for</strong>m of cytokines, interleukins, growth factors, vaccines,<br />

and antibodies may become available, providing physicians with powerful options<br />

<strong>for</strong> enhancing immune function. In fact, the biologic revolution may deliver potential<br />

immune therapeutic agents to the bedside at a rate faster than the medical mycology<br />

community can evaluate them. Biologic response modifiers and immune therapies are<br />

complex modalities that require a sophisticated understanding of immune function and<br />

microbial pathogenesis <strong>for</strong> optimal use. Considering the diversity of fungal pathogens,<br />

the complexity of the immune system, the variety of immune modulators available, and<br />

the heterogeneity of patients with immune deficiencies at risk <strong>for</strong> fungal infection, the<br />

current challenge is to design systems <strong>for</strong> the expedient testing of immune therapy.<br />

REFERENCES<br />

1. Kullberg BJ. Trends in immunotherapy of fungal infections. Eur J Clin Microbiol Infect<br />

Dis 1997; 16:51–55.<br />

2. Wingard JR, Elfenbein GJ. Host immunologic augmentation <strong>for</strong> the control of infection.<br />

Infect Dis Clin North Am 1996; 10:345–364.<br />

3. Anaissie EJ. Immunomodulation in the treatment of invasive fungal infections: present<br />

and future directions. Clin Infect Dis 1998; 26:1264–1265.<br />

4. Walsh TJ, Hiemenz J, Anaissie EJ. Recent progress and current problems in treatment of<br />

invasive fungal infections in neutropenic patients. Infect Dis Clin North Am 1996;<br />

10:365–400.<br />

5. Stevens DA. Combination immunotherapy and antifungal therapy. Clin Infect Dis 1998;<br />

26:1266–1269.<br />

6. Rodriguez-Adrian LJ, Grazziutti ML, Rex JH, Anaissie EJ. The potential role of cytokine<br />

therapy <strong>for</strong> fungal infections in patients with cancer: is recovery from neutropenia all that<br />

is needed? Clin Infect Dis 1998; 26:1270–1278.<br />

7. Roilides E, Dignani MC, Anaissie EJ, Rex JH. The role of immunoreconstitution in the<br />

management of refractory opportunistic fungal infections. Med Mycol 1998; 36(suppl<br />

1):12–25.<br />

8. Han Y, Cutler JE. Assessment of a mouse model of neutropenia and the effect of an anticandidiasis<br />

monoclonal antibody in these animals. J Infect Dis 1997; 175:1169–1175.<br />

9. DiNubile MJ. Therapeutic role of granulocyte transfusions. Rev Infect Dis 1985;<br />

7:232–243.<br />

10. Chanock SJ, Gorlin JB. Granulocyte transfusions. Time <strong>for</strong> a second look. Infect Dis Clin<br />

North Am 1996; 10:327–343.<br />

11. Wright DG. Leukocyte transfusions: thinking twice. Am J Med 1984; 76:637–644.<br />

12. Dale DC, Liles WC, Llewellyn C, Rodger E, Price TH. Neutrophil transfusions: kinetics<br />

and functions of neutrophils mobilized with granulocyte-colony-stimulating factor and<br />

dexamethasone. Transfusion 1998; 38:713–721.<br />

13. Rex JH, Bhalla SC, Cohen DM, Hester JP, Vartivarian SE, Anaissie EJ. Protection of<br />

human polymorphonuclear leukocyte function from the deleterious effects of isolation,<br />

irradiation, and storage by interferon-� and granulocyte-colony-stimulating factor. Transfusion<br />

1995; 35:605–611.<br />

14. Strauss RG. Neutrophil (granulocyte) transfusions in the new millennium. Transfusion<br />

1998; 38:710–712.<br />

15. Clarke K, Szer J, Shelton M, Coghlan D, Grigg A. Multiple granulocyte transfusions facilitating<br />

successful unrelated bone marrow transplantation in a patient with very severe<br />

aplastic anemia complicated by suspected fungal infection. Bone Marrow Transplant<br />

1995; 16:723–726.

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