Adjunct oral immunotherapy in patients with re-treated, multidrug-resistant or HIV-coinfected TB
Abstract
This Phase IIb, placebo-controlled study involved 55 TB patients treated with anti-TB therapy. They were divided into two groups, matched by age, gender, baseline bodyweight and clinical manifestations: one group (n = 27) received a once-daily V-5 Immunitor (V5) immunotherapy pill and the other (n = 28) received placebo. Only one (3.7%) and three (10.7%) subjects in V5 and placebo arms, respectively had first-diagnosed, drug-sensitive TB; the remaining patients had re-treated TB, multidrug-resistant TB or HIV–TB coinfection. After 1 month, 26 out of 27 patients (96.3%) became sputum smear negative in the V5 group (p < 0.0000001), whereas seven out of 28 (25%) in the placebo group had converted (p = 0.005). V5 contributed to the downregulation of TB-associated inflammation, as shown by normalization of high leukocyte counts, erythrocyte sedimentation rate and faster defervescence than controls. Patients in both arms experienced an increase in the levels of hemoglobin corresponding to 128.9 ± 17.6 versus 133.1 ± 14.7 g/l (p = 0.03) and 112.6 ± 14 versus 117 ± 11.7 g/l (p = 0.03) in V5 and placebo arms, respectively. In total, 19 out of 28 placebo patients (67.9%) gained, on average, 1.07 kg (59.1 ± 10 vs 60.1 ± 10.4 kg; p = 0.003). By contrast, all patients in the V5 group gained weight with mean 3.4 kg (59.7 ± 8 vs 63.1 ± 9 kg; p = 5.7E-007). Clinical symptoms improved among all patients in V5 arm, while 28.6% of patients on placebo reported satisfactory results (p = 0.007). No adverse or side effects attributable to V5 were seen at any time. Further studies are needed to gauge the extent of the benefits of V5 as safe and effective adjunct immunotherapy for TB.
Papers of special note have been highlighted as: ▪ of interest ▪▪ of considerable interest
Bibliography
- 1 Nunn P, Williams B, Floyd K, Dye C, Elzinga G, Raviglione M: Tuberculosis control in the era of HIV. Nat. Rev. Immunol.5,819–826 (2005).Crossref, Medline, CAS, Google Scholar
- 2 Drobniewski F, Nikolayevsky V, Asmolov A, Bazhora Y, Servetsky S: Increasing trends in HIV and TB rates in Odessa and the Ukraine. Int. J. STD AIDS16,374–378 (2005).Crossref, Medline, CAS, Google Scholar
- 3 Nikolayevskyy VV, Brown TJ, Bazhora YI, Asmolov AA, Balabanova YM, Drobniewski FA: Molecular epidemiology and prevalence of mutations conferring rifampicin and isoniazid resistance in Mycobacterium tuberculosis strains from the southern Ukraine. Clin. Microbiol. Infect.13,129–138 (2007).Crossref, Medline, CAS, Google Scholar
- 4 Feshchenko II, Poddubnyi AF, Kunichkina SA, Antoniak SM: Pulmonary tuberculosis and acquired immunodeficiency syndrome in Ukraine (first communication). Probl. Tuberk.4,55–57 (1997).Google Scholar
- 5 van der Werf MJ, Yegorova OB, Chentsova N et al.: Tuberculosis–HIV coinfection in Kiev City, Ukraine. Emerg. Infect. Dis.12,766–768 (2006).Crossref, Medline, Google Scholar
- 6 Raykhert I, Miskinis K, Lepshyna S et al.: HIV seroprevalence among new TB patients in the civilian and prisoner populations of Donetsk Oblast, Ukraine. Scand. J. Infect. Dis.40,655–662 (2008).Crossref, Medline, Google Scholar
- 7 Small PM: Tuberculosis: a new vision for the 21st Century. Kekkaku84,721–726 (2009).Medline, Google Scholar
- 8 Churchyard GJ, Kaplan G, Fallows D, Wallis RS, Onyebujoh P, Rook GA: Advances in immunotherapy for tuberculosis treatment. Clin. Chest. Med.30,769–782 (2009).Crossref, Medline, Google Scholar
- 9 Batdelger D, Dandii D, Jirathitikal V, Bourinbaiar AS: Open label trial of therapeutic hepatitis B vaccine V-5 Immunitor (V5) delivered by oral route. Lett. Drug Design Discovery4,540–544 (2007).Crossref, CAS, Google Scholar
- 10 Batdelger D, Dandii D, Jirathitikal V, Bourinbaiar AS: Open label trial of therapeutic immunization with oral V-5 Immunitor (V5) vaccine in patients with chronic hepatitis C. Vaccine26,2733–2737 (2008).Crossref, Medline, CAS, Google Scholar
- 11 Batdelger D, Dandii D, Dahgwahdorj YA et al.: Clinical experience with therapeutic vaccines designed for patients with hepatitis. Curr. Pharm. Design15,1159–1171 (2009).Crossref, Medline, CAS, Google Scholar
- 12 Arjanova OV, Prihoda ND, Yurchenko LV et al.: Phase II trial of V-5 Immunitor (V5) in patients with chronic hepatitis C coinfected with HIV and Mycobacterium tuberculosis. J. Vaccin. Vaccinat.1,103 (2010).▪ First published report describing the anti-TB effect of Immunitor V-5 (V5).Crossref, CAS, Google Scholar
- 13 Zaitzeva SI, Matveeva SL, Gerasimova TG et al.: Treatment of cavitary and infiltrating pulmonary tuberculosis with and without the immunomodulator Dzherelo. Clin. Microbiol. Infect.15,1154–1162 (2009).Crossref, Medline, CAS, Google Scholar
- 14 Arjanova OV, Prihoda ND, Yurchenko LV et al.: Enhancement of efficacy of tuberculosis drugs with Immunoxel (Dzherelo) in HIV-infected patients with active pulmonary tuberculosis. Immunotherapy1,549–556 (2009).Link, CAS, Google Scholar
- 15 Espinal MA, Kim SJ, Suarez PG et al.: Standard short-course chemotherapy for drug-resistant tuberculosis: treatment outcomes in six countries. JAMA283,2537–2545 (2000).Crossref, Medline, CAS, Google Scholar
- 16 Chan ED, Laurel V, Strand MJ et al.: Treatment and outcome analysis of 205 patients with multidrug-resistant tuberculosis. Am. J. Respir. Crit. Care Med.169,1103–1109 (2004).Crossref, Medline, Google Scholar
- 17 Fu Y, Chu NH, Yuan SL et al.: The effect of interventional therapy in multimodality treatment on multi-drug resistant pulmonary tuberculosis. Zhonghua Jie He He Huxi Za Zhi31,95–98 (2008).Medline, Google Scholar
- 18 Greinert U, Hillemann D, Lange C, Richter E: Antibiotic drug-resistant tuberculosis. Med. Klin. (Munich)102,957–966 (2007).Crossref, Medline, Google Scholar
- 19 Ostrovskii VK, Asanov BM, Iangolenko DV: Some blood indices and the leukocytic index of intoxication in tuberculosis, pneumonias, abscesses, and cancer of the lung. Probl. Tuberk. Bolezn. Legk.3,43–46 (2005).Google Scholar
- 20 Ellner JJ: Immunoregulation in TB: observations and implications. Clin. Transl. Sci.3,23–28 (2010).▪▪ Reviews and questions the need for induction of stronger immune response as means to overcome active TB is questioned.Crossref, Medline, CAS, Google Scholar
- 21 Das BS, Devi U, Mohan Rao C, Srivastava VK, Rath PK, Das BS: Effect of iron supplementation on mild to moderate anaemia in pulmonary tuberculosis. Br. J. Nutr.90,541–550 (2003).Crossref, Medline, Google Scholar
- 22 Edwards LB, Livesay VT, Acquaviva FA, Palmer CE: Height, weight, tuberculous infection, and tuberculous disease. Arch. Environ. Health22,106–112 (1971).Crossref, Medline, CAS, Google Scholar
- 23 Villamor E, Saathoff E, Mugusi F, Bosch RJ, Urassa W, Fawzi WW: Wasting and body composition of adults with pulmonary tuberculosis in relation to HIV-1 coinfection, socioeconomic status, and severity of tuberculosis. Eur. J. Clin. Nutr.60,163–171 (2006).Crossref, Medline, CAS, Google Scholar
- 24 Kaufmann SH: Is the development of a new tuberculosis vaccine possible? Nat. Med.6,955–960 (2000).Crossref, Medline, CAS, Google Scholar
- 25 Lei JP, Xiong GL, Hu QF, Li Y, Zong PL, Tu SH, Tu RY: Immunotherapeutic efficacy of BCG vaccine in pulmonary tuberculosis and its preventive effect on multidrug-resistant tuberculosis. Zhonghua Yu Fang Yixue Za Zhi42,86–89 (2008).▪ Representative trial of postexposure bacillus Calmette–Guérin vaccine, which shows negligible effect in treatment outcome.Medline, Google Scholar
- 26 Radaeva TV, Nikonenko BV, Kapina MA, Mishchenko VV, Apt AS: Experimental approaches to designing vaccines against tuberculous infection reactivation. Probl. Tuberk. Bolezn. Legk.5,45–48 (2006).▪ Animal study that shows Koch-like reaction (i.e., disease reactivation) when a TB vaccine is used for therapeutic purposes.Medline, Google Scholar
- 27 Derrick SC, Perera LP, Dheenadhayalan V, Yang A, Kolibab K, Morris SL: The safety of postexposure vaccination of mice infected with Mycobacterium tuberculosis. Vaccine26,6092–6098 (2008).▪ Animal study that indicates that risk of Koch-like reaction is negligible, when TB vaccine is used as postexposure vaccine.Crossref, Medline, CAS, Google Scholar
- 28 Stanford J, Stanford C, Stansby G, Bottasso O, Bahr G, Grange J: The common mycobacterial antigens and their importance in the treatment of disease. Curr. Pharm. Des.15,1248–1260 (2009).▪ Review article by original discoverers of Mycobacterium vaccae, which summarizes their experience with immune therapies for TB and other seemingly unrelated diseases.Crossref, Medline, CAS, Google Scholar
- 29 Luo Y, Lu S, Guo S: Immunotherapeutic effect of Mycobacteium vaccae on multi-drug resistant pulmonary tuberculosis. Zhonghua Jie He He Huxi Za Zhi23,85–88 (2000).Medline, CAS, Google Scholar
- 30 Vilaplana C, Montané E, Pinto S et al.: Double-blind, randomized, placebo-controlled Phase I clinical trial of the therapeutical antituberculous vaccine RUTI. Vaccine28,1106–1116 (2010).▪ Phase I study showing safety of therapeutic vaccine RUTI® consisting of inactivated Mycobacterium tuberculosis.Crossref, Medline, CAS, Google Scholar
- 31 Zhao G-R, Feng D-H: A systematic review of inactivated Mycobacterium phlei injection for adjunctive treatment of drug resistant pulmonary tuberculosis Pharm. J. Chin. PLA25,361–364 (2009).▪ Summarizes Chinese experience with Mycobacterium phlei vaccine.CAS, Google Scholar
- 32 Patel N, Trapathi SB: Improved cure rates in pulmonary tuberculosis category II (retreatment) with mycobacterium w. J. Indian Med. Assoc.101,680–682 (2003).▪ One of several articles reporting Indian experience with Mycobacterium w vaccine.Medline, Google Scholar
- 33 Tomioka H: Adjunctive immunotherapy of mycobacterial infections. Curr. Pharm. Des.10,3297–3312 (2004).Crossref, Medline, CAS, Google Scholar
- 34 Prihoda ND, Arjanova OV, Yurchenko LV et al.: Open label trial of adjuvant immunotherapy with Dzherelo, Svitanok and Lizorm, in MDR TB, XDR-TB and TB/HIV coinfected patients receiving anti-tuberculosis therapy under DOT. J. Med. Plant Res.1,117–122 (2007).Google Scholar
- 35 Nikolaeva LG, Maystat TV, Pylypchuk VS, Volyanskii YuL, Masyuk LA, Kutsyna GA: Effect of oral immunomodulator Dzherelo (Immunoxel) in TB/HIV coinfected patients receiving anti-tuberculosis therapy under DOTS. Intl. Immunopharmacol.8,845–851 (2008).Crossref, Medline, CAS, Google Scholar
- 36 Prihoda ND, Arjanova OV, Yurchenko LV et al.: Adjuvant immunotherapy of tuberculosis in drug-resistant TB and TB/HIV co-infected patients. Intl J. Biomed. Pharm. Sci.2,59–64 (2008).Google Scholar
- 37 Zaitzeva SI, Matveeva SL, Gerasimova TG et al.: Efficacy and safety of phytoconcentrate Dzherelo (Immunoxel) in treatment of patients with multi-drug resistant TB (MDR TB) in comparison to standard chemotherapy. Res. J. Med. Sci.3,36–41 (2009).Google Scholar
- 38 Arjanova OV, Prihoda ND, Sokolenko NI et al.: Impact of adjunct immunotherapy with multi-herbal supplement Dzherelo (Immunoxel) on treatment outcomes in end-stage TB/HIV patients. J. Antivir. Antiretrovir.1,86–88 (2009).Crossref, CAS, Google Scholar
- 39 Prihoda ND, Arjanova OV, Yurchenko LV et al.: Adjuvant immunotherapy of extensively drug-resistant tuberculosis (XDR-TB) in Ukraine. Curr. Res. TB1,1–6 (2009).Google Scholar
- 40 Parida SK, Kaufmann SH: Novel tuberculosis vaccines on the horizon. Curr. Opin. Immunol.22,374–384 (2010).▪ Summarizes state-of-the-art in the field of TB vaccines.Crossref, Medline, CAS, Google Scholar
- 41 Laurenzi M, Ginsberg A, Spigelman M: Challenges associated with current and future TB treatment. Infect. Disord. Drug Targets7,105–119 (2007).▪ Reviews and succinctly elaborates on the goals and challenges in TB treatment.Crossref, Medline, CAS, Google Scholar
- 42 Silin DS, Lyubomska OV, Jirathitikal V, Bourinbaiar AS: Oral vaccination: where we are? Expert. Opin. Drug Deliv.4,323–340 (2007).Crossref, Medline, CAS, Google Scholar
- 43 Dlugovitzky D, Notario R, Martinel-Lamas D et al.: Immunotherapy with oral, heat-killed, Mycobacterium vaccae in patients with moderate to advanced pulmonary tuberculosis. Immunotherapy2,159–169 (2010).▪▪ First report of oral TB vaccine as a therapeutic modality, showing that mucosal delivery is not inferior to parenteral or injectable vaccine.Link, CAS, Google Scholar
- 44 Hanekom WA, Lawn SD, Dheda K, Whitelaw A: Tuberculosis research update. Trop. Med. Int. Health15,981–989 (2010).▪ Most recent up-to-date review summarizing advances in TB research.Crossref, Medline, CAS, Google Scholar
- 45 Lahey T, Arbeit RD, Bakari M et al.: Immunogenicity of a protective whole cell mycobacterial vaccine in HIV-infected adults: a Phase III study in Tanzania. Vaccine28(48),7652–7658 (2010).Crossref, Medline, Google Scholar
- 46 Byrne ST, Denkin SM, Zhang Y: Aspirin and ibuprofen enhance pyrazinamide treatment of murine tuberculosis. J. Antimicrob. Chemother.59,313–316 (2007).Crossref, Medline, CAS, Google Scholar
- 47 Byrne ST, Denkin SM, Zhang Y: Aspirin antagonism in isoniazid treatment of tuberculosis in mice. Antimicrob. Agents Chemother.51,794–795 (2007).Crossref, Medline, CAS, Google Scholar

