Re: I need you research help!

[Guest guest]

Toni, I've come across the phrase " cytokine storm " in my reading before. I

did more research on it since you asked, and, most of the time, it's used to

describe a systemic, acute, and potentially life-threatening situation.

Some context and definitions:

************************

" The key element in generating the storm is an uncontrolled exuberant immune

response to the virus, in which there is an outpouring of proinflammatory

cytokines and chemoattractants. "

Source:

NEJM

May 5, 2005

" Preparing for the Next Pandemic " :

http://content.nejm.org/cgi/content/full/352/18/1839

(includes diagram of proposed cytokine storm mechanism)

--------------------------------------------

" Septic shock is characterized by hemodynamic imbalance and the production

of proinflammatory and antiinflammatory molecules called cytokines. These

cytokines are released by various cells throughout the body, where they gain

access to the circulation and are delivered to target cells in various

tissues. Thus, a systemic inflammatory response is mounted with collateral

damage to tissues and organs, and this is further aggravated by insufficient

tissue perfusion due in part to a dysfunctional blood clotting system.

The causes of septic shock are not well understood. In many cases, a

localized infection or blood borne infectious agent can be identified in

septic patients, but this is not always the case (1) . This, or some other

unknown stimulus, provokes a systemic inflammatory response with widespread

production of inflammatory mediators including cytokines. We, and others in

the field, believe that this " cytokine storm " is the cause of the majority

of the morbidity and mortality of septic shock. A considerable portion of

our research is directed towards a better understanding of the molecular

mechanisms underlying the septic disease process. "

Source:

Department of Critical Care Medicine

University of Pittsburgh

http://www.ccm.upmc.edu/research/mantra/mantra_delude.htm

-----------------------------------

" In the patients suffering from MODS, a systemic release of various

cytokines is not properly regulated, and the high blood levels of the

proinflammatory cytokines induce an autodestructive generalized inflammatory

reaction. This condition is termed " cytokine Storm " by the author. In the

cytokine storm, not only proinflammatory cytokines but also

anti-inflammatory cytokines are elevated in the blood stream. "

Source:

" Cytokine storm in the pathogenesis of multiple organ dysfunction syndrome

[MODS] " :

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & list_uids=8\

940690 & dopt=Citation

************************

I don't think there is a specific link between cytokine storm and RA or

lap-band patients. It can occur in a wide variety of situations. One

infectious disease expert (the author of the NEJM article referenced above),

Osterholm, states that healthy patients who become infected with

avian flu may actually be more at risk of experiencing a cytokine storm than

immunocompromised individuals:

http://www.hon.ch/News/HSN/529060.html

The talk about bird flu and cytokine storm is interesting; however, I'm not

sure anti-TNF therapies will be all that effective. Trials have been

conducted with patients affected by sepsis and SIRS (systemic inflammatory

response syndrome) who were treated with TNF blockers (since TNF-alpha is

thought to be a major player in those situations), and the results have been

fairly disappointing. Here's a recent article related to that:

************************

Rheumatology

2005

" TNF-alpha neutralization in cytokine-driven diseases: a mathematical model

to account for therapeutic success in rheumatoid arthritis but therapeutic

failure in systemic inflammatory response syndrome " :

http://rheumatology.oxfordjournals.org/cgi/content/abstract/44/3/323

************************

Not to say that you aren't very ill, but I believe your primary is

overstating things by describing your situation as being caused by a

cytokine storm. Patients experiencing a cytokine storm are most likely to be

in an ICU (or should be). The article you posted about the unfortunate

patients in the TGN 1412 trial is probably a cytokine storm scenario.

We also had at least one story in our group that sounded like a case of

cytokine storm: a member nearly died when her infected prosthesis led to

severe sepsis/SIRS and shock and months of hospitalization. Of note, shortly

before this terrible episode, the person in question received a Remicade

infusion.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] I need you research help!

> ,

> Can you research cytokine storm as it relates to RA as well as how it

> relates to gastric bypass patients and lapband patients. I shall post

> my reason why in a seperate e-mail...but I am sooo pissed at my silly

> rheummy!!!

>

> Thank you Sooo much!!!

>

> Toni

[Guest guest]

, how is Debs doing, anyway? We haven't heard anything from her in

ages, and I keep wondering if she's any better.

Sue

On Wednesday, March 22, 2006, at 05:57 PM, wrote:

>

> We also had at least one story in our group that sounded like a case of

> cytokine storm: a member nearly died when her infected prosthesis led

> to

> severe sepsis/SIRS and shock and months of hospitalization. Of note,

> shortly

> before this terrible episode, the person in question received a

> Remicade

> infusion.

[Guest guest]

Sue, I haven't heard anything from Debs for a very long time.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

Re: [ ] I need you research help!

> , how is Debs doing, anyway? We haven't heard anything from her in

> ages, and I keep wondering if she's any better.

>

> Sue