Chemotherapy for a disorder of the immune system may - at least in theory - be effective against severe human avian influenza infection, this suggest scientists at the Karolinska Institutet.

The Hypothesis is published on online by The Lancet. The authors suggest that although chemotherapy for avian influenza is a substantial jump in thinking, such therapy could still be reasonable, particularly since it has been shown to be very effective in decreasing mortality in an immune disorder called haemophagocytic lymphohistiocytosis disease (HLH), which may be associated with severe infection by the Epstein-Barr virus.

The mortality rate for avian influenza A virus subtype H5N1 infection is around 50 percent, according to the World Health Organization, WHO, and there is an urgent need for novel treatments.

In their Hypothesis professor Jan-Inge Henter at the Karolinska Institutet in Stockholm and colleagues in Hong Kong state that patients with H5N1 infection have some symptoms and post-mortem features in common with people with the immune disorder HLH. Patients with HLH have too many infection-fighting white blood cells, which can accumulate in good tissue and cause damage to a variety of organs. One of the key treatments for HLH is the chemotherapy drug etoposide, which helps kill the excess of immune cells.

The scientists emphasize that their suggestion at present merely is a hypothesis, and that the treatment not yet has been tested in patients affected by avian influenza infection.

We would welcome the WHO to consider a platform for the undertaking of clinical trials based on a modified HLH protocol. including etoposide and corticosteroids, in addition to supportive and antiviral therapy for patients infected by H5N1, says professor Jan-Inge Henter.

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