SERUM NEOPTERIN, INTERLEUKIN-4, AND INTERLEUKIN-6 CONCENTRATIONS IN CEREBRAL MALARIA PATIENTS AND THE EFFECT OF IRON CHELATION-THERAPY

To determine if iron chelation therapy alters immune responses in chil dren with cerebral malaria, we retrospectively measured mean serum lev els of neopterin, interleukin-4 (IL-4), and IL-6 in children who recei ved desferrioxamine B or placebo for three days in addition to quinine -based therapy. Mean levels of neopterin, IL-4, and IL-6 were elevated above the expected normal range on admission. Neopterin correlated si gnificantly with the degree of anemia, IL-4 with the duration of fever prior to admission, and IL-6 with parasite density. Serial measuremen ts of cytokines and neopterin were performed over four days in 39 chil dren, 21 randomized to receive desferrioxamine B and 18 to receive pla cebo. Mean concentrations of neopterin did not change significantly in either group while levels of IL-4 increased significantly in the plac ebo group (P = 0.04) but remained unchanged in the desferrioxamine B g roup. Interleukin-6 concentrations decreased markedly in both groups ( P < 0.025). Stable IL-4 levels in children given desferrioxamine B may represent an inhibition of the T helper lymphocyte-2 (TH-2) response resulting from a strengthened TH-1 response associated with iron chela tion therapy. Any effect of iron chelation on immunity in the setting of severe malaria will have to be confirmed in future prospective inve stigations.