THE EFFECT OF ANTIBODY AGAINST TNF-ALPHA ON CYTOKINE RESPONSE IN JARISCH-HERXHEIMER REACTIONS OF LOUSE-BORNE RELAPSING FEVER

Severe Jarisch Herxheimer reaction (J-HR) precipitated by antibiotic t reatment of louse-borne relapsing fever (LBRF) is associated with a tr ansient, marked rise in circulating tumour necrosis factor alpha (TNF alpha), interleukin 6 (IL-6) and interleukin 8 (IL-8). Ovine polyclona l anti-TNF alpha antibody fragments (Fab) were used in a randomized do uble blind placebo controlled trial in an attempt to prevent this reac tion. Within 4 h after penicillin, in controls (n = 29), a several-fol d rise in cytokines occurred, concomitant with a fall in spirochaetes and maximal clinical manifestations of the J-HR. An intravenous infusi on of anti-TNF alpha Fab, 30 min before penicillin in 20 patients redu ced peak plasma levels of IL-6 and IL-8 (but not IL-1 beta) compared w ith controls (p = 0.01 and <0.001, respectively) and the incidence of the J-HR, indicating some neutralization of TNF alpha. An apparent fal l in TNF alpha reflected interference of anti-TNF alpha in the immunoa ssay.