一例粒细胞集落刺激因子致脾梗死

脾脏梗死是一种少见疾病,且有自愈倾向而被临床医生忽视。本文报告一例残胃癌术后化疗期间,静脉使用人粒细胞集落刺激因子治疗骨髓抑制并发脾脏梗死,探讨脾梗死的病因,为临床医师提供参考。

参麦注射液足三里穴位注射、艾灸中脘和关元联合重组人粒细胞集落刺激因子注射液皮下注射治疗化疗后粒细胞减少症50例

目的:观察参麦注射液足三里穴位注射、艾灸中脘和关元联合重组人粒细胞集落刺激因子注射液皮下注射治疗化疗后粒细胞减少症的临床疗效。方法:将100例本科室住院的化疗后粒细胞减少症患者采用随机数字表法随机分为两组,每组50例。两组均给予常规剂量化疗。对照组皮下注射重组人粒细胞集落刺激因子注射液150μg/次,1次/d,连用5 d。治疗组在对照组治疗基础上以参麦注射液进行双侧足三里穴位注射,每3天1次,连续治疗3次;同时艾灸中脘、关元,20 min/次,1次/d,连续治疗10 d。结果:治疗组显效40例,有效8例,无效2例,有效率为96%;对照组显效32例,有效15例,无效3例,有效率为94%。两组疗效对比,差别无统计学意义(P>0.05)。治疗组治疗时间平均(8.61±2.65)d,对照组治疗时间平均(11.59±2.87)d,两组对比,差别有统计学意义(P<0.05)。结论:参麦注射液足三里穴位注射、艾灸中脘和关元联合重组人粒细胞集落刺激因子注射液皮下注射治疗化疗后粒细胞减少症有较好疗效。

IFN-α联合GM-CSF诱导胃癌患者外周血单个核细胞分化为树突状细胞

目的:探索干扰素-α(interferon-α,IFN-α)联合粒细胞-巨噬细胞集落刺激因子(granulocyte-macrophage colony-stim-ulating factor,GM-CSF)体外诱导胃癌患者外周血单个核细胞(peripheral blood mononuclear cell,PBMC)向树突状细胞(dendriticcell,DC)分化的可能性。方法:10例胃癌患者PBMC分别用GM-CSF 100 ng/ml联合IFN-α500 IU/ml(命名为IFN-αDC)或GM-CSF 100 ng/ml联合50 ng/ml IL-4(命名为IL-4 DC)体外培养,然后用CD40L、LPS诱导DC成熟。Giemsa染色法观察IFN-αDC和IL-4 DC的形态,流式细胞术分析IFN-αDC和IL-4 DC表面CD1a、CD80、CD83、CD86和HLA-DR的表达情况,同种异体混合淋巴细胞反应(mixed lymphocyte reaction,MLR)检测不同的成熟DC刺激同种异体T淋巴细胞增殖的能力。结果:IFN-αDC和IL-4 DC均呈现典型DC形态。IFN-αDC和IL-4 DC分别在诱导第3天和第5天时,细胞表面CD1a、CD80、CD83、CD86和HLA-DR表达达到较高水平,成熟IFN-αDC表面CD83[(78.25±15.36)%vs(50.14±10.24)%,P<0.05]和CD86[(84.84±10.12)%vs(62.93±15.12)%,P<0.05]的表达均高于成熟IL-4 DC。成熟IFN-αDC刺激异体T淋巴细胞增殖能力强于未成熟IFN-αDC(P<0.05)。在DC与T细胞数量比为1∶40和1∶20时,成熟IFN-αDC刺激同种异体T淋巴细胞增殖的能力明显强于成熟IL-4 DC[(39.43±9.21)%vs(27.34±10.63)%,(60.31±7.86)%vs(48.63±6.25)%;均P<0.05]。结论:相比常用的IL-4联合GM-CSF诱导方法,IFN-α联合GM-CSF可以在更短时间内将胃癌患者PBMC诱导成具有更强刺激同种异体T淋巴细胞增殖能力的DC细胞,这可能与其表面CD83和CD86表达增高有关。

Outcomes of CAG Regimen for Refractory Biphenotypic Acute Leukemia Patients

Objective To evaluated the efficiency of low-dose cytosine arabinoside plus aclarubicin with concurrent administration of granulocyte colony-stimulating factor （CAG） regimen for refractory biphenotypic acute leukemia （BAL）. Methods We treated 5 refractory BAL patients by CAG regimen （10 mg.m 2 cytosine arabinoside subcutaneously administrated every 12 hours, day 1-14; 5-7 mg·m^-2 aclarubicin intravenously administrated daily, day 1-8; and concurrently used 200 μg·m^-2·d^-1 granulocyte colony-stimulating factor subcutaneously） from November 2002 to April 2007. The efficacy of the regimen was evaluated by response rate, and the side effects were also measured. Results The complete remission rate was 80%, median duration of absolute neutrophil count〈5.0×10^8/L and platelet count〈2.0×10^10/L was day 13 and day 1, respectively; and the infection rate was low （Ⅲ-Ⅳ infection rate, 20.00%）.

Pharmacokinetic Study of a Novel Recombinant Human Granulocyte Colony-stimulating Factor in Rats

Objective To study the pharmacokinetics of a novel recombinant human granulocyte colonystimulating factor (rhG-CSFa) in rats and to determine the proteolytic rates of rhG-CSFa in the whole blood and serum of rats in vitro. Methods The pharmacokinetics of rhG-CSFa and conventional (wild type,WT) granulocyte colonystimulating factor (G-CSF) were investigated in Sprague-Dawley rats which received either intravenous or subcutaneous injection of rhG-CSFa or WT G-CSF at three different doses (20,50,or 100 μg/kg). The blood samples of rats were collected at multiple time points (from 0.08 to 12 h) and the concentrations of rhG-CSFa and WT G-CSF in serum were determined with a sandwich enzyme-linked immunosorbent assay (ELISA). For the study of proteolytic rates in vitro,the concentrations of rhG-CSFa or WT G-CSF were determined at 3-minute intervals after addition of the respective drug to rat’s whole blood or serum. Results Pharmacokinetic analysis of serum rhG-CSFa or WT G-CSF levels indicated that,at each dose tested,for either route of drug administration,the area under concentration-time curve values and the maximum serum concentration of rhG-CSFa were higher than those of WT G-CSF,and the serum half life of rhG-CSFa was longer than that of WT G-CSF. Subsequent in vitro whole blood and serum stability study showed that the rates of drug degradation in WT G-CSF were 1.8 folds and 1.5 folds higher than those in rhG-CSFa,respectively. Conclusion rhG-CSFa has better serum and whole blood stability in vitro and higher bioavailability in vivo as compared to WT G-CSF.

Expression characteristics of neutrophil and mononuclear-phagocyte related genes mRNA in the stable angina pectoris and acute myocardial infarction stages of coronary artery disease

Objective To investigate expression differences of neutrophil and mononuclear phagocyte related gene mRNAs among acute myocardial infarction （AMI）, stable angina （SA） and control groups, and then discuss their expression characteristics in the stable angina pectoris （SAP） and AMI stages of coronary artery disease （CAD）. Methods Whole Human Genome Oligo Microarrays were applied to assess the differential expression characteristics of neutrophil and mononuclear phagocyte related mRNAs in patients with AMI （n = 20）, SA （n = 20） and controls （n = 20）. Results （1） Almost all colony-stimulating factors （CSF） and their receptors related mRNAs was up-regulated in AMI and SA groups compared with the control group, and the expression of granulocyte-macrophage colony stimulating factor receptor （GM-CSFR） and granulocyte colony stimulating factor receptor （G-CSFR） mRNAs in the AMI group was significantly up-regulated compared with the other two groups （P 〈 0.01）. （2） The expression of mRNAs related to monocyte chemoattractant protein-1 （MCP-1）, CCR2 （MCP-1 receptor） and CXCR2 （IL-8 receptor） was significantly up-regulated （P 〈 0.01） in AMI group compared with SA and control groups IL-8 mRNA expression in the AMI group was clearly higher than the controls （P 〈 0.05）. （3） All mRNAs expression related to opsonic re- ceptors （IgG FoR and C3bR/C4bR） was significantly up-regulated in AMI group compared with SA and control group （P 〈 0.01）, and the SA group showed an upward trend compared with controls. （4） Most pattern recognition receptor （PRR）-related mRNAs expression was up-regulated in AMI group compared with SA and control groups. Most toll-like receptor （TLR） mRNAs expression was significantly up-regulated （P 〈 0.01） than the SA and control groups, macrophage scavenger receptor （MSR） mRNA was significantly up-regulated in AMI group compared with the control group （P 〈 0.01）, and the SA group showed an upward trend compared with the controls. Conclusions The expression of most neutrophil and mononuclear-macrophage function related genes mRNAs was significantly up-regulated by stages during the progression of CAD, suggesting that the adhesive, chemotactic and phagocytic functions of neutrophil and mononudear-macrophage were strengthened in the occurrence and development of coronary atherosclerosis and AMI. This also showed a stepped up- ward trend as the disease progressed.

Chronic Toxicity of a Novel Recombinant Human Granulocyte Colony-stimulating Factor in Rats

Objective To assess the severity and reversibility of the chronic toxicity of a novel recombinant human granulocyte colony-stimulating factor (rhG-CSFa) in rats and the dose-effect relationship.Methods A total of 100 Sprague-Dawley rats (equal numbers of male and female) were randomly divided into five groups (20 rats in each group):four groups were treated with rhG-CSFa at 500,100,10,1 μg/kg,respectively,and one group was treated with vehicle only to serve as the control.The rats were received subcutaneous injections of rhG-CSFa or vehicle daily for 13 weeks.During the course of the chronic toxicity study,the physical status,body weight,and food consumption were monitored.Half of the rats in each group (n=10) were sacrificed after the last rhG-CSFa administration,and the other half were sacrificed at five weeks after the last rhG-CSFa administration.Urinalyses,blood biochemistry,hematological analysis,histopathological examination,and immunological tests were performed for each of the rats.Results The hematological analyses revealed that the mean white blood cells count,neutrophils count,and neutrophils percentage were increased in male rats at the dose of 10 μg/kg or higher,and these were related with the biological activity of rhG-CSFa.Some small abnormalities were observed in the spleen of a few rats when used highest dose (500 μg/kg,a dosage of 200 folds higher than the normal clinical dosage),but these abnormalities were recovered within 5-week recovery period.No other rhG-CSFa-related abnormalities were observed in this chronic toxicity study.Conclusion No significant toxicity and immunogenicity are observed with rhG-CSFa administration to rats in the chronic toxicity studies.

Granulocyte-macrophage colony stimulating factor improves cardiac function in rabbits following myocardial infarction

Objective: To investigate the therapeutic potency of recombinant human Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) in a rabbit myocardial infarction model. Methods: A myocardial infarction was created by the ligation of the major ventricular branch of the left coronary artery in rabbits. After myocardial infarction, the animals were randomly assigned to GM-CSF treatment group, untreated groups and sham-operated group. The rabbits of the treated group were injected into GM-CSF by subcutaneous administration, 10 μg/kg/day, once a day for 5 days. The untreated and sham-operated group received a equal saline in the same manner as treated group. Six weeks later echocardiography and haemodynamic assessment were undertaken to assesse cardiac function. The size of the infarct region of the heart were also studied. Results: The untreated group exhibited significant higher left ventricle end-diastolic pressure, higher central venous pressure, and with significant lower mean blood pressure, lower peak first derivative of left ventricle pressure (dP/dt) than the sham group. Also, Rabbits in untreated group display significant systolic dysfunction shown by the decreased ejection fraction, diastolic dysfunction shown by increasing in the ratio of E wave to A wave (E/A), and display left ventricle enlargement. However, GS-CSF singnificantly prevented heart dysfunction, left ventricle enlargement, and reduced infarct size in treatment group. Conclusion: Administration GM-CSF after cardiac infarction can improve heart function. These findings indicate the technique may be a novel and simple therapeutic method for ischemic myocardium.

Effects of granulocyte-colony stimulating factor on peritoneal defense mechanisms and bacterial translocation after administration of systemic chemotherapy in rats

AIM： To investigate the effects of granulocyte-colony stimulating factor （G-CSF） on peritoneal defense mechanisms and bacterial translocation after systemic 5-Fluorouracil （5-FU） administration. METHODS： Thirty Wistar albino rats were divided into three groups; the control, 5-FU and 5-FU ＋ G-CSF groups. We measured bactericidal activity of the peritoneal fluid, phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid, total peritoneal cell counts and cell types of peritoneal washing fluid. Bacterial translocation was quantified by mesenteric lymph node, liver and spleen tissue cultures. RESULTS： Systemic 5-FU reduced total peritoneal cell counts, neutrophUs and macrophage numbers. It also altered bactericidal activity of the peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid. 5-FU also caused significant increase in frequencies of bacterial translocation at the liver and mesenteric lymph nodes. G-CSF decreased bacterial translocation, it significantly enhanced bactericidal activity of the peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid. It also increased total peritoneal cell counts, neutrophils and macrophage numbers. CONCLUSION： Systemic 5-FU administration caused bacterial translocation, decreased the bactericidal activity of peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid. G-CSF increased both bactericidal activity of the peritoneal fluid and phagocytic activity of polymorphonuclear leucocytes in the peritoneal fluid, and prevented the bacterial translocation. We conclude that intraperitoneal GCSF administration protects the effects of systemic 5-FU on peritoneal defense mechanisms.

肿瘤化疗后Ⅳ度骨髓抑制临床分析

目的:探讨肿瘤化疗引起Ⅳ度骨髓抑制的临床特点及治疗方法。方法:回顾性分析57例患者接受79例/次化疗后出现Ⅳ度骨髓抑制的临床资料。结果:Ⅳ度骨髓抑制临床症状多样性。应用紫杉类和蒽环类化疗药物、既往接受过多程化疗及接受过放疗者易发生Ⅳ度骨髓抑制,为化疗后第6～14天,经治疗,52例治愈,3例出院,2例死亡,治愈者外周血象恢复时间为3～25天。结论:出现Ⅳ度骨髓抑制的患者尽快行保护性隔离、应用抗生素、粒细胞集落剌激因子及支持治疗,绝大部分患者可安全度过骨髓抑制的危险期。

G-CSF in Peg-IFN induced neutropenia in liver transplanted patients with HCV recurrence

AIM:To evaluate the efficacy of granulocyte colony stimulating factors(G-CSF)in liver transplanted patients with hepatitis C(HCV)recurrence and Pegylated-IFN α-2b induced neutropenia,and to evaluate the impact of G-CSF administration on virological response. METHODS:Sixty-eight patients undergoing antiviral treatment for post-liver transplantation(OLT)HCV recurrence were enrolled.All patients developing neutropenia received G-CSF. RESULTS:Twenty three(34%)received G-CSF.Mean neutrophil count at the onset of neutropenia was 700/mmc(range 400-750/mmc);after 1 mo of G-CSF it increased to 1210/mmc(range 300-5590/mmc) (P<0.0001).Three patients did not respond to G-CSF. Treatment duration was similar in neutropenic and non-neutropenic patients.No differences in the rate of discontinuation,infections or virological response were observed between the two groups.G-CSF was protective for the onset of de novo autoimmune hepatitis(P<0.003). CONCLUSION:G-CSF administration is effective in the case of Peg-IFN induced neutropenia increasingneutrophil count,prolonging treatment and leading to sustained virological response(SVR)rates comparable to non-neutropenic patients.It prevents the occurrence of de novo autoimmune hepatitis.

Changes of Circulating Platelet-Derived Growth Factor and Granulocyte Colony-Stimulating Factor in Patients with Condyloma Acuminatum

Objective: To study the expression levels of platelet-derived growth factor (PDGF) and granulocyte colony-stimulatingfactor (G-CSF) in peripheral blood and their role in thepathogenesis of Condyloma acuminatum (CA). Methods: Sera were taken from 70 patients with Condylomaacuminatum and compared with 35 healthy controls. PDGFand G-CSF in serum were quantitated using a dual antibodysandwich enzyme-linked immunoabsorbent assay (ELISA). Results: Serum concentrations of PDGF and G-CSF weresignificantly increased in patients with Condylomaacuminatum (CA) compared to controls (P<0.001 and P<0.005respectively). Serum levels of PDGF and G-CSF correlatedwith clinical severity of CA, but no significant difference wasobserved between different duration of disease groups. Asignificant positive correlation was noticed between neutrophilcount and G-CSF levels (γ=0.38, P<0.001), and the neutrophilcount showed no significant correlation with PDGE Conclusion: The results indicated that increased expressionof PDGF an -CSF in peripheral blood might be involved in pathogenesis of CA.

The current G-CSF use in cancer patients with chemotherapy

Objective: The purpose of the study was to survey current G-CSF use in cancer patients, investigate whether the use of granulocyte colony-stimulating factor(G-CSF) is standardized. Methods: From July 2012 to October 2012, patients in a third-grade class-A hospital were investigated by self-designed questionnaires, according to ASCO's recommendations for white blood cell growth factors in 2006 and NCCN myeloid growth factors guideline in 2012. Results: Two hundred and twenty-two patients treated with 724 courses of chemotherapy were included. In prophylactic use, 259(35.8%) cases used G-CSF that the guideline doesn't recommend, which belonged to excessive use, the dose were 274 700 μg, accounting for 59.7% of the totle prophylactic use; 105(14.5%) didn't use while the guideline recommend, belonging to lack of use. 89.0% of the prophylactic use were 24–72 h after chemotherapy, only a few(5.4%) on the day of chemotherapy. In therapeutic use, only 3.1% were standardized, with the dose of 23 000 μg, accounting for 7.4% of the total. So 92.6% were excessive. 14.2% of the therapeutic use were 24–72 h after chemotherapy, 21.2% on the day of chemotherapy. Conclusion: More than 50% use of G-CSF weren't standardized, especially the excessive use.

The side effects of docetaxel with cyclophosphamide as postoperative adjuvant chemotherapy for elderly breast cancer patients

Objective: The aim of this study was to investigate the side effects of docetaxel with cyclophosphamide as postoperative adjuvant chemotherapy for elderly breast cancer patients. Methods: Thirty-six operable elderly breast cancer patients at intermediate risk based on the St Gallen risk classification underwent modified radical mastectomy and then were given four cycles of TC regimen (docetaxel 75 mg/m2 i.v. on day 1; cyclophosphamide 600 mg/m2 i.v. on day 1; every 21 days ). Primary prophylaxis granulocyte colony stimulating factor (G-CSF) 200μg i.h. was administered on day 4-6. Results: The main side effect was neutropenia. Grade 3 neutropenia developed in 36.1% and G4 in 19.4%, respectively. Most of the other side effects were G1-2. Dose reduction occurred in 11.1% patients. The completion rate of chemotherapy was 100%. Conclu-sion: Docetaxel with cyclophosphamide as postoperative adjuvant chemotherapy regimen with G-CSF primary prophylaxis is tolerable for elderly patients in general good condition.

Cost Effectiveness Analysis of Filgrastim versus Placebo in Post AIIogentic Bone Marrow Transplantation

Filgrastim is used to accelerate hematopoietic recovery after ABMT （allogeneic bone marrow transplantation）. Its impact on the total cost of patient care remains to be explored. We therefore undertook a cost effectiveness analysis in the context of a randomized single blinded clinical trial of Filgrastim versus placebo in post ABMT. A primary endpoint, duration of myelosuppression, and three secondary end points （number of days of fever, length of hospital stay, survival at one hundred days） were used to assess efficacy. Direct costs were evaluated and allowed the calculation of the ICER （incremental cost-effectiveness ratios） for the major endpoint of the trial. Sixteen patients were included in the study. The duration of myelosuppression was significantly decreased in the Filgrastim arm with medians of 15 days vs. 19 days in the placebo arm （p = 0.023）. Cost analysis showed no statistically significant difference between the two arms. According to the calculation of ICER, Filgrastim was more costly and more effective than placebo for the number of days of aplasia avoided and the number of days with fever avoided. Placebo strictly dominated filgrastim for days of hospitalization avoided. Filgrastim has proven effective in reducing the duration of aplasia without increasing costs.

The molecular mechanisms of Yang Wei Kang Liu powder on anticancer and reducing chemotherapy side-effect in combination with chemotherapy

Objective:We studied the molecular mechanisms of Yang Wei Kang Liu Power(YWKL,traditional Chinese medicine for nourishing stomach and anticancer) on anticancer and reducing chemotherapy side-effect in combination with chemotherapy.Methods:615 pre-cancer mouse model of YWKL for 10 days and CTX 1 time,semi-quantitative reverse transcription-polymerase chain reaction(RT-PCR) to detect bone marrow granulocyte-macrophage colony-stimulating factor(GM-CSF) gene and cancer proto-oncogene Bcl-2,c-myc expression.Results:YWKL in combination with chemotherapy could obviously promoted the expression of GM-CSF gene and inhibited the expression of Bcl-2 and c-myc oncogenes of FC 615 mice.Conclusion:The molecular mechanisms of anticancer and reducing chemotherapy side-effect of YWKL in combination with chemotherapy are to promote the expression of GM-CSF gene and inhibit the expression of Bcl-2 and c-myc oncogenes.

MEASUREMENT OF SERUM GRANULOCYTE COLONY-STIMULATING FACTOR LEVELS IN PATIENTS WITH DIFFERENT PHASE OF INFECTION

Objective To detect the serum granulocyte colony-stimulating factor (G-CSF) levels betweenthe patients with frequently repeated infection ( repeaters) and others (non-repeaters) in different phase of infection.Methods An enzyme-linked immunosorbent assay (ELISA) method was used to detect serum G-CSF levels in 50cases (32 non-repeaters and 18 repeaters) with acute phase of infection. Serum G-CSF levels were detected inrecovery phase in 10 cases. Results Serum G-CSF levels were significantly higher (1429. 97 ±506. 43ng/L) in32 non-repeaters with acute infection. There was a positive correlation between white blood cell count ( WBC) andserum G-CSF level (r =0. 396, P <0. 05). There was also a positive correlation between absolute neutrophil count(ANC) and serum G-CSF level (r =0. 346,P <0. 05). Serum G-CSF levels were higher (98. 62 ±56. 40ng/L) in18 repeaters with acute infection. It was showed that serum G-CSF levels were significantly higher in non-repeatersthan in repeaters with acute phase of infection (P <0. 001). In the meanwhile, the body temperature was signifi-cantly higher in non-repeaters than in repeaters with acute infection (37. 95 ±0. 14 vs 36. 91 ±0. 13 ,P<0. 001). There were no significant differences in age, WBC, ANC, type of bacterial, liver function and renal func-tion (P >0. 05). Serum G-CSF levels in recovery phase of the two groups were below the sensitivity of the assay( <60 ng/L). Conclusion It is suggested that application of recombinant G-CSF may be useful for the patientswith repeated infection.

Analysis of the GM-CSF and GM-CSF/IL-3/IL-5 receptor common beta chain in a patient with pulmonary alveolar proteinosis

Objective To investigate the expression of the granulocyte-macrophage colony-stimulating factor (GM-CSF) and GM-CSF/IL-3/IL-5 receptor common beta chain (βc receptor) in an adult patient with idiopathic pulmonary alveolar proteinosis (PAP), so as to demonstrate the possible association of the GM-CSF and βc receptor with the pathogenesis of human PAP.Methods The GM-CSF levels were measured with a commercial ELISA kit (sensitivity 5?pg/ml) and the βc receptor expression on the cell surface was detected by flow cytometry analysis. Reverse transcription-polymerase chain reaction (RT-PCR) analysis was employed to detect the expression of the GM-CSF mRNA and the βc receptor mRNA in peripheral blood mononuclear cells and alveolar macrophages. The entire coding regions of the GM-CSF cDNA and the βc receptor cDNA were sequenced by the Sanger dideoxy-mediated chain termination method to detect possible mutations.Results The patient with PAP failed to release the GM-CSF protein either from circulating mononuclear cells or from alveolar macrophages. The expression of the GM-CSF mRNA was normal after the stimulation of lipopolysaccharide, whereas a point mutation at position 382 of the GM-CSF cDNA from 'T' to 'C' was revealed by cDNA sequencing, which caused a change in amino acid 117 of the protein from isoleucine to threonine. The βc receptor expression on the cell surface was normal, and the βc receptor mRNA expression and the sequence of the entire coding region of the βc receptor were also normal.Conclusions The decreased GM-CSF production is associated with the pathogenesis of human PAP. A point mutation of the GM-CSF cDNA may contribute to the decreased GM-CSF production in our adult PAP patient. The mutation of the βc receptor in some of paediatric patients with PAP may not be a common problem in adult patients.

A pilot study on the combined therapy of granulocyte-macrophage colony-stimulating factor and hepatitis B vaccine on chronic hepatitis B virus carrier children

Objective To observe the efficacy of treating intrauterine infected chronic hepatitis B virus (HBV) carrier children with a combination of granulocyte macrophage colony stimulating factor (GM CSF) or hepatitis B immunoglobulin (HBIG) plus recombinant hepatitis B vaccine (rHBvac) Methods A total of 27 chronic HBV infected children, who were born to HBV carrier mothers and received hepatitis B immunoprophylaxis at birth, were randomized into 2 groups: one receiving a combined therapy of 50 μg of GM CSF plus 10 μg of rHBvac injected intramuscularly at the same location (GM CSF group, 14 children) or 200 IU HBIG and 10 μg rHBvac in different muscles (HBIG group, 13 children) on a monthly four dose schedule HBV DNA quantification and other HBV serological markers were tested before and after the four dose therapy Results Twelve children in each group completed the study Of them, 3 children in the GM CSF group and 4 in the HBIG group had elevated serum alanine transaminase (ALT) before the trial, and then 2 in each group became ALT normal after the treatment Before the therapy, hepatitis B e antigen (HBeAg) positivity was found in nine children in the GM CSF group and 10 in the HBIG group One from each group had an HBeAg/anti HBe seroconversion after the treatment The quantity of HBV DNA was significantly lower after the treatment ( P =0 023) in GM CSF group, but was not significantly reduced in HBIG group No subjects were found to be negative for hepatitis B surface antigen (HBsAg) after the treatment, and no serious adverse events occurred in either group Conclusion Combined GM CSF and rHBvac therapy inhibit HBV replication in carrier children who were not protected after treatment with immunoprophylaxis