Effects of thymostimulin on chemotherapy-induced toxicity and long-term survival in small cell lung cancer patients

The effects of hymostimulin on chemotherapy-induced toxicity and long-term survival were studied in 26 evaluable patients with small cell lung cancer. Patients were randomly treated with six cycles of two alternating regimens (cyclophosphamide, 4'-epidoxorubicin, and etoposide; cisplatin and etoposide), with (n = 15) or without (n = 11) thymostimulin (1 mg/Kg i.m., days 7-14 of every cycle). Only complete responders received maintenance treatment, consisting of thymostimulin administered 1 mg/Kg i.m., twice weekly, until tumor relapse. Myelosuppression, fever and documented infectious episodes were significantly less severe in thymostimulin-treated patients, allowing the administration of significantly higher drug doses at shorter intervals between chemotherapy cycles; a significant improvement in complete response rate and survival were also observed. Results suggest that the addition of thymostimulin to standard chemotherapeutic regimens might be of benefit, in view of its favourable effects on toxicity and long-term survival.

Phase I/II trial of thymostimulin in opportunistic infections of the acquired immune deficiency syndrome

Fifteen patients with acquired immune deficiency syndrome (AIDS) and opportunistic infection, were randomized to receive treatment with either thymostimulin (TP-1) at 1 mg/kg for 14 days then weekly for 12 weeks or placebo. The objectives of this study were to evaluate the toxicity of TP-1 in this patient population and to make observations on clinical response as measured by time to second opportunistic infection (OI) and changes in laboratory parameters of immune function. The study demonstrates that TP-1 can be administered safely. There were no differences, however, in time to second OI or overall survival between patient groups. In addition, no change in the immune function could be detected in patients receiving thymostimulin.

[Evaluation of the effectiveness of thymomodulin in children with recurrent respiratory infections]

Numerous trials of prophylaxis of recurrent respiratory infections in children have been performed, even though the only controlled trials providing incontrovertible results were the ones carried out with levamisole and thymostimulin through intramuscular administration. We have experimented a calf-thymic extract administered by oral route (thymomodulin). During the summer we enrolled 40 children aged between 3.5, and 9 years who had suffered from RRI during the previous winter. The patients were randomly divided in two groups and respectively treated with thymomodulin or with placebo; 21 children were given the thymic extract and 19 the placebo. The trial was carried out according to a double-blind schedule for a period of four months, from the beginning of October '84. At the end of the trial we assessed the catharral bouts observed during the research period by the family doctors and the parents evaluation on the clinical state. The difference between the two groups is statistically highly significant both with reference to the reduction of the total number of catharral bouts and to the general clinical state according to the parents opinion. The research clearly demonstrates the protective effect of the thymomodulin, probably due to the "restorative" effect on some immunological functions, temporarily compromised during the infection bouts.

[Effects of T-activin in viral myocarditis in animal experiments]

The efficacy of immunomodulating agent T-activin has been studied in adult BALB/C mice infected with Coxsackie B1 virus. Optical, electron microscopic and immunological tests have shown that T-activin protects myocardium and modulates immune disorders in mice with viral myocarditis.

Thymostimulin treatment in AIDS-related complex

Thirty-four patients with AIDS-related complex (ARC) were treated for 6 months with thymostimulin, a thymic hormone. Clinical and immunological findings after a 1-year follow-up were compared with those in 24 age- and sex-matched controls receiving no immunotherapy. Statistical evaluation after 6 and 12 months showed significant differences in the two groups. The thymostimulin-treated group had higher leukocyte and lymphocyte counts, more positivity in intradermal tests with multiple recall antigens, and less lymphadenopathy and weight loss. The number of OKT3+ and OKT4+ lymphocytes decreased significantly in the control group, but did not change in the thymostimulin-treated patients. Finally, after 18 months of follow-up, no progression to AIDS was seen among the treated subjects, whereas 3 of the controls developed the disease. We conclude that thymostimulin, alone or in combination with antiviral drugs, may be helpful in the management of ARC patients.

Enhancement of interleukin-2 and gamma-interferon production in vitro on cord blood lymphocytes and in vivo on primary cellular immunodeficiency patients with thymic extract (thymostimulin)

Cord blood mononuclear cells (MNC) were isolated from 20 normal full-term newborns. These MNC were preincubated with either 50, 100, or 200 micrograms/ml Thymostimulin or without Thymostimulin. The interleukin-2 (IL-2) and gamma-interferon (gamma-IFN) production, cytotoxicity, and lymphoproliferation and IL-2 receptor (Tac) expression were all significantly increased after Thymostimulin treatment. For evaluation of the in vivo effect, two combined-immunodeficiency patients defective on the thymic level, one with progressive BCG infection, and one with DiGeorge syndrome were used. Before Thymostimulin treatment, the patient's MNC did not produce sufficient amounts of IL-2 and gamma-IFN. The cytotoxicity and lymphoproliferation were also low. After Thymostimulin treatment, the IL-2 and gamma-IFN production, cytotoxicity, and lymphoproliferative response were enhanced. These results suggest that Thymostimulin may be beneficial in the clinical treatment of primary cellular immunodeficiency. The improved immune reactivity including cytotoxicity and enhanced IL-2 and gamma-IFN production in the Thymostimulin treatment also indicates that there may be a beneficial effect on the combination of chemotherapy and Thymostimulin.

Heterogeneity of immunological patterns in Langerhan's histiocytosis and response to crude calf thymic extract in 11 patients

Response to treatment with daily intramuscularly administered crude calf thymic extract (Suppressin) in 11 patients with Langerhan's histiocytosis (L.H.) is reported. In ten patients, T-lymphocytic subsets were studied before starting immunotherapy: OKT3 positive and OKT4 positive cells were reduced in four patients; OKT8 positive cells were reduced in two patients; three patients were normal. After immunotherapy, one patient entered complete remission, four patients had stationary disease, and six had marked clinical progression. Subsequently eight patients underwent conventional chemotherapy, and only three entered complete remission. This study has demonstrated the heterogeneity of immunological patterns in L.H. and justifies the necessity for investigations on the immunoregulatory mechanism of L.H.

A randomized trial to evaluate the immunorestorative properties of thymostimulin in patients with Hodgkin's disease in complete remission

A total of 19 Hodgkin's disease (HD) patients (12 male, 7 female) aged 26-67 years, who had been in complete unmaintained remission for 6 months or more when the study was initiated, were randomly given 50 mg thymostimulin (TS) i.m. daily (G1) or every other day (G2) for 35 days. A third group (G3) was not treated. Then TS, at the same dose was administered twice a week for the following 22 weeks in patients both initially receiving loading or intermittent TS treatment. When compared with age- and sex-matched controls, as a group, the patients' circulating OKT3+, OKT4+, OKT11+ and E-AETR+ cells were depressed (P less than 0.001 for both proportions and absolute numbers), whereas their OKT8+ cell population was not. Following 5 weeks of daily TS administration, the proportions and numbers of all T cell fractions significantly increased in G1 patients (P less than 0.03 for all the comparisons tested), while following intermittent TS treatment (G2) only the proportions of OKT3+ and OKT11+ cells (P less than 0.03), but not of other T cell fractions, significantly increased. In addition, no significant changes in the absolute numbers of T cell fractions were observed in this group of patients. Furthermore, no spontaneous variations in the T cell pool size occurred in untreated patients. TS maintenance therapy did not produce any further improvement in the size of overall T cells and T cell subsets but sustained percentage and absolute numbers of these cells during administration and the absolute number of T cells even after discontinuation of therapy. The TS-induced improvement in the T cell pool was not associated with any change in the size of circulating non-T lymphocytes and monocytes. In vitro phytohemagglutinin-induced interleukin-2 (IL-2) and gamma-interferon (IFN-gamma) synthesis was assessed in 11 patients (3 G1, 4 G2, and 4 G3). Although it was not statistically significant, a rise in IL-2 and IFN-gamma production was observed in TS-treated patients, but not in untreated controls. TS failed to exert any effect on the serum circulating levels of neopterin, type I and II IFN, beta-2 microglobulin (B2-M) and immunoglobulins (Ig). TS can thus improve defective T cell frequences and numbers and may modulate IL-2 and IFN-gamma production.

[Prevention of the formation of the infectious process with biologically active thymic factors in the Salmonella typhimurium challenge of mice coincident with macrophage activation]

A single injection of thymostimulin into mice in a dose of 45 micrograms/kg b.w. enhances the functional activity of macrophages, reaching it maximum on day 10, which prevents the formation of an infectious process in mice challenged with S. typhimurium (LD50). The irradiation of the animals in a sublethal dose leads to the complete abolition of the stimulating effect of thymostimulin on macrophages. The presence of an inducer mechanism of the activation of macrophages by thymostimulin, realized in the production of lymphokines, is suggested.

A calf thymus acid lysate improves clinical symptoms and T-cell defects in the early stages of HIV infection: second report

Thymomodulin is a calf thymus acid lysate capable of inducing T lymphocyte maturation. Fifteen patients with HIV infection at different stages according to the Walter Reed classification were treated with 60 mg/day of thymomodulin syrup for more than 50 days. Two WR6B subjects had clinical and immunological parameters unchanged and died, while the patient suffering from Kaposi's sarcoma presented an evident clinical and laboratory improvement with remission of the neoplasia. The other 12 patients ranging from WR2 to WR5B showed an improvement of clinical symptoms after thymomodulin therapy accompanied by the normalization of CD4/CD8 ratio (P less than 0.001). This helpers/suppressors increase was due to a significant increase of CD4 cells (P less than 0.01) and also to a decrease of the CD8 lymphocytes (P less than 0.05). Thymomodulin administration did not cause an enhancement of the urinary levels of neopterin, a marker of T-cell activation.

[Perennial allergic rhinitis. Prophylaxis of acute episodes using thymomodulin]

The therapeutical effectiveness of a calf thymic derivative (thymomodulin), orally administrable, in patients suffering from perennial allergic rhinitis is described. The use of thymomodulin for 4 months at the dosage of 120 mg daily in 20 patients significantly reduced (p less than 0.001), if compared with the previous year, the monthly mean frequency of allergic episodes. Also objective symptoms improved (p less than 0.05). The clinical course was associated with the normalization of IgE plasmatic levels (p less than 0.001) and consequently the mean of RAST and PRICK tests scores decreased (p less than 0.001). Eosinophil count was significantly reduced (p less than 0.001), while IgG serum levels were increased (p less than 0.02).

[Prevention of recurrent respiratory infections in adults]

The authors compared the results obtained by using antibiotic therapy, vaccine, thymomodulin (a calf thymus acid lysate) and association of vaccine-thymomodulin in order to prevent acute infectious episodes in a group of 85 patients suffering with recurrent respiratory infections. The use of thymomodulin, alone and in association with vaccine, at the dose of 120 mg/die for 20 days/month during the period of observation (4 months), determined a higher reduction, (p less than 0.001) if compared with the other treatments, of the number and the duration of infectious episodes and moreover of the antibiotics' intake. Also the respiratory symptoms, and in particular the fits of coughing, showed an improvement. The pulmonary function indices and the laboratory parameters were unchanged in all groups studied.

[Effect of thymostimulin on chemotherapy-induced changes in lymphocyte subset distribution. A longitudinal study in patients with primary inoperable oropharyngeal cancers]

20 patients with primarily inoperable squamous cell carcinoma of the head and neck were treated with 2 cycles of chemotherapy prior to surgical treatment. The lymphocyte subsets were determined prior to chemotherapy, as well as directly after and 3 weeks after start of each chemotherapy cycle. For this, 2 different flow cytometric techniques were used in parallel. After the second cycle of chemotherapy 10 patients were additionally treated with thymostimulin for 2 weeks. The remaining ten patients received no additional immunotherapy and served as control group. Three patients (one in the control group and two in the verum group) had to be excluded from the study because the immunological examination could not be performed in accordance with the protocol. In addition another patient had a local skin reaction so that thymostimulin therapy could not be started as allergy to bovine proteins was suspected. Prior to the first chemotherapy treatment, there is no detectable defect in the distribution of lymphocyte subsets. Under chemotherapy treatment the absolute number of Pan-T cells, T-helper cells, T-suppressor cells and Leu-10 positive B-cells decreased. In contrast, additional treatment with thymostimulin directly after the chemotherapeutic regimen resulted in a marked increase of all T-lymphocytes as well as the Leu-10-positive cells. The results measured with two different flow cytometric techniques were comparable.

Treatment of combined immunodeficiency with thymic extract (Thymostimulin)

A 14-day-old Chinese male baby was admitted with extensive skin lesions. A wound culture grew Staphylococcus aureus, Acinetobacter anitratus, Enterobacter cloacae, and Candida albicans and a blood culture grew group A beta-Streptococcus hemolyticus. The patient's lymphocyte counts were low and his lymphocytes were unable to produce IgG and IgA in vitro. The immunoglobulin-bearing cell studies also failed to demonstrate IgG and IgA bearing cells. Active Tac+ T cells, total T cells, and T cell subsets were at very low levels. Lymphoproliferative response to mitogens was also poor. Migration inhibitory factor production to Candida antigen was also decreased. The initial lymph node biopsy demonstrated no follicular formation and extensive depletion of lymphocytes in both thymic-dependent and thymic-independent areas. After Thymostimulin (a specific bovine thymic extract, TP-1) treatment, the second lymph node biopsy demonstrated germinal centers containing IgA-bearing cells and IgM-bearing cells and, subsequently, cortical and medullary differentiation. Serum IgG, IgA, and IgM became detectable at low levels and IgG-, IgA-, and IgM-bearing lymphocytes appeared in the peripheral blood. This also correlated with in vitro immunoglobulin synthesis. Active Tac+ T cells, total T cells, T cell subsets and lymphoproliferative response to mitogens increased gradually after thymostimulin therapy. This investigation demonstrated the therapeutic effectiveness of Thymostimulin in combined immunodeficiency both histologically and immunologically and the successful reconstitution of B cell function that did not require continued therapy.

Thymostimulin in the treatment of hepatitis B surface antigen-positive chronic active hepatitis. Controlled clinical trial--two years follow-up

In this paper results obtained with thymostimulin (TP-1 Serono) in patients with hepatitis B surface antigen (HBsAg)-positive chronic active hepatitis after 2 years follow-up are reported. The favourable trend observed in a previous trial was confirmed after a longer observation period, most patients showing a significant amelioration of clinical, biochemical and histological parameters, with respect to control group. Hepatitis B virus (HBV) serology, too, showed a significantly higher rate of seroconversion and antigen disappearance in treated patients. Finally, hospitalization period of the latter was significantly lower. These results, though obtained in a small population of patients, seem to indicate a role for thymic hormone therapy in the management of chronic active hepatitis.

Sarcoidosis complicated by HTLV III-infection: steroid therapy in combination with thymostimulin

Report on a patient suffering from severe lung sarcoidosis and HTLV III-infection. Under combined treatment with cortisone and thymostimulin the patient recovered surprisingly well. The X-ray showed a frank improvement of the lung alterations, and in addition an extensive normalization of leucocytes and lymphocytes could be noticed. No side-effects could be observed under this treatment.

Update and future perspectives of a thymic biological response modifier (Thymomodulin)

Thymomodulin (Ellem Industria Farmaceutica spa, Milan, Italy) is a calf thymus acid lysate with immunomodulating activities. It is composed of several peptides with a molecular weight range of 1-10kD. Extensive studies in animal systems showed that Thymomodulin exhibited no, or very little toxicity even when used at high doses. Studies done in vitro and in vivo demonstrated that Thymomodulin is a biologically active compound which regulates the maturation of human and murine pre T lymphocytes, as well as modulate the functions of apparently mature human and animal B and T lymphocytes. It was observed that Thymomodulin can promote myelopoiesis as demonstrated by an increase of granulocyte-macrophage colonies in agar. Although additional studies to examine its target cell lineage are required, it appears that Thymomodulin exhibits specificity toward T cells. Therefore, enhancement of other cell lineage functions by Thymomodulin may be indirect, and mainly due to its effect on T cells. Of major importance is to note that Thymomodulin is prepared in a manner which allows it to maintain its biological activity when administered orally.

Serial immunologic and histopathologic studies in the treatment of necrotizing fasciitis with combined immunodeficiency by a bovine thymic extract (thymostimulin)

A 25-day-old Chinese female baby developed necrotizing fasciitis (NF) with indurated erythematous patches with superficial necrosis over two thirds of the back. Skin cultures of the lesions yielded Streptococcus pyogenes, enterococcus, Pseudomonas aeruginosa, and Candida species. The patient had lymphopenia with low T cells and T cell subsets. The lymphoproliferative response to mitogen and macrophage migration (MIF) production were also poor. Her lymphocytes were unable to produce IgG in vitro. Also, IgG bearing cells were not demonstrable. The initial lymph node biopsy demonstrated an absence of follicular formation and depletion of lymphocytes in both thymic-dependent and thymic-independent areas. Five weeks after bovine thymic extract (Thymostimulin) treatment, a second lymph node biopsy demonstrated germinal centers containing IgG bearing cells. Three weeks later, a third lymph node biopsy showed germinal centers with cuffs of lymphocytes. Differentiation of the cortex and medulla of the node was demonstrated. IgG was also detectable in an in vitro Ig synthesis study. The total T cells, T cell subsets, lymphoproliferative response MIF production also increased gradually after Thymostimulin treatment. This investigation demonstrated the therapeutic effectiveness of Thymostimulin in NF with underlying combined immuno-deficiency, both serious and frequently fetal diseases, by the histologic and immunologic reconstitution of T and B cell function.

Thymostimulin prophylaxis of postoperative infections in anergic patients

The rate of postoperative infections is significantly increased in anergic patients. The authors evaluated prospectively, in a controlled, randomized and stratified study, the efficiency of thymostimulin in reducing postoperative infections in 42 such patients. Excluded were those who were malnourished in whom preoperative alimentation corrected the anergy. The incidence of infections was significantly (p less than 0.05) reduced in thymostimulin-treated patients (4.8% versus 28.6%).

[Clinical experience with thymostimulin (TP-1) therapy. Preliminary findings]

In order to verify the immunostimulant effect of thymus humoral factors, a bovine thymic extract (TP 1-Thymostimulin) was given to 9 patients affected by primary immunodeficiency (mild deficit T/B combined) and to 8 patients affected by acquired immunodeficiency because of old age, lung neoplasm or with recurrent herpes simplex labialis. 6 patients affected by chronic hepatitis HBsAg+ and 1 patient affected by Behçet's syndrome were also studied. At the end of the study, after six months, all the patients with primary or acquired immunodeficiency showed a normalization of their immunological parameters and a clinical improvement. A clinical improvement was also observed in the patients affected by lung neoplasm. Instead, patients suffering from chronic active hepatitis HBsAg+ showed unsatisfactory results; the study did not reveal any clinical or immunological improvement in these cases. The patient affected by Behçet's syndrome showed a decreased recurrent uveitis.