Sodium fusidate in Gillain-Barré syndrome: a case report

Decitabine induces regulatory T cells, inhibits the production of IFN-gamma and IL-17 and exerts preventive and therapeutic efficacy in rodent experimental autoimmune neuritis

Guillain-Barré syndrome (GBS) is an immune-mediated acute disorder of the peripheral nervous system. Despite treatment, there is an associated mortality and severe disability in 9 to 17% of the cases. Decitabine (DAC) is a hypomethylating drug used in myelodisplastic syndrome, that has been shown to exert immunomodulatory effects. We have evaluated the effects of DAC in two rodent models of GBS, the Experimental Allergic Neuritis (EAN). Both prophylactic and therapeutic treatment with DAC ameliorated the clinical course of EAN, increasing the numbers of thymic regulatory T cells and reducing the production of proinflammmatory cytokines. Our data suggest the possible use of decitabine for the treatment of GBS.

Lack of effect of intermittently administered sodium fusidate in patients with newly diagnosed type 1 diabetes mellitus: the FUSIDM trial

AIMS/HYPOTHESIS

We evaluated in a double-blind study the effect of early treatment with the immunomodulatory drug fusidin in patients with newly diagnosed type 1 diabetes mellitus.

METHODS

Twenty-eight adults with newly diagnosed type 1 diabetes were included in the study. The patients were randomly assigned (computer-generated random number sequence) to two experimental groups. Patients allocated to the fusidin (FUS) group (n=15) received sodium fusidate (fusidin; 500 mg orally three times daily for 4 weeks). Subsequently the drug was given at the same dose and scheduled for two consecutive weeks a month followed by 2 weeks a month without the drug for 20 weeks. Subjects allocated to the placebo (PCB) group (n=13) received placebo according to the same schedule and conditions described for sodium fusidate in the FUS group. All patients received a diet adjusted to their age and BMI, and intensive insulin therapy.

RESULTS

There were no statistically significant differences between the FUS and PCB groups in beta cell function, evaluated by basal and glucagon-stimulated C-peptide values during the follow-up (24 and 48 weeks). There was also no difference between the two groups in insulin requirement after 48 weeks (0.4+/-0.2 and 0.4+/-0.2 U/kg body weight for the FUS and PCB groups, respectively). Antibody titres, including insulin autoantibodies, were similar in the two groups during the follow-up.

CONCLUSIONS/INTERPRETATION

Early treatment of newly diagnosed type 1 diabetes patients with intermittently administered fusidin failed to influence the natural course of the disease.

Curative effects of sodium fusidate on the development of dinitrobenzenesulfonic acid-induced colitis in rats

Fusidic acid and sodium fusidate (fusidin) are antibiotics with low toxicity and powerful immunomodulatory activities in vitro and in vivo. In this study we have evaluated the effect of fusidin on the development of dinitrobenzenesulfonic acid (DNB)-induced colitis in rats that serves as a preclinical model of human inflammatory bowel disease (IBD). The data show that when administered orally at the dose of 80 (but not 40) mg/kg body wt under a "therapeutic" regimen soon after DNB application, fusidin significantly ameliorates clinical, histological, and seroimmunological signs of disease. These entailed a significant reduction in body weight loss, smaller increase in colon weights, milder macroscopic damage, and lower histological scores. In addition, when sacrificed at the end of the study, fusidin-treated rats had significantly lower blood levels of tumor necrosis factor alpha and interferon-gamma compared with untreated controls. The present findings concur with the beneficial actions of fusidin in a pilot study conducted in patients with Crohn's disease and warrant controlled studies in humans with IBD.

Antidiabetogenic effect of fusidic acid in diabetes prone BB rats: a sex-dependent organ accumulation of the drug is seen

Fusidic acid and its sodium salt (fusidin) are widely used antistaphylococcal drugs which possesses immunomodulatory properties. This prompted us to investigate whether high concentrations of fusidin could lower the diabetes incidence in diabetes-prone BB (BioBreeding) rats. As fusidin has previously been claimed to be poorly absorbed in rats after oral administration we wanted to measure the activity of the drug in various organs. Three groups of BB rats were used: 63 rats received fusidin dissolved in drinking water; 65 rats received chow containing fusidin; and 72 rats served as controls. The content of fusidin in the organs were examined microbiologically. The incidence of diabetes was significantly lower in the two fusidin-treated groups compared to the control group. The incidence was lower for male than for female rats in both experimental groups while no gender difference was seen in the control group. The female rats had a substantially higher content of fusidin in their organs than the males regardless of the administration way and regardless of diabetes outbreak or not. Interestingly, the fusidin treated non-diabetic rats displayed a lower random blood glucose level than the controls. In conclusion, fusidin is well absorbed after oral administration and it significantly reduces the diabetes incidence in BB rats. Fusidin accumulates substantially more in female rats which may be due to the steroid structure of fusidin. Whether the same phenomenon takes place in human beings is not known.

Sodium fusidate (fusidin) ameliorates the course of monophasic experimental allergic encephalomyelitis in the Lewis rat

We have evaluated the effect of the immunosuppressant sodium fusidate (fusidin) on the course of acute monophasic experimental encephalomyelitis (EAE) in male Lewis rats. Prophylactic treatment with fusidin, 80 or 120 mg/kg bd wt., markedly ameliorated the course of the disease in rats immunized with myelin basic proteins in complete Freund's adjuvant, entailing delayed onset of symptoms, lower clinical scores and more rapid recovery than PBS-treated control rats. The fusidin-treated, immunized rats exhibited milder mononuclear cell infiltration of brains and spinal cords than control animals. These data provide further evidence for the anti-inflammatory effect of fusidin and suggest that this drug may be valuable for the treatment of human multiple sclerosis.

Sodium fusidate ameliorates the course of diabetes induced in mice by multiple low doses of streptozotocin

We studied the effects of the immunosuppressant sodium fusidate (fusidin) on murine immunoinflammatory diabetes mellitus (DM) induced by multiple low doses of streptozotocin (SZ). Fusidin was given by gavage to three strains of mice (C57KsJ, C57BL/6, CD1) at doses 10 or 100 mg/kg body weight every other day. The drug was administered as an early or late prophylactic regime starting either 1 day prior to the first or after the fifth and last injection of SZ. In both situations the largest dose of fusidin successfully reduced the clinical, chemical and histological signs of DM, the treated mice having significantly lower glycaemic values and milder (often absent) insulitis compared with sham-treated animals or controls given SZ alone. The antidiabetogenic effect was long-lasting as it was maintained up to 1 month after cessation of therapy. In contrast, fusidin prophylaxis failed to prevent development of hyperglycaemia acutely induced by one single and high (160 mg/kg) dose of SZ, which is a model of DM primarily due to the toxic action of SZ on the beta cells and does not involve immunopathogenetic mechanisms. On day 14 after SZ, fusidin markedly altered the circulating cytokine profile induced in vivo by ConA, reducing the levels of IFN-gamma, IL-2 and TNF-alpha and augmenting the level of IL-6. However, only the inhibitory effect of the drug on the synthesis/release of IFN-gamma seemed to be causally related to its capacity to counteract the SZ-induced DM. In fact, the disease was prevented by a neutralizing monoclonal antibody (mAb) against IFN-gamma, but not by anti-IL-2 receptor mAb, a soluble form of TNF-receptor type 1 or recombinant human IL-6. The prevention of disease by fusidin was also partly reversed by exogenously administered recombinant mouse IFN-gamma. The data provide further in-vivo evidence for the anti-diabetogenic and immunomodulatory properties of fusidin and indicate that this drug could have a role in prevention and treatment of human type 1 DM.

Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy. Two thirds of GBS patients are unable to walk at their most severe state of disease. Respiratory insufficiency and autonomic failure are probably the main causes of death. Optimal general care, physiotherapy and the availability of intensive care facilities at short distance are of great importance. Randomized controlled trials show that intravenous immune globulin (IVIg) and plasma exchange (PE) are equally effective in reducing the time to functional recovery. The combination of PE followed by IVIg, is not significantly better than IVIg or PE alone. Corticosteroids alone are not effective in GBS. Approximately 10% of GBS patients deteriorate after initial improvement or stabilization following IVIg or PE treatment, and often require repeated treatment. These "treatment related clinical fluctuations" are more frequently seen in relatively young patients with severe motor and sensory involvement associated with a preceding and possibly ongoing cytomegalovirus infection. Predominantly motor GBS is frequently preceded by a Campylobacter jejeuni infection. Diarrhea prior to GBS is associated with a worse predicted outcome. Further confirmation is needed to determine whether this is especially the case in those patients treated with PE. GBS patients who are unable to walk without assistance, and who are still within their first 2 weeks of the disease, need to be treated. One PE study showed that patients who are only mildly disabled showed positive progress from two plasma exchange sessions. Presently, due to its wide availability, ease of administration, and favorable side-effect profile, IVIg is considered to be the first-line treatment for patients with GBS. Current investigations are trying to determine if IVIg used in combination with methylprednisolone is even more effective in treating GBS.

Treatment of immune-mediated inflammatory neuropathies

Experimental models have suggested potential new treatments for human inflammatory neuropathy, but current practice is largely based on empirical trials. Evidence from randomized trials supports the use of intravenous immunoglobulin in Guillain-Barré syndrome, chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy with conduction block (MMNCB). In Guillain-Barré syndrome and CIDP intravenous immunoglobulin is equivalent to but more convenient than plasma exchange. In MMNCB adequate comparative studies of intravenous immunoglobulin and plasma exchange have not been performed. Corticosteroid treatment is beneficial in CIDP, but not in Guillain-Barré syndrome and may worsen MMNCB. More randomized trials and systematic reviews are needed to improve the evidence base for clinical practice.

Amelioration of experimental allergic neuritis by sodium fusidate (fusidin): suppression of IFN-gamma and TNF-alpha and enhancement of IL-10

The immunomodulating antibiotic drug fusidic acid and its sodium salt sodium fusidate (fusidin) ameliorate several organ-specific immunoinflammatory diseases. Because preliminary observations suggest that fusidin may also exert a beneficial effect in Guillain-Barré syndrome (GBS), here we have studied the effects of fusidin on actively induced experimental autoimmune neuritis (EAN) in rats, a known animal model for GBS. Both prophylactic and therapeutic treatment with fusidin (4 mg/rat day ip) markedly ameliorated the clinical course of the disease compared to vehicle-treated animals. The beneficial effects were associated with profound modifications of the capacity of these rats to produce and release pro- and anti-inflammatory cytokines such as IFN-gamma, TNF-alpha and IL-10, which are important in regulating the development of EAN.