[A case report of eosinophilic cystitis treated with oral suplatast tosilate]

A 61-year-old female was referred to our hospital presenting with micturition pain and urinary frequency, which was not relieved by antibiotics. A cystoscopic examination revealed an erosion, reddening and edematous lesion in the left bladder wall. Pathological examination of transurethral biopsy showed erosion and cystitis. After biopsy, micturition pain and urinary frequency became worse. The pathological examination was reviewed, and the diagnosis of eosinophilic cystitis was made. Administration of a corticosteroid had provided a short duration of relief, but her symptoms recurred within the five weeks of treatment. Therefore, she was treated with a combination of corticosteroid and suplatast tolilate, followed by monotherapy with suplatast tolilate. The relief of the symptoms by suplatast to lilate therapy continued for five months. However, the symptoms relapsed. Re-administration of steroidal agents was considered, but the patient suffered from uncontrolled diabetes. Therefore, she was treated with a combination of suplatast tosilate, anti-allergic drugs and mirabegron. Fourteen months after treatment with suplatast tosilate, no disease progression was noted.

A tertiary sulfonium compound, dimethylsulfoniopropionate in green sea algae, completely suppresses crucial Ehrlich ascites carcinoma in mice

BACKGROUND/AIM

Dimethylsulfoniopropionate (DMSP) has been intensively studied in bacteria, plankton, algae and salt-resistant plants to investigate its metabolism and fate in the atmosphere. However, its effects on diseased terrestrial animals have not yet been examined. We have found that DMSP exerts a great healing effect for a variety of inflammatory disorders in rodents. In the present study, effects of single and high concentration of DMSP on terrible Ehrlich ascites carcinoma (EAC) bearing-mice with unavoidable-rapid death were examined.

RESULTS

We found that high concentration of DMSP completely suppresses acute EAC, which has never been eradicated, and accumulates large amounts of activated macrophages with no inflammation on various viscera in the peritoneal cavity of normal mice.

CONCLUSION

These results show that DMSP is a new and potent anticancer compound with no side-effects, most likely playing a vital role for cancer immune therapy.

[Effects of suplatast tosilate on airway inflammation and interleukin-5 in asthmatic rats]

OBJECTIVE

To study the effects of suplatast tosilate (IPD) on the airway inflammation and expression of interleukin-5 in asthmatic rats.

METHODS

Fifty adult male Sprague-Dawley rats (4-week- old) were randomly assigned to five groups: placebo control, untreated asthma, budesonide(BUD)-treated asthma , early or late IPD intervention group (n=10 rats each). Asthmatic mode was prepared by ovalbumin sensitizion and challenge. Inflammatory cells and the percentage of EOS were detected in bronchoalveolar lavage fluid (BALF). The lung tissues were removed to detect the lung histomorphology. Gene expression of IL-5 was measured by reverse transcription-polymerase chain reaction (RT-PCR). Levels of interleukin 5 (IL-5) in BALF were measured using ELISA.

RESULTS

The inflammatory cells and the percentage of EOS in BALF, IL-5 levels in BALF and IL-5 mRNA expression in the lung tissues were obviously higher in the untreated asthma group than the control group (P<0.05), while the parameters in the IPD or BUD-treated asthma groups were significantly lower than the untreated asthma group (P<0.05).

CONCLUSIONS

IPD treatment can alleviate airway inflammation in asthmatic rats, possibly through inhibiting IL-5 mRNA transcripts.

Prophylactic effectiveness of suplatast tosilate in children with asthma symptoms in the autumn: a pilot study

BACKGROUND

Exacerbations of bronchial asthma usually occur in the autumn. To our knowledge, however, the effectiveness of drugs for preventing exacerbations of asthma in the autumn has not been studied previously, except for leukotriene receptor antagonists and Omalizmab.

METHODS

This study compared the prophylactic effectiveness of suplatast tosilate with that of mequitazine in children with asthma symptoms, which is usually exacerbated in the autumn. The study group comprised 27 children aged 2 to 15 years who required treatment for asthmatic attacks during the past year and tested positive at least for mite allergen in the preceding autumn. The subjects were randomly assigned to receive either suplatast or mequitazine. The primary endpoint of this study was the number of days without symptoms during the 8 weeks of treatment. In addition, the Japanese Pediatric Asthma Control Program (JPAC) scores were also recorded every 2 weeks in each group.

RESULTS

Overall, 14 patients received suplatast, and 13 received mequitazine for 8 weeks from September through early October. During follow-up, the number of days without symptoms and the total JPAC scores did not differ significantly between the groups. However, as compared with weeks 1 to 2 of treatment, the mean number of days without symptoms during weeks 7 to 8 increased significantly in only the suplatast group (8.6 vs. 11.5 days; p = 0.004).

CONCLUSIONS

Our results suggest that short-term additional treatment with suplatast is useful for preventing asthma symptoms in children with asthma, which is usually exacerbated in the autumn.

Usefulness of suplatast tosilate for chronic cough following lung cancer surgery

OBJECTIVE

Chronic dry cough is reported to occur in about 25% of patients following lung cancer surgery. Experimental data suggest that it may be caused mainly by stimulation of C-fibers, which are widely distributed to the lower trachea and bronchi. We assessed the clinical usefulness of suplatast tosilate (IPD) for chronic dry cough after lung cancer surgery.

METHODS

The subjects were patients with stage I lung cancer who had undergone lobectomy combined with mediastinal lymph node dissection. IPD was administered orally at 400 mg daily, and its efficacy was evaluated by patient interview 1, 2, and 3 months after the start of treatment. The subjects were 19 patients, and the duration of cough before entering the study was 393.2 days.

RESULTS

The response rate was 84.2% (16/19) 1 month after the start of treatment. It seems that IPD inhibits cough resulting from stimulation of the bifurcated trachea with a high content of C-fibers.

CONCLUSION

The present study suggested the efficacy of IPD for controlling chronic dry cough after lung cancer surgery.

Effect of suplatast tosilate on antileukotriene non-responders with mild-to-moderate persistent asthma

BACKGROUND

Immunomodulatory therapy has been recently introduced for the management of asthma. Suplatast tosilate (ST), a new immune-modifying drug, is known to improve the airway function by inhibiting the release of Th-2 cytokines. However, its efficacy as a controller listed in the guideline, Global Initiative for Asthma 2005 has not been established. In this study we investigated the role of ST in leukotriene receptor antagonist (LTRA) non-responders with mild-to-moderate persistent asthma before initiating corticosteroids inhalation therapy.

METHODS

This was a prospective open-level clinical trial. LTRAs was given to 41 patients with asthma for 4 weeks and clinical efficacy was assessed using daily symptom scores. The 10 patients, aged 2.5-8.5 years, who failed to show clinical improvement, were defined as LTRA non-responders. After a 1-week washout period, the efficacy of ST was investigated and compared with LTRA non-responders for the following 4 weeks.

RESULTS

LTRA non-responders showed a significant improvement in the average symptom score, peak expiratory flow, use of rescue medication and the proportion of symptom-free days with ST therapy.

CONCLUSIONS

ST is a good choice for patients who have failed to respond to LTRAs. ST should therefore be added to the list of treatment options for such patients.

Inhibitory effects of suplatast tosilate on the differentiation and function of monocyte-derived dendritic cells from patients with asthma

BACKGROUND

Dendritic cells (DCs) are antigen-presenting cells that efficiently activate T cells.

OBJECTIVE

We examined the effects of suplatast tosilate, which prevents T-helper type 2 responses, on the differentiation and function of monocyte-derived DCs (moDCs).

METHODS

DCs were differentiated in vitro from peripheral monocytes from patients with asthma by the addition of granulocyte macrophage colony-stimulating factor and IL-4 in the presence or absence of suplatast tosilate. Cell surface molecules (CD1a, CD14, CD80, CD83, CD86, HLA-DR) on immature and mature DCs were analysed with flow cytometry, and the secretion of CC chemokine ligand (CCL)17 (thymus and activation-regulated chemokine), IL-12p70, IL-12p40, and IL-10 was measured with an ELISA. We also studied the proliferative responses of allogeneic CD4(+) T cells from healthy subjects to DCs differentiated in the presence of suplatast tosilate. In addition, the production of IFN-gamma and IL-5 by CD4(+) T cells after coculture with untreated DCs or suplatast tosilate-treated DCs was measured with ELISA.

RESULTS

Suplatast tosilate significantly inhibited the expression of CD1a, CD80, and CD86 on immature DCs and of CD1a, CD80, CD83, and CD86 on mature DCs. Suplatast tosilate also significantly inhibited the secretion of CCL17, IL-12p70, and IL-12p40; however, the secretion of IL-10 was not affected. The proliferative responses of allogeneic CD4(+) T cells to suplatast tosilate-treated DCs were suppressed. Moreover, suplatast tosilate-treated DCs had an impaired capacity to stimulate CD4(+) T cells to produce IFN-gamma and IL-5.

CONCLUSION

Suplatast tosilate inhibits the differentiation, maturation, and function of moDCs.

Beneficial effects of suplatast tosilate (IPD-1151T) in a rat cystitis model induced by intravesical hydrochloric acid

OBJECTIVE

To examine the effects of suplatast tosilate (IPD-1151T), a Th2 cytokine inhibitor recently recognized to improve the symptoms in patients with interstitial cystitis (IC), in a rat model of HCl-induced chronic cystitis, to elucidate the possible mechanisms by which the drug improves the symptoms of IC.

MATERIALS AND METHODS

Chronic cystitis was induced by intravesical instillation of 0.2 mL of 0.4 m HCl in female adult rats. After a once-daily oral administration of IPD-1151T (0.1-100 mg/kg) or prednisolone (5 mg/kg) for 7 days, cystometry was performed under urethane anaesthesia. The bladder from HCl-induced cystitis rats was also assessed histopathologically.

RESULTS

On cystometrography there was frequent voiding in cystitis rats. Administration of IPD-1151T for 7 days after intravesical HCl instillation dose-dependently increased the micturition volume and intercontraction intervals. Treatment with prednisolone had similar therapeutic effects. Histological analyses in the bladder from cystitis rats revealed oedema and infiltration of inflammatory cells such as mast cells and eosinophils in the lamina propria and the transitional epithelial thickening. These histological changes and the number of mast cells and eosinophils were reduced by administration of IPD-1151T or prednisolone.

CONCLUSION

The present results indicate that IPD-1151T improves bladder function and pathological changes in HCl-induced cystitis rats, as previously observed in patients with IC. The rat cystitis model induced by HCl could provide useful information for studying proposed therapies for IC which might involve T cell-dependent inflammatory responses as one of its potential pathophysiologies.

Effect of s-methylmethionine sulphonium chloride on oesophagogastric ulcers in pigs

OBJECTIVE

To assess the value of s-methylmethionine sulphonium chloride (SMMSC) (200 mg/kg) on nutritional performance of pigs and as prevention or therapy for oesophagogastric ulcers.

DESIGN

Sixty pigs from a high health status herd with continuing oesophagogastric ulcer problems were endoscopically assessed for the presence or absence of oesophagogastric ulcers. Forty-eight pigs were then selected and allocated according to an initial oesophagogastric epithelial (ulcer score) classification to replicated treatment groups in a 2 x 2 factorial design. Weight gain and feed intake were measured over 49 d, after which pigs were killed and stomachs were collected, re-examined and scored for oesophagogastric ulceration.

RESULTS

There was no difference over the 49 d in weight gain, feed intake and backfat in pigs with and without SMMSC supplementation between pigs with or without fully developed oesophagogastric ulcers at the start of the study. In pigs with an initially low ulcer score, feeding SMMSC did not prevent further oesophagogastric ulcer development. No significant effect of SMMSC was apparent when final mean oesophagogastric ulcer scores were compared in pigs with existing high ulcer score. However, further analysis of the changes in individual pig oesophagogastric ulcer scores during the experiment showed that the observed reductions in scores of the high ulcer group was significantly different from all other groups.

CONCLUSION

This study has indicated that supplementation of pig diets with SMMSC cannot be justified unless the slight ulcer score improvement observed could be translated to some commercial production advantage such as a reduction in pig mortalities due to oesophagogastric ulcers. This study has further confirmed the benefit of endoscopy as a tool to enable objective assessment of oesophageal gastric health.

Suplatast/tacrolimus combination therapy for refractory facial erythema in adult patients with atopic dermatitis: a meta-analysis study

BACKGROUND

Combination of suplatast tosilate with tacrolimus ointment was reported to reduce the dose of tacrolimus ointment with maintained treatment efficacy for refractory facial erythema in atopic dermatitis (AD), however these were only case-controlled studies and the number of cases was not sufficiently large. Thus, the efficacy of a combination therapy of tacrolimus ointment and suplatast tosilate for treating AD including refractory facial erythema was investigated using a method of meta-analysis on the basis of published papers collected by database search.

METHODS

We searched the literature on the efficacy of a combination of topical tacrolimus and suplatast tosilate for refractory facial erythema in patients with adult atopic dermatitis, and related data were collected for meta-analysis.

RESULTS

Our meta-analysis study showed that suplatast/tacrolimus combination therapy revealed better improvement in skin symptom scores and significantly decreased the dose of tacrolimus compared with topical tacrolimus monotherapy. In addition, a significantly greater number of patients could stop using tacrolimus ointment by using the combination with suplatast tosilate than by tacrolimus monotherapy for refractory facial erythema.

CONCLUSIONS

The combination therapy with suplatast tosilate decreased the effective dosage of tacrolimus ointment supporting use of the combination therapy for refractory facial erythema.

Ameliorating effect of dimethylsulfoniopropionate on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson's disease of mice

The effect of dimethylsulfoniopropionate (DMSP) on the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-induced Parkinson's disease (PD) of mice was examined for 5 d. The distilled water (the control group) and the DMSP solution at 5 x 10(-4) M (the DMSP group) were supplemented ad libitum to six mice each in two groups for 2 wk. An appropriate amount of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) solution (20 mg/kg body wt) was then intraperitoneally injected into all the test mice once a day initially for 3 d, which definitely made the control mice similar to the PD-model mice. The moving ability (running power) of the mice in both groups was measured using an automatic Wheel Running Instrument. The immobility duration of the upside-down mice in both groups was estimated by a newly developed polygraph (RMP-6008M, Nihon Koden Co., Ltd., Japan). The results indicated that the mice in the DMSP group showed a stronger moving ability and a shorter immobility duration compared to the mice in the control group during the experimental period. Furthermore, the amounts of catecholamines (dopamine and norepinephrine) in the brains except for the cerebellums of all the test mice were estimated 2 d after the last MPTP injection, which demonstrated that the brains of the mice in the DMSP group accumulate larger amounts of catecholamines, especially dopamine, than them in the control group. Accordingly, the administration of low concentrations of DMSP proved to prevent and/or ameliorate the decreased mobility and the typical immobility (Akinesia) of the MPTP-induced PD-model mice probably due to increased amounts of dopamine in the brains of the DMSP group mice.

Topical suplatast tosilate (IPD) ameliorates Th2 cytokine-mediated dermatitis in caspase-1 transgenic mice by downregulating interleukin-4 and interleukin-5

BACKGROUND

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by elevated serum levels of IgE. AD is associated with Th2 cytokines including interleukin (IL)-4, IL-5, IL-13 and IL-10. Systemic administration of suplatast tosilate (IPD) is currently used to treat Th2 cytokine-mediated AD.

OBJECTIVES

To evaluate the effect of topical IPD on skin lesions of AD using a genetically engineered AD mouse model (K14/caspase-1 transgenic mouse: KCASP1Tg).

METHODS

IPD ointment (3%) and white petrolatum (WP) were applied to KCASP1Tg mice every other day from 6 to 14 weeks after birth. Histopathological analysis of skin lesions and measurement of mRNA expression of cytokines in skin lesions and spleen cells were carried out. We also compared changes in serum parameters between IPD-treated and WP-treated KCASP1Tg mice.

RESULTS

WP-treated mice developed dermatitis at 8 weeks after birth. However, skin lesions in IPD-treated mice were limited. Histopathologically, skin lesions in WP-treated KCASP1Tg mice showed marked inflammatory changes with increased mast cell infiltration. However, mice treated with IPD showed minimum skin lesions with scarce mast cell infiltration. WP-treated KCASP1Tg mice had significant elevation in the serum levels of histamine, IgE and IL-18 as compared with IPD-treated KCASP1Tg mice. mRNA expression of IL-4 and IL-5 in the skin lesions from WP-treated KCASP1Tg mice was significantly higher than in those from IPD-treated mice. In the spleen, the expression of IL-4, IL-5 and interferon-gamma was significantly increased in WP-treated KCASP1Tg mice as compared with their IPD-treated counterparts.

CONCLUSIONS

This study shows that topical therapy with IPD inhibits the expression of IL-4 and IL-5 and ameliorates skin manifestations in an AD mouse model, suggesting the potential usefulness of topical IPD for the treatment of AD.

7. Control of allergic airway inflammation through immunomodulation

Among the asthma clinical trials published over the last several years, a unique subset has focused on novel means for inhibiting the airway inflammation that is believed to cause airway obstruction in many patients. Such interventions, broadly considered here as immune-modifying or immunomodulatory therapies, include several new drugs (omalizumab, suplatast tosilate, anti-cytokine antibodies, soluble receptors, and recombinant cytokines) and bacterial extracts. In this chapter we review the major findings with these clinical trials and indicate which have changed the management of asthma, which have not, and those that deserve further study.

Suplatast tosilate alters DC1/DC2 balance in peripheral blood in bronchial asthma

Suplatast tosilate is an antiallergic drug that selectively suppresses Th2-cytokine production and inhibits airway hyperresponsiveness and eosinophilic airway inflammation. This drug has been also shown to improve pulmonary function and symptoms in steroid-dependent asthma, resulting in a decrease in doses of inhaled corticosteroid. However, the precise mechanism by which suplatast tosilate exerts an antiasthmatic effect in vivo remains to be known. Our previous study showed the polarization of circulating type 1 dendritic cells (DC1)/type 2 dendritic cells (DC2) balance toward DC2 in asthma, which might be associated with its Th2-dominant immune response. In the present study, we attempted to clarify the effect of suplatast tosilate on DC1/DC2 balance in asthma. Using multicolor flow cytometry, we enumerated circulating DC1 and DC2 before and 8 weeks after treatment with suplatast tosilate in nine patients with asthma. Before the treatment, the patients with asthma had a significant higher percentage of DC2 together with a significant lower ratio of DC1/DC2 compared with normal subjects. Administration of suplatast tosilate significantly decreased the percentage of DC2, but not that of DC1, resulting in a significant raises of the ratio of DC1/DC2. Concomitantly, intracellular cytokine analysis showed that the percentage of IL-4 producing CD4+ T cells was significantly decreased after the treatment. These data suggest that suplatast tosilate normalizes the polarized DC1/DC2 balance toward DC2 in asthma, which may also alter its Th2-dominant Th1/Th2 balance toward Th1.

Effect of suplatast tosilate on goblet cell metaplasia in patients with asthma

BACKGROUND

Goblet cell metaplasia is a pathologic characteristic of asthma, associated with excess mucus secretion. Interleukin (IL)-4 and IL-13 plays an important role in mucus hypersecretion. Suplatast tosilate (suplatast), an antiallergic agent, is a Th2 cytokine inhibitor that suppresses the synthesis of IL-4, IL-5, IL-13, and eosinophilic airway inflammation.

OBJECTIVE

We examined the effects of suplatast on mucus production in bronchial biopsy specimens taken from asthmatic subjects.

METHODS

Oral suplatast 300 mg daily, or placebo was administered for 3 months in a double-blind, parallel-group study in 25 patients with asthma. Biopsy specimens were evaluated at before and after treatment for alcian blue/period acid-Schiff (AB/PAS), MUC5AC staining in bronchial epithelium and IL-4+, IL-13+ cells as well as inflammatory cells in lamina propria.

RESULTS

There were significant decreases in the percentage of AB/PAS (P < 0.01) and MUC5AC (P < 0.01) stained area in the suplatast group. These changes were accompanied by significant decreases in IL-4+ and IL-13+ cells in suplatast-treated subjects. Additionally, we have observed that the number of infiltrating eosinophils and CD4+ T cells significantly decreased.

CONCLUSIONS

These findings suggest that suplatast prevents goblet cell metaplasia through modulation of Th2 cytokine production and the recruitment of eosinophils and CD4+ T cells in the asthmatic airways.

[Case of interstitial cystitis accompanied by food allergy]

A case is a 62 years old woman who consulted her family physicion with pollakiuria and sharp pain at the time of urinary bladder distention. Since anti-H1-antagonist but not antibiotics was partially effective against the symptoms and some specific food ingestion appeared to increase the bladder pain, she was referred to our hospital. Treatment with spulatast tosilate and elimination of food products that revealed the presence of specific IgE antibodies and positive skin reactiont resulted favorable clinical response. Cystoscopic examination showed reduction in bladder capacity, mucosal injection and vascularization, besides pinpoint submucosal hemorrage and linear ulcer by hydrodistension. The diagnosis of interstitial cystitis was established by those evidences and histological findings. The patient got apparent remission after the bladder hydrodistension and is now in steady state with an addition of suplatast tosilate, a Th2 cytokine inhibitor, on the treatment mentioned above. Interstitial cystitis is a very rare disease which is characterized by cystitis-symptoms with normal urinary finding and non-effectiveness of antibiotics. The pathogenesis of the disease is unclear but considered as allergic inflammation. We report a case of interstitial cystitis accompanied by food allergy.

CD28 and secretory immunoglobulin A-dependent activation of eosinophils: inhibition of mediator release by the anti-allergic drug, suplatast tosilate

BACKGROUND

Eosinophils are major effector cells in allergic diseases. After their recruitment to sites of inflammation, they contribute to the pathophysiology of the disease by releasing granule proteins and cytokines. Suplatast tosilate (IPD-1151T), a new anti-allergic agent, has shown beneficial effect in the treatment of asthma, associated with reduced bronchoalveolar lavage eosinophil infiltration and eosinophilic cationic protein (ECP) release in serum and sputum.

OBJECTIVE

We investigated whether suplatast tosilate could exert direct effects on human eosinophil activation.

METHODS

Eosinophils from hypereosinophilic patients or normal donors were purified by Percoll gradient and the magnetic cell separation system. Chemotaxis was studied using the Boyden chamber technique using three chemoattractants, formyl-methionine-leucine-phenylalanine (fMLP), IL-5 and eotaxin. Oxidative metabolism was determined by a luminol-dependent chemiluminescence assay after activation with eotaxin or secretory IgA (sIgA). The release of ECP and eosinophil derived neurotoxin (EDN) was measured by radioimmunoassay and cytokine production was determined by ELISA following activation with sIgA or anti-CD28.

RESULTS

The chemotactic response to fMLP, IL-5 and eotaxin was significantly inhibited by IPD-1151T. Suplatast tosilate was partially inhibiting the release of reactive oxygen species (ROS) induced by eotaxin and sIgA. Activation by sIgA and CD28 ligation resulted in the release of ECP and EDN, which was inhibited by IPD-1151T. Upon activation by anti-CD28, only IL-13 production was inhibited by IPD-1151T, whereas release of IL-2 and IFN-gamma was not affected. IL-10 release induced by sIgA was also inhibited by IPD-1151T. Additionally, the pro-inflammatory cytokine IL-6, which was secreted following anti-CD28 and sIgA stimulation, was strongly inhibited by IPD-1151T.

CONCLUSION

Through inhibition of chemotaxis, IPD-1151T might limit the number of eosinophils at the inflammation site. Furthermore, it could reduce the pathological potential of eosinophils by inhibiting the release of ROS and cationic proteins, main inflammatory mediators produced by eosinophils. Moreover, the inhibition of immunoregulatory cytokines released by eosinophils could locally modify the immune response.

Rationale for new treatments aimed at IgE immunomodulation

OBJECTIVE

To review potential or current therapies that decrease IgE synthesis or effects.

DATA SOURCES

Relevant literature in peer-reviewed journals and abstracts from national meetings.

STUDY SELECTION

Key articles were selected by the authors.

RESULTS

Modulation of IgE-mediated diseases can occur at several levels. Transcription factors may be altered to differentiate lymphocytes into a TH1 phenotype, thus decreasing TH2-driven IgE production. This may be accomplished by inhibiting GATA-3 with peroxisome proliferator-activated receptor agonists or promoting T-bet expression with CpG motifs. Inhibiting IgE-promoting cytokines may be accomplished by blocking the effects or synthesis of interleukin 4 (IL-4) or IL-13 by suplatast tosilate. Cytokine therapy with anti-IL-4 or anti-IL-13 has the potential to directly influence IgE-mediated diseases, but strategies aimed at IL-4 alone have been disappointing. Clinical trials with interferon-gamma or IL-12, 2 cytokines important in promoting TH1 and inhibiting TH2 responses, have been fraught with adverse effects that make their use limited. The use of plasmids encoding interferon-gamma or IL-12 has shown promise in animal models. Inhibition of IgE synthesis has been demonstrated with anti-CD23 antibodies. Early human studies have been very encouraging, and larger studies are under way. The only IgE immunomodulator currently available for use is omalizumab. Omalizumab is effective for allergic asthma in children and adults.

CONCLUSIONS

Newer therapies hold great promise for the future treatment of allergic respiratory diseases, but clinical trials are necessary to accurately evaluate risk-benefit ratios of IgE immunomodulators.

Add-on effects of suplatast tosilate in bronchial asthma patients treated with inhaled corticosteroids

Th2 cytokines play an important role in the pathogenesis of asthma. In the present study, we investigated the effect of suplatast tosilate, a selective Th2 cytokine inhibitor, on asthma control, in terms of subjective symptoms and pulmonary function in patients treated with inhaled corticosteroids. Thirty-eight patients with bronchial asthma being treated with inhaled corticosteroids were given suplatast tosilate (100 mg three times daily) for 12 weeks, in a multicenter setting. During the study period, other medications were continued. Morning and evening peak expiratory flow, asthma symptoms, blood eosinophil count and serum IgE levels were monitored. Suplatast tosilate treatment was associated with a significant improvement in mean morning peak expiratory flow (from 295 L/min to 348 L/min, P < 0.01) and evening peak expiratory flow (from 313 L/min to 357 L/min, P < 0.01). The mean daily variation in peak expiratory flow was significantly reduced (from 11.6% to 7.3%, P < 0.01) by suplatast tosilate treatment. The greatest improvement in peak expiratory flow was observed in patients whose blood eosinophil counts were decreased by suplatast tosilate treatment. Treatment with suplatast tosilate improved pulmonary function in patients with bronchial asthma. Our results suggest the therapeutic effects observed may occur through suppression of eosinophilic inflammation.

[The effect of suplatast tosilate on the patients with atopic dermatitis--relationship between clinical symptoms and immunological parameters]

The Th2 cytokine inhibitor, suplatast tosilate (300 mg/day) was administered to 45 cases of patients with atopic dermatitis for 8 weeks. The clinical scores, peripheral blood eosinophil counts, serum LDH levels, total IgE levels, serum eosinophil cationic protein (ECP) levels, and serum IL-5 levels before and after the treatment were observed and comparatively evaluated. The results of this study were summarized as follows. 1) Temporary improvements were found in the severity score, itching score, and sleeplessness score. All evaluated scores decreased significantly for all observation periods at 2, 4, 6 and 8 weeks after administration of suplatast tosilate compared with those before the administration. 2) In severe group, there was a significant improvement of severity score of lower limb. In moderate group there were significant improvements of severity score of head, face, neck and of upper limb. There were significant improvements of severity score of trunk and upper limbs in mild group. 3) The peripheral blood eosinophil counts and serum LDH levels significantly diminished compared with those before administration, but no significant difference was found in total IgE levels and serum ECP levels. 4) The serum IL-5 levels decreased after administration, however, there was no statistical significance. 5) The positive correlations between delta-severity score and delta-peripheral eosinophil count, delta-serum LDH levels, delta-serum ECP levels were found. 6) The positive correlations between delta-peripheral eosinophil count and delta-serum LDH levels, delta-serum ECP levels were observed. 7) There was no sign of adverse effects of the drug. From the above mentioned results, we confirmed the high efficacy of suplatast tosilate in the treatment of atopic dermatitis.

Effects of suplatast tosilate on allergic eosinophilic airway inflammation in patients with mild asthma

BACKGROUND

Bronchial asthma is a chronic inflammatory disease characterized mainly by infiltration of the airway mucosa by various inflammatory cells, notably eosinophils. T(H)2-type cytokines are suggested to be deeply involved in the pathogenesis of asthma.

OBJECTIVE

We sought to determine the suppressive effects of suplatast tosilate, an inhibitor of T(H)2-type cytokines, on eosinophilic inflammation of the bronchial mucosa in patients with mild asthma.

METHODS

Airway hyperresponsiveness tests, pulmonary function tests, eosinophil measurements in induced sputum, and bronchial mucosa biopsies were performed before and after treatment with suplatast tosilate for 6 weeks in 15 patients with mild asthma and in 13 control patients with mild asthma not receiving suplatast tosilate. This study was performed as a case-controlled open study.

RESULTS

In the treatment group a significant improvement in the provocation concentration of histamine was observed (P <.05). Improvements in peak expiratory flow (P <.01) and in symptom score (P <.05) were also noted in the suplatast tosilate-treated group. Moreover, the average number of infiltrating eosinophils and EG2(+) cells significantly decreased (both P <.05), as did the ratios of eosinophils and EG2(+) cells in sputum (both P <.01). The average number of CD4(+) and CD25(+) T lymphocytes also decreased (both P <.05).

CONCLUSION

Suplatast tosilate appears to inhibit allergic airway inflammation mediated by T(H)2-type cytokine and to improve clinical symptoms in patients with mild asthma.

Suppression of the Th2 pathway by suplatast tosilate in patients with perennial nasal allergies

BACKGROUND

Suplatast tosilate (IPD-1151T), a selective Th2 cytokine inhibitor that suppresses the production of interleukin (IL)-4 and IL-5 in vitro or in animal models has been proved clinically effective for allergic rhinitis (AR). The aim of this study was to investigate changes in the Th2 pathway in human nasal mucosa after medication with IPD-1151T. Twelve patients were treated with IPD-1151T.

METHODS

Twelve healthy volunteers served as normal controls. The following parameters were evaluated: (i) subjective nasal clinical symptoms, (ii) percentages of inflammatory cells (EG2, CD4, and CD8) by immunocytological staining, and (iii) levels of cytokines (IL-4, IL-5, IL-13, regulated on activation, normal T-cell expressed, and secreted [RANTES], and interferon [IFN] gamma) by enzyme-linked immunosorbent assay.

RESULTS

Nasal symptom scores significantly decreased after treatment. With respect to cell infiltration, a significant decrease was observed in the percentage of inflammatory cells (EG2 and CD4) and CD4/CD8 ratio. The levels of cytokines (IL-4, IL-5, IL-13, and IFN-gamma) and the IL-5/IFN-gamma ratio were significantly decreased, and the IL-4/IFN-gamma ratio became not significantly different from that in normal subjects. In contrast, RANTES did not change significantly. The percentage of reduction in IL-5 correlated with that in eosinophil infiltration, whereas that in RANTES did not.

CONCLUSION

These results suggest that IPD-1151T can reduce the Th2 pathway.

Improvement of alanine aminotransferase by administration of suplatast tosilate plus ursodeoxycholic acid in patients with resistance to ursodeoxycholic acid monotherapy on hepatitis C virus-related chronic liver disease

OBJECTIVE

Inflammatory liver damage and viral persistence after hepatitis C virus (HCV) infection are known to be related in host immunity. Suplatast tosilate is an immunomodulator that selectively inhibits type 2 cytokine production by helper T cells. We investigated the efficacy and safety of the administration of suplatast tosilate for patients with HCV infection by examining the level of serum alanine aminotransferase (ALT) and viremia.

PATIENTS AND METHODS

Thirty-eight patients who had shown resistance to ursodeoxycholic acid (UDCA) therapy (600 mg/day tid) over 6 months for HCV-related chronic liver disease were randomized into two groups and received UDCA alone (600 mg/day tid) or UDCA (600 mg/day tid) plus suplatast tosilate (300 mg/day tid) by means of sealed envelopes.

RESULTS

After 24 weeks, serum ALT was decreased in the patients receiving UDCA plus suplatast tosilate, with the mean reduction being 40.2% (from 132 to 79 IU/l; p=0.001). In the patients receiving UDCA alone, ALT decreased by 8.3% (from 133 to 122 IU/l; ns). Multiple comparison of individual ALT changes showed that the UDCA plus suplatast tosilate achieved significantly greater improvement (p = 0.001). However, serum HCV RNA was unchanged in both groups. Two patients developed adverse reactions to suplatast tosilate, which resolved promptly after the discontinuation of the therapy.

CONCLUSION

These findings suggest that suplatast tosilate promotes biochemical improvement in the patients with chronic hepatitis C.

Effect of suplatast tosilate on airway hyperresponsiveness and inflammation in asthma patients

Because eosinophilic airway inflammation is a characteristic of bronchial asthma, the treatment of such inflammation is important in the management of this disease. Suplatast tosilate is a novel anti-asthma drug that suppresses eosinophil proliferation and infiltration through selective inhibition of Th2 cytokine synthesis. We investigated the effect of oral suplatast tosilate therapy in patients with mild and moderate asthma. Twenty-eight asthma patients were randomized into two groups with or without suplatast tosilate treatment (100 mg t.i.d. for 28 days). We examined the blood eosinophil counts, eosinophilic cationic protein level, sputum eosinophil count, exhaled nitric oxide level, and airway responsiveness before and after treatment. In patients treated with suplatast tosilate, the eosinophil count in the blood and sputum was significantly decreased after treatment, while there was no such change in the patients without suplatast treatment. The exhaled nitric oxide level and airway responsiveness (measured using an Astograph) were also decreased after treatment with suplatast tosilate, while there were no significant changes in patients without suplatast tosilate. These results strongly suggest that oral administration of suplatast tosilate suppresses airway hyperresponsiveness in asthma patients by reducing eosinophilic inflammation in the airways.

Effect of suplatast tosilate, a Th2 cytokine inhibitor, on cough variant asthma

STUDY OBJECTIVE

Th2 cytokines play an important role in the pathogenesis of asthma. Our study objective was to determine the effect of suplatast tosilate, a Th2 cytokine inhibitor, on patients with cough-variant asthma.

METHODS

Twenty patients with cough-variant asthma (CVA) were assigned to a suplatast tosilate (100 mg three times daily) group or a placebo group for 6 weeks in a double-blind randomized study. The cough scores, medication scores, pulmonary function, bronchial hyperresponsiveness to methacholine, cough threshold for capsaicin, percentage of eosinophils and concentrations of eosinophilic cationic protein (ECP) in hypertonic saline-induced (induced) sputum were evaluated. The main outcome measures were capsaicin cough threshold and concentrations of ECP in induced sputum.

RESULTS

In the suplatast group, the cough scores and the medication scores decreased significantly over time. The percentage of eosinophils in induced sputum significantly decreased from 53.5+/-5.6% to 13.6+/-2.6%. The cough threshold for capsaicin improved significantly from 2.72+/-3.41 microM to 39.7+/-22.7 microM in the suplatast group. The concentrations of ECP in induced sputum decreased significantly from 435+/-123 microg/l to 56+/-34 microg/l in the suplatast group. The bronchial responsiveness to methacholine changed from 8.45+/-3.43 units to 11.4+/-3.76 units in the suplatast group.

CONCLUSIONS

Suplatast improved the cough scores and the cough threshold for capsaicin in patients with CVA without significant side effects, suggesting the effectiveness of suplatast in the treatment of CVA. Suplatast also decreased the percentage of eosinophils and concentrations of ECP in induced sputum, suggesting improvement in eosinophilic inflammation in patients with CVA. Further pharmacodynamic research is needed to explain the precise mechanism.

Targeting afferent hyperexcitability for therapy of the painful bladder syndrome

The involvement of C-fiber afferent pathways in urinary frequency and pain associated with painful bladder syndrome raises the possibility of multiple targets for the treatment of this disease. Using an in vivo measurement of bladder activity as well as whole-cell patch clamp recording techniques to examine the properties of bladder afferent neurons in animal models of chronic cystitis, we have documented that tetrodotoxin-resistant sodium channels encoded by the Na(v) 1.8 (PN3/SNS) gene and nitric oxide acting via a cyclic guanosine monophosphate (cGMP)-dependent mechanism are important in modulating bladder pain responses. Thus, suppression of C-fiber afferent nerve activity by blocking specific sodium channels, elevating nitric oxide levels, or activating cGMP-dependent pathways might represent novel strategies for the treatment of symptoms in patients with painful bladder syndrome. Another treatment strategy is suppression of release or activity of proinflammatory agents that can cause normally unexcitable C-fiber afferents to become hyperactive or hyperexcitable. This approach to management of bladder pain was tested in patients with painful bladder syndrome by examining the effectiveness of the antiallergic agent suplatast tosilate (IPD-1151T), which suppresses urinary frequency in a rat model of cystitis. IPD-1151T is an immunoregulator that suppresses cytokine production in T-helper 2 cells and inhibits immunoglobulin E antibody formation and antigen-induced histamine release from mast cells. Preliminary data from an open-label clinical trial showed that 16 of 23 (70%) patients responded to treatment with IPD-1151T (300 mg/day orally for 12 months). The finding that expression of platelet-derived endothelial cell growth factor, which can activate mast cells, was lower in the bladder of responders than nonresponders indicates that bladder levels of platelet-derived endothelial cell growth factor may be a useful marker for this disease.

Understanding chronic pelvic pain syndrome

Patients with non-inflammatory chronic pelvic pain syndrome, the largest group of prostatitis patients according to the US National Institute of Diabetes and Digestive and Kidney Diseases classification, are characterized by the absence of objective findings. Nothing thus links the symptoms of this disease to the prostate or other male organs in particular. For this reason, observations on interstitial cystitis in women are of interest to understand the chronic pelvic pain syndrome. New information from studies on the inflammatory response in expressed prostatic secretion in patients with chronic pelvic pain syndrome and in bladder tissue from patients with interstitial cystitis indicates that complex systems on the cytokine gene expression level may be operating in these diseases. Research findings point to a common denominator at the level of molecular biology that might explain how the symptoms of chronic pelvic pain syndrome and interstitial cystitis can be precipitated by pathogens, inflammatory reactions and even neurological mechanisms. The initial clinical trial reports of drugs that modulate the inflammatory response in interstitial cystitis are met with great interest.

Effects of suplatast tosilate, a new type of anti-allergic agent, on airway cough hypersensitivity induced by airway allergy in guinea-pigs

BACKGROUND

Cough receptor hypersensitivity is a fundamental feature of some conditions presenting with chronic non-productive cough. Suplatast tosilate, an anti-allergic agent, is a T helper (Th)2 cytokine inhibitor that inhibits the synthesis of interleukin (IL)-4, IL-5, immunoglobulin (Ig)E production, and local eosinophil accumulation.

OBJECTIVE

The purpose of this study was to investigate the effect of suplatast on antigen-induced airway cough hypersensitivity and eosinophil infiltration into the airway.

METHODS

Number of coughs elicited by inhalation of increasing concentrations of capsaicin (10-8, 10-6 and 10-4 M) was counted 24 h after an antigen challenge in conscious guinea-pigs and then bronchoalveolar lavage was performed. We investigated the effect of single (before antigen challenge or capsaicin provocation) or repetitive treatment with intraperitoneal suplatast at a dose of 10 or 30 mg/kg on antigen-induced cough hypersensitivity.

RESULTS

Twenty-four hours after antigen challenge, guinea-pigs developed an increase in cough receptor sensitivity to inhaled capsaicin and eosinophil infiltration in the airways. After a 2-week treatment with suplatast, but not after only a single treatment before antigen challenge or capsaicin provocation, the antigen-induced early phase bronchoconstriction, cough hypersensitivity, and airway eosinophilia were inhibited in a dose-dependent manner.

CONCLUSION

These results indicate that suplatast inhibits airway cough hypersensitivity underlying allergic eosinophilic inflammation.

Effects of suplatast tosilate on airway inflammation and airway hyperresponsiveness

Suplatast tosilate (IPD) is a Th2 cytokine inhibitor that lowers the titer of the IgE antibody through specific inhibition of the production of IL (interleukin)-4 and IL-5 by T cells and inhibits tissue infiltration by eosinophils. In this clinical trial, suplatast tosilate (300 mg/day) was administered orally for 4 weeks to 25 patients (13 patients with atopic asthma, 12 patients with nonatopic asthma) whose bronchial asthma was staged in step 1 or step 2 according to the Guidelines for Prevention and Management of Bronchial Asthma, 1998. Before and after administration, the parameters of airway inflammation, that is, peripheral blood eosinophils count, serum level of eosinophil cationic protein (ECP), ECP level in induced sputum, airway hyperresponsiveness (Dmin), and morning peak expiratory flow (PEF), were measured. The peripheral blood eosinophil count, serum level of ECP, and ECP level in induced sputum decreased significantly. Of these parameters, the ECP level in induced sputum was the most sensitive. Furthermore, suplatast tosilate significantly inhibited Dmin. These results were especially significant in patients with atopic asthma. Suplatast tosilate was considered to have inhibited airway eosinophilic inflammation through decreases in peripheral blood eosinophils counts and in ECP levels in induced sputum, which resulted in inhibition of airway hyperresponsiveness.

[Cytokine production by peripheral blood mononuclear cells in bronchial asthma treated with suplatast tosilate]

Supratast tosilate is a newly developed 'anti-allergic' drug and it has been shown to suppress cytokine production by type-2 helper T cells (Th2) in vitro. However, it is unclear whether a similar inhibitory effect on Th2 cytokines production is produced iv vivo. To elucidate the actions of the in vivo mechanisms of this drug, we isolated peripheral blood mononuclear cells (PBMCs) from 10 atopic asthmatics treated with supratast tosilate and investigated the capacity for cytokine production ex vivo. Interleukin (IL)-5 production by PBMCs stimulated with the combination of phorbol myristate acetate and ionomycin were reduced significantly 6 or 12 weeks after the treatment with supratast tosilate. In contrast, no significant reduction was seen in IL-4 or Interferon (IFN)-gamma production. The peripheral blood eosinophil count and weeks, but no significant difference was sees in total IgE levels. Both morning and evening peak expiratory flow were significantly elevated after 6 weeks. These results suggest that supratast tosilate improves the disease status of bronchial asthma through its ability to inhibit the production Th2 cytokines, at least IL-5, in vivo.

[The effect of suplatast tosilate on immunological parameters for the patients with atopic dermatitis]

A dose of 300 mg/day of suplatast tosilate was administered to one hundred one cases of atopic dermatitis for eight weeks, and the severity scores, peripheral blood eosinophil count, total serum IgE levels, plasma eosinophil cationic protein (ECP) levels, and other immunological parameters before and after the trial were observed and comparatively examined. The results are as follows: 1) Temporary improvements were found in the scores of severity and itchiness on all evaluated skin regions (face, limbs, and trunk). These scores decreased significantly for all observation periods at two, four, six and eight weeks after administration of suplatast tosilate compared with those before the administration (p < 0.01). 2) There was no sign of adverse effects on the drug. In the blood tests, one patient displayed elevated levels of GPT and another showed elevated total bilirubin. In the urine test (qualitative test), one case with positive urinary protein was observed. 3) Clinical examinations including assessment of the immunologic parameters were conducted at an average of 8.68 +/- 0.36th week. The peripheral blood eosinophil count, the percentage of eosinophil, and plasma ECP levels significantly diminished compared with those before administration, but no significant difference was found in total serum IgE levels and LDH levels. 4) The subjects were divided into two groups, one in which the clinical scores were improved by more than five and another with scores of less than five (including worsening), and the fluctuation of the immunological parameters (values before and after administration of the drug) of the two groups were compared. As a result, a significant difference was observed in the plasma ECP levels (p = 0.02) and peripheral blood eosinophil count (p = 0.091), but no difference was observed in total serum IgE levels and LDH levels. From the above mentioned results, the high efficacy and safety of suplatast tosilate in the treatment of severe atopic dermatitis were confirmed. At the same time, a decrease in the peripheral blood eosinophil count and the serum ECP levels were observed, suggesting the possibility that these values could be used as indices of the severity of atopic dermatitis.

Effect of suplatast tosilate, a Th2 cytokine inhibitor, on steroid-dependent asthma: a double-blind randomised study. Tokyo Joshi-Idai Asthma Research Group

BACKGROUND

Th2 cytokines play an important part in the pathogenesis of asthma. Our aim was to study the effect of suplatast tosilate, a selective Th2 cytokine inhibitor, on asthma control and asthma exacerbations during reduction of inhaled corticosteroid dose in patients with steroid-dependent asthma.

METHODS

85 patients with moderate to severe asthma taking high doses (> or = 1500 microg per day) of inhaled beclometasone dipropionate, were assigned suplatast tosilate (100 mg three times daily) or placebo for 8 weeks in a double-blind, randomised, parallel-group, multicentre trial. During the first 4 weeks, other medications remained unchanged (add-on phase); during the next 4 weeks, the doses of beclometasone were halved (steroid-reduction phase). Main outcome measures were pulmonary function, asthma symptoms, and use of beta2-agonists.

FINDINGS

Data were available from 77 patients. During the add-on phase, suplatast tosilate treatment, compared with placebo, was associated with higher forced expiratory volume in 1 s (mean difference between groups for changes from baseline at week 4, 0.20 L [95% CI 0.16-0.24], p=0.043), morning peak expiratory flow (18.6 L/min [14.1-23.1], p=0.037), and less diurnal variation in peak expiratory flow rate, asthma symptom scores (7.1 [6.6-7.6], p=0.029), and serum concentrations of eosinophil cationic protein and IgE. In the steroid-reduction phase, pulmonary function, asthma symptoms, and use of beta2-agonist deteriorated significantly more in the placebo group than in the suplatast group.

INTERPRETATION

Treatment with a Th2 cytokine inhibitor in steroid-dependent asthma improves pulmonary function and symptom control, and allows a decrease in dose of inhaled corticosteroid without significant side-effects. Some improvements in pharmacokinetics are, however, needed.

[Inhibitory effect of suplatast tosilate on eosinophil migration]

Suplatast tosilate has been shown to inhibit generation of Th2-type cytokines in vitro and used in the treatment of allergic diseases. Although the exact mechanism remains unknown, this compound attenuates the eosinophil infiltration in the asthmatic airway. In the present study, we examined whether suplatast tosilate directly modulates eosinophil migration in response to inflammatory mediators in vitro. Suplatast did not modify the spontaneous migration of eosinophils. On the other hand, eosinophil migration in response to PAF (1 microM) was significantly inhibited by 1 microM suplatast. Similarly, IL-5 (100 pM)-induced eosinophil migration was inhibited by 1 microM suplatast. These results suggest that suplatast tosilate inhibits eosinophil locomotion in response to PAF or IL-5 and thereby attenuates infiltration of the cells in allergic inflammation.

Effect of suplatast tosilate (IPD-1151T) on a mouse model of asthma: inhibition of eosinophilic inflammation and bronchial hyperresponsiveness

BACKGROUND

Suplatast tosilate (IPD) is a newly developed 'anti-allergic' drug. It seems to be a unique compound because of its ability to suppress IgE but not IgG or IgM production in vivo and cytokine production from type 2 helper T cells (Th2) in vitro. However, information on its in vivo effect on an animal model of asthma is limited.

METHOD

BALB/c mice sensitized to ovalbumin (3 times, 2-week interval) were challenged with ovalbumin by inhalation (50 mg/ml for 20 min, once a day for 6 days). In this study, we explored the influence of IPD on eosinophil infiltration into the airways, bronchial hyperresponsiveness (BHR) to methacholine, specific IgE antibody production, and cytokines in bronchoalveolar lavage fluid (BALF) using this murine model.

RESULTS

Treatment with IPD significantly reduced the number of total cells and eosinophils in BALF (around -40%) and almost completely inhibited the development of antigen-induced BHR. Histological findings confirmed the reduction of submucosal cell infiltration in the lung, and disclosed the marked inhibition of bronchial epithelial cell damage. Ovalbumin-specific IgE was slightly but significantly reduced. The levels of IL-4, IL-5 and IL-13 in BALF were significantly decreased in mice treated with the compound compared to those in untreated mice.

CONCLUSION

These results suggest that IPD is capable of inhibiting the production of Th2 cytokines, which inhibit eosinophil infiltration into the murine airway, IgE synthesis, and development of BHR, in a murine model of asthma.

[Chronic eosinophilic pneumonia complicated by bronchial asthma and diabetes mellitus successfully treated with suplatast tosilate and high-dose inhaled corticosteroid therapy]

A 54-year-old woman complained of dyspnea, cough, and productive sputum. Auscultation detected a wheeze in the left and right lung fields. Chest x-ray and computed tomographic films showed non-segmental infiltration in the left upper lung field. Laboratory data revealed eosinophilia in peripheral blood and sputum, elevated levels of serum interleukin-5 (IL-5), airflow limitation, hypoxemia, and heightened airway sensitivity to methacholine (D min : 0.42 units). Bronchoalveolar lavage disclosed an increase in the total number of cells, a 32% increase in eosinophils, and a decreased CD 4/CD 8 ratio of 0.7. Transbronchial lung biopsy specimens revealed infiltrations of eosinophils in the alveolar and interstitial compartments. The histologic features of bronchial biopsy specimens included increased eosinophils in the submucosa and squamous metaplasia. In addition, blood glucose and HbA 1 c levels were elevated. Chronic eosinophilic pneumonia complicated by bronchial asthma and diabetes mellitus was diagnosed. Because the patient was diabetic, she was given suplatast tosilate to reduce the production of IL-5, and high-dose inhaled corticosteroid (beclometasone dipropionate, 1,600 mcg/day) instead of oral corticosteroid therapy. Her symptoms were relieved, peak expiratory flow rates increased, serum IL-5 levels became undetectable, airway sensitivity to methacholine decreased (D min : 4.64 units), and the radiographic abnormalities disappeared. Furthermore, treatment with beclomethasone dipropionate was progressively reduced to 1,200 mcg/day over the subsequent year without relapse. It was concluded that suplatast tosilate and high-dose inhaled corticosteroid therapy may be an effective alternative therapeutic approach to chronic eosinophilic pneumonia in some cases.

Selective enhancement of production of IgE, IgG4, and Th2-cell cytokine during the rebound phenomenon in atopic dermatitis and prevention by suplatast tosilate

BACKGROUND

Atopic dermatitis is a chronic inflammatory skin disease, which is commonly treated with topical steroids. It is, however, associated with rebound after therapy has been discontinued.

OBJECTIVE

This study was designed to elucidate the mechanisms of the rebound phenomenon, and to test the effect of an oral anti-allergic medication, suplatast tosilate, on atopic dermatitis.

METHODS

This is a randomized, placebo controlled study. Patients with atopic dermatitis who had been treated with strong steroid ointment (dexamethasone valerate) for several years were divided into two groups. One group (the control group, n = 15) was treated with a non-steroid anti-inflammatory ointment (bufexamac ointment), while the other group (the suplatast tosilate group, n = 17) was treated with the anti-allergic medications, suplatast tosilate and bufexamac ointment. In each group, in vitro production of immunoglobulins and cytokines before and after 2 weeks of treatment was measured.

RESULTS

In the control group, 15 of the 15 patients experienced rebound and mean production of IgE, IgG4, IL-4, IL-5, IL-10, and IL-13 was enhanced after 2 weeks. In contrast, only 2 of the 17 patients in the suplatast tosilate group experienced rebound. There was no enhancement of production of immunoglobulins and cytokines after 2 weeks of treatment.

CONCLUSION

Enhanced production of the Th2-cell cytokines, which selectively induces IgE and IgG4 production, may be involved in the pathogenesis of the rebound phenomenon, and that suplatast tosilate may prevent the rebound phenomenon by down-regulating the production of these cytokines.

Suplatast tosilate affects the initial increase in specific IgE and interleukin-4 during immunotherapy for perennial allergic rhinitis

Suplatast tosilate can inhibit IL-4 production and suppress IgE synthesis in vitro. However, the theory that the agent causes changes in production of IL-4 and IgE in vivo has little experimental support. Immunotherapy could decrease the specific IgE response, but such a favourable effect is only possible with prolonged therapy after an initial increase in specific IgE. The use of suplatast tosilate together with immunotherapy may blunt the initial rise in specific IgE and decrease serum levels of specific IgE more quickly. Eighty-three adult patients with perennial allergic rhinitis due to Dermatophagoides farinae (D. farinae) were treated for 6 months with one of 3 treatments. Seventeen patients were treated with oral administration of 300 mg/day suplatast tosilate alone. Forty-six patients were treated with immunotherapy using standardized D. farinae alone. Twenty patients were treated with immunotherapy together with concurrent oral administration of 300 mg/day suplatast tosilate. Serum samples were collected 3 times from each patient, at enrollment, at 3 months and at 6 months after enrollment. Oral administration of suplatast tosilate for 3 and 6 months significantly decreased serum levels of IL-4 and specific IgE, and the rate of decrease in specific IgE correlated significantly with the rate of decrease in IL-4. The rates of decrease in IL-4 and specific IgE at 3 and 6 months were significantly greater in the patients treated with suplatast tosilate and immunotherapy than in those treated with immunotherapy alone. In conclusion, suplatast tosilate is able significantly to decrease serum levels of IL-4 and specific IgE, and the use of the drug together with immunotherapy can blunt the initial increase in specific IgE during the first 6 months of immunotherapy.

Kimura's disease associated with bronchial asthma presenting eosinophilia and hyperimmunoglobulinemia E which were attenuated by suplatast tosilate (IPD-1151T)

A 29-year-old man developed atopic bronchial asthma in association with eosinophilia and hyperimmunoglobulinemia E (hyper-IgE). A biopsy specimen from an inguinal lymph node showed changes consistent with Kimura's disease. IPD-1151T (suplatast tosilate), an anti-allergy drug, attenuated eosinophilia and hyper-IgE as well as the serum level of eosinophil cationic protein (ECP). The drug, however, did not affect the positivity for specific IgE antibodies against common allergens or the bronchial hyperresponsiveness to acetylcholine. Interleukin (IL)-2, IL-4, IL-5, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha were measured to be undetectable in serum before or during therapy. However, the expressions of mRNAs for IL-2, IL-4, IL-5, IFN-gamma, and TNF-alpha in peripheral blood T-lymphocytes and the expression of IL-5 mRNA in peripheral blood eosinophils were detected before and during therapy, which were unchanged by therapy with IPD-1151T. The present results suggest that different mechanisms other than the predominance of type 2 helper (T(H2))-like T-lymphocytes may underlie Kimura's disease and atopic bronchial asthma regarding the findings of eosinophilia and hyper-IgE, which could be modulated by IPD-1151T.

[Chronic eosinophilic pneumonia successfully treated with suplatast tosilate]

The patient was a 45-year-old woman in whom a chest X-ray film obtained on admission showed bilateral infiltrative shadows. A chest CT scan revealed areas of consolidation and ground-glass opacities. Examination of bronchoalveolar lavage fluid revealed many eosinophils, and specimens obtained by transbronchial lung biopsy showed thickened alveolar septa with infiltration of eosinophils. The numbers of eosinophils and the level of IgE in blood were low. The radiographic appearance improved after administration of suplatast tosilate. The level of interleukin 5 was high both in plasma and in bronchoalveolar lavage fluid before treatment, but the level of IL-5 in plasma was low after suplatast tosilate was given. Suplatast tosilate, which suppresses the production of cytokines, may be useful in patients with chronic eosinophilic pneumonia.

[Successful treatment of chronic eosinophilic pneumonia with suplatast tosilate]

The patient was a 59-year-old woman who complained of coughing, sputum production, and dyspnea. Abnormal moving shadows were found by chest radiography. There was prolonged eosinophilia in blood. Eosinophilia was also found in bronchoalveolar lavage fluid, and examination of a specimen obtained by transbronchial lung biopsy revealed eosinophil infiltration in alveolar septal walls, which led to a diagnosis of chronic eosinophilic pneumonia. Because of an attack of bronchial asthma and a high level of IL-5 in serum on admission, the patient was given suplatast tosilate. Symptoms were relieved, eosinophil counts in blood and in bronchoalveolar lavage fluid decreased, and the radiographic abnormality disappeared. The patient was not treated with steroids, and there has been no reccurrence to date, one year after discharge.

Sulphydryl-containing agents and the prevention of duodenal ulcer relapse

This prospective randomized double-blind controlled study investigated whether sulphydryl-containing agents protect against the recurrence of duodenal ulceration. To this end, DL-cysteine (200 mg 4 times daily) and DL-methionine-methyl sulphonium chloride (MMSC, 500 mg 4 times daily) were administered orally. Three hundred and six consecutive smokers with previous symptomatic endoscopy-proven duodenal ulceration which had been shown endoscopically to have healed were randomized to receive for 1 year either placebo, cimetidine 400 mg at bedtime, cysteine, or MMSC. In 221 patients evaluable for efficacy, the cumulative relapse rate at 1 year was: placebo 64%, cimetidine 30%, cysteine 11% and MMSC 12%. Cimetidine was significantly effective in preventing ulcer relapse (p < 0.01), however cysteine and MMSC were more effective in this respect (p < 0.05). In the patients who relapsed, ulcer recurrence tended to occur early on placebo but to be evenly distributed over the year on active therapy. In all the study groups, the relative frequency of symptomatic to silent relapse was similar in the first and second halves of the year and was comparable among these groups. These results show that sulphydryl-containing agents significantly reduce the recurrence rate of duodenal ulceration.