Gert van der Hoek
In Memoriam - Editor, Senior Moderator
On the Fly, German Doctors Find Treatment for Deadly E. coli Infections
by Kai Kupferschmidt on 27 May 2011
In the middle of the biggest outbreak of food poisoning caused by the bacterium enterohemorrhagic Escherichia coli (EHEC) that Germany has ever seen, a group of doctors may have found a way to treat the most severe cases. The finding appears today in The New England Journal of Medicine (NEJM).
At least four people have died in the outbreak, thought to have been caused by eating contaminated vegetables. To date, 276 patients have developed hemolytic uremic syndrome (HUS). The potentially fatal syndrome, characterized by a destruction of red blood cells and severe kidney problems caused by the bacteria’s toxin, is the most severe complication of an EHEC infection.
In the article, Franz Schaefer, a nephrologist at the Center for Pediatrics and Adolescent Medicine in Heidelberg, Germany, and other physicians describe how they successfully treated three EHEC-infected children suffering from HUS with a novel approach. They used the monoclonal antibody eculizumab, which has been on the market since 2007, to treat a rare blood disorder. Eculizumab inhibits a part of the human immune system called the complement system that usually destroys invading cells that have been tagged for destruction by other parts of the immune system.
The complement system has been implicated for some time in certain patients who develop HUS without any EHEC infection, known as atypical HUS patients, and eculizumab has been used successfully to treat them. Recent research suggests that the complement system might also be involved in the HUS cases caused by EHEC.
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Jens Nürnberger, nephrologist at a clinic in Schwerin is somewhat skeptical of the treatment. “There is no real evidence for this treatment," he says. “It might work or it might not." The cases described in Schaefer’s paper could also be spontaneous remissions, he cautions. "The other problem is that this drug is hugely expensive, costing at least €15000 per patient, and the health insurance is not going to pay for it.“
However, in cases in which no other option remains, doctors would be right to try the new drug anyway, Nürnberger says. “But we should really be defining groups of patients who will get the drug and groups who do not and make this into a kind of controlled study," he says. “Instead, a lot of people will be treated this way, some will get better, some will not. In the end, we will not have learned anything.“ But he, like everyone else, is still hoping that this will turn out to be the right treatment at the right time.
Science
by Kai Kupferschmidt on 27 May 2011
In the middle of the biggest outbreak of food poisoning caused by the bacterium enterohemorrhagic Escherichia coli (EHEC) that Germany has ever seen, a group of doctors may have found a way to treat the most severe cases. The finding appears today in The New England Journal of Medicine (NEJM).
At least four people have died in the outbreak, thought to have been caused by eating contaminated vegetables. To date, 276 patients have developed hemolytic uremic syndrome (HUS). The potentially fatal syndrome, characterized by a destruction of red blood cells and severe kidney problems caused by the bacteria’s toxin, is the most severe complication of an EHEC infection.
In the article, Franz Schaefer, a nephrologist at the Center for Pediatrics and Adolescent Medicine in Heidelberg, Germany, and other physicians describe how they successfully treated three EHEC-infected children suffering from HUS with a novel approach. They used the monoclonal antibody eculizumab, which has been on the market since 2007, to treat a rare blood disorder. Eculizumab inhibits a part of the human immune system called the complement system that usually destroys invading cells that have been tagged for destruction by other parts of the immune system.
The complement system has been implicated for some time in certain patients who develop HUS without any EHEC infection, known as atypical HUS patients, and eculizumab has been used successfully to treat them. Recent research suggests that the complement system might also be involved in the HUS cases caused by EHEC.
- snip-
Jens Nürnberger, nephrologist at a clinic in Schwerin is somewhat skeptical of the treatment. “There is no real evidence for this treatment," he says. “It might work or it might not." The cases described in Schaefer’s paper could also be spontaneous remissions, he cautions. "The other problem is that this drug is hugely expensive, costing at least €15000 per patient, and the health insurance is not going to pay for it.“
However, in cases in which no other option remains, doctors would be right to try the new drug anyway, Nürnberger says. “But we should really be defining groups of patients who will get the drug and groups who do not and make this into a kind of controlled study," he says. “Instead, a lot of people will be treated this way, some will get better, some will not. In the end, we will not have learned anything.“ But he, like everyone else, is still hoping that this will turn out to be the right treatment at the right time.
Science