As toll mounts, researchers peer into the H1N1 death spiral

[indigo girl]

http://www.theglobeandmail.com/news/national/as-toll-mounts-researchers-peer-into-the-h1n1-death-spiral/article1381119/

Canadian article explaining "the cytokine storm" phenomenom.

So far, 309 people have died across Canada since the pandemic began in the spring, and roughly one-third had no underlying health conditions.

The lungs were heavy, difficult to deflate, and beefy looking. To the pathologist who held them, they belied their own anatomy, resembling a liver.

They belonged to an Ontarian who, until contracting H1N1, had been healthy and in early middle age. Within days, the person was dead, being dissected at Toronto's University Health Network. Pathologists concurred on the likely mechanism of death - an immune system reaction, most common among the young and people in their prime, called a cytokine storm. "Once the inflammatory cascade gets established, it's like a runaway freight train - it's just going to keep going," said pathologist David Hwang, who consulted on the samples. "In some of these patients, even if you clear the virus, the cytokine storm has already taken hold and it takes on a life of its own."

(hat tip pfi/homebody)

[morte, LPN, LVN]

http://www.jleukbio.org/cgi/reprint/81/3/599.pdf

http://bja.oxfordjournals.org/cgi/content/abstract/aep037v1

i cant seem to find the one i found months ago, when someone posted a question about reverse immune cascade....but there is much interesting

also, any of these patients smokers who quit when they got sick? does this cause a rebound effect? any of them on AD stop taking them when they got sick, same question.....

[CuriousMe]

http://www.jleukbio.org/cgi/reprint/81/3/599.pdf

http://bja.oxfordjournals.org/cgi/content/abstract/aep037v1

i cant seem to find the one i found months ago, when someone posted a question about reverse immune cascade....but there is much interesting

also, any of these patients smokers who quit when they got sick? does this cause a rebound effect? any of them on AD stop taking them when they got sick, same question.....

Pardon my ignorance....what's AD?

[indigo girl]

A Cautionary Tale about Cytokine Storm

http://scienceblogs.com/effectmeasure/2006/10/a_cautionary_tale_about_cytoki.php

This commentary was written with bird flu in mind in October of 2006.

The pandemic was a long expected event. The surprise was that it was the less virulent, but more transmissible swine flu virus in the starring role. And, the predicted cytokine storm phenomenom has been occurring with severe cases.

The Reveres over at Effect Measure graphically depict the cytokine storm in this example of an experiment that turned deadly.

Here's a cautionary tale. Many readers know that H5N1 infection is capable of causing a sudden over activity of the immune system, manifested in a so-called cytokine storm. Over active immune systems have been implicated in many other diseases, as well, although the type of "over activity" isn't the same. Autoimmune diseases, like rheumatoid arthritis or lupus erythematosus are caused by the body making antibodies to its own tissues. As in cytokine storm, an immune system that normally functions to protect us, makes us sick. To damp down the inappropriate activity, drugs like steroids are used to modulate the immune reaction. Steroids have also been used to treat cytokine storm, to varying but usually modest or no success. Still, many readers here equate "over active immune system" with cytokine storm. It is a dangerous way to think.

[morte, LPN, LVN]

Pardon my ignorance....what's AD?

antidepressants...since serotonin was mentioned in at least one of the citations

[oramar]

Kind of off topic here, you know I recently read an article about medical risk. The author seemed to think that a 1/10,000 chance of dying from H1N1 wasn't that bad. He excluded children and was talking about HEALTHY people between the ages of 18 and 49 with no risk factor. I couldn't help but think that in actually number that is a lot of dead healthy young people. I guess that is about the same as the chances of a healthy young adult getting killed in an accident. That happens way to often.

[lamazeteacher]

The following quotes seem unnecesarily pessimistic, since they arise from educated conjecture, not verifiable studies. Imaginative guesses take on their own lives, becoming facts if not identified as such.

Studies on at least 500 patients need to be done, that include antigen and antibody levels at similar points of treatment/identified time increments in illness with H1N1; and effects of gamma globulin administration on the above. This should be done in an approved format with the double blind method.

From: http://www.theglobeandmail.com

"...........even if you clear the virus, the cytokine storm has already taken hold and it takes on a life of its own.”

From Science Blog:

"................ As in cytokine storm, an immune system that normally functions to protect us, makes us sick. To damp down the inappropriate activity, drugs like steroids are used to modulate the immune reaction. Steroids have also been used to treat cytokine storm, to varying but usually modest or no success."

[indigo girl]

St. Paul, Minnesota

http://www.startribune.com/lifestyle/health/virus/78612267.html?elr=KArksLckD8EQDUoaEyqyP4O%3ADW3ckUiD3aPc%3A_Yyc%3AaULPQL7PQLanchO7DiUss

He survived despite cytokine storm possibly because they had access to the new drug, Peramivir.

...in some people with H1N1 the immune system overreacts. It sends out millions of cells called cytokines, which normally coordinate the body's defense against invaders. Only in ARDS, the immune system creates what experts call a cytokine storm -- a massive inflammation that floods the lungs with proteins, blood and fluids.

"You wait. You wait for the lungs to heal themselves," he said. The bed, called a RotoProne, is used in extreme cases. The rotation of the bed moves the fluid around in the lungs, increasing oxygen in the body and allowing the lung tissue to heal.

Weeks later Wirtz got the final test results on Brad Lange - he did have H1N1. It's impossible to know for sure whether the Peramivir made a difference at that point in his illness. But suppressing the virus, in theory, would stop the cascading immune response that flooded his lungs, Wirtz said.

(hat tip pfi/pixie)

[lamazeteacher]

Was Peramivir not mentioned in the article, as there would be resultant clamor for it, limiting its supply?

In an earlier post, the newsletter of Byron J. Richard's "Wellness Resources" had the following statement regarding that drug:

"Like Tamiflu and Relenza, Peramivir is a neuraminidase inhibitor. Neuraminidase (the N part of H1N1) is a viral protein that must be active in order for new viruses to emerge from a virally infected cell. If it can be blocked, then viral spreading can be reduced."

It went on to say that the FDA approved its use in H1N1 flu cases, if all other treatments were unsuccessful.

[indigo girl]

http://www.thestreet.com/story/10622376/1/biocryst-ships-flu-drug-to-us-government-biobuzz.html?cm_ven=GOOGLEN

BioCryst Pharmaceuticals(BCRX Quote) said Thursday that it shipped 10,000 courses of its intravenous H1N1 flu drug peramivir , valued at $22.5 million, to the U.S. government.

The number of peramivir courses ordered initially by the U.S. Department of Health and Human Services is lower than the maximum 40,000 courses conceived under the agency's original request submitted to the company in late September.

But the $2,250-per-course price that the U.S. government is paying to stockpile peramivir is on the high end, if not higher, than expectations.

The peramivir shipped Wednesday enters the government stockpile and will be distributed by the Centers for Disease Control and Prevention to doctors on a per-patient basis when need to treat seriously ill, hospitalized patients stricken with the H1N1 flu virus.

(hat tip pfi/monotreme)