Three vials filled with human leukocyte interferon.
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Interferon gamma

Interferons (IFNs) are natural proteins produced by the cells of the immune systems of most animals in response to challenges by foreign agents such as viruses, bacteria, parasites and tumor cells. Interferons belong to the large class of glycoproteins known as cytokines. more...

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Types

In humans, there are 3 major classes of interferon (IFN):

  1. The human type I IFNs consists of 13 different alpha isoforms (subtypes with slightly different specificities) - IFNA(1,2,4,5,6,7,8,10,13,14,16,17,21), and single beta - IFNB1, omega - IFNW1, epsilon - IFNE1 and kappa - IFNK isoforms. Homologous molecules are found in many species, including rats and mice (and most mammals) and have been identified in birds, reptiles, amphibians and fish species. In addition to these IFNs, IFN zeta (limitin) in mice,IFN nu in cats, IFN tau in ruminants and IFN delta in pigs have been identified. All type I IFNs bind to a specific cell surface receptor complex known as IFNAR consisting of IFNAR1 and IFNAR2 chains.
  2. The type II IFNs consists of IFN gamma - IFNG, its sole member. The mature IFNG ligand is an anti-parallel homodimer, and it binds to the IFNG receptor (IFNGR) complex, which is made up of two of each IFNGR1 and IFNGR2 subunits.
  3. The recently discovered 3rd class consists of IFN-lambda with 3 different isoforms - IL29. IL28A, IL28B and signal through a receptor complex consisting of IL10R2 and IFNLR1.

While there are evidence to suggest other signaling mechanisms exist, the JAK-STAT signaling pathway is the best-characterised and commonly accepted IFN signaling pathway.

Principles

In a majority of cases, the production of interferons is induced in response to microbes such as viruses and bacteria and their products (viral glycoproteins, viral RNA, bacterial endotoxin, flagella, CpG DNA), as well as mitogens and other cytokines, for example interleukin-1, interleukin-2, interleukin-12, tumor-necrosis factor and colony-stimulating factor, that are synthesised in the response to the appearance of various antigens in the body. Their metabolism and excretion take place mainly in the liver and kidneys. They hardly pass the placenta and the blood-brain barrier.

Interferon-alpha and -beta are produced by many cell types, including T-cells and B-cells, macrophages, fibroblasts, endothelial cells, osteoblasts and others, and are an important component of the anti-viral response. They stimulate both macrophages and NK cells. Interferons -alpha and -beta are also active against tumors.

Interferon-gamma is involved in the regulation of the immune and inflammatory responses; in humans, there is only one type of interferon-gamma. It is produced in activated T-cells. Interferon-gamma has some anti-viral and anti-tumor effects, but these are generally weak; however, interferon-gamma potentiates the effects of interferon-alpha and interferon-beta. However, interferon-gamma must be released at the site of a tumor in very small doses; at this time, interferon-gamma is not very useful for treating cancer.

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Aerosolized interferon gamma: a novel approach to therapy in idiopathic pulmonary fibrosis?
From CHEST, 10/1/05 by Hooman Mobassery

PURPOSE: In controlled studies, subcutaneous injection of interferon gamma (IFN-[gamma]) has been shown to be ineffective in the treatment of idiopathic pulmonary fibrosis (IPF). One explanation for the lack of efficacy may be inadequate drug levels in the lung interstitium using subcutaneous dosing strategies. We have developed an aerosol of IFN-[gamma] designed to target the airways directly. We present the dose to the lung, local cytokine response, and clinical course in a 38 year old woman with biopsy proven usual interstitial pneumonia, treated with aerosolized IFN-[gamma].

METHODS: The patient received 400 [micro]g of aerosol IFN-[gamma] (two 200 [micro]g doses) three times per week. Pulmonary function test (PFT), exercise testing, and the University of California, San Diego shortness of breath questionnaire (SOBQ) were performed and completed prior to starting IFN-[gamma] therapy and at the end of three months. Subsequent PFTs were performed at the discretion of the patient's private pulmonologist. Bronchoalveolar lavage was assayed for transforming growth factor-beta (TGF-[beta]) prior to the start and at the end of three months. The pattern of deposition and dose to the lung parenchyma were measured by gamma camera.

RESULTS: Clinical responses included decreased dyspnea with improvement in her SOBQ measurement, stabilization of pulmonary function tests (improvement in DLCO/VA from 51% to 68% and stabilization of FEV1 and TLC) and improvement in objective parameters during exercise testing (increased maximal oxygen consumption). The dose to the lung parenchyma, as measured by gamma camera, was 54.4 [micro]g per treatment with a peripheral deposition pattern. With this regimen, bronchoalveolar lavage TGF-[beta], a key molecular mediator of matrix deposition, levels decreased.

CONCLUSION: This is the first report of aerosol treatment with IFN-[gamma] and measurement of lung deposition in a patient with IPF. This study illustrates the potential use of aerosolized IFN-[gamma] for the treatment of IPF by means of targeted therapy directly at the site of disease.

CLINICAL IMPLICATIONS: This is a novel approach in the treatment of IPF.

DISCLOSURE: Hooman Mobassery, Product/procedure/technique that is considered research and is NOT yet approved for any purpose. Interferone gamma is FDA approved but the delivery of this drug by aerosol is considered experimental.

Hooman Mobassery MD * Rany Condos MD Gerald C. Smaldone MD SUNY at Stony Brook University Hospital, Stony Brook, NY

COPYRIGHT 2005 American College of Chest Physicians
COPYRIGHT 2005 Gale Group

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