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Online Discussion: Tracking new emerging diseases and the next pandemic; Now tracking the Aussie Flu.

CYTOKINE STORM - IMMUNE SYSTEM

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    Posted: February 17 2006 at 5:56am

This thread will be for discussing issues related to the immune system and Cytokine Storm. 

There are many people that are trying to boost their immune systems, which is a big mistake.

We need to educate the public regarding this matter.  If anyone has any information pertaining to the "cytokine storm", please share it. 

 

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The Immune System and the 1918 Avian Flu Pandemic

 

During the 918 Avian Flu Pandemic the strongest immune systems suffered the highest mortality rates. November 2005 issue of Scientific American. http://www.sciam.com

Article excerpt:

"In contrast, the 1918 pandemic strain was most lethal to otherwise healthy young adults in their 20s and 30s, in part because their immune systems were so hardy. Researchers studying that virus have discovered that it suppresses early immune responses, such as the body's release of interferon, which normally primes cells to resist attack. At the same time, the virus provokes an extreme immune overreaction known as a cytokine storm, in which signaling molecules called cytokines summon a ferocious assault on the lungs by immune cells.”

 

Refering to a recnt study on the Avian flu (H5N1), Michael T Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota School of Public Health states "This study confirms earlier work that H5N1 induces a cytokine 'storm,'" said "It helps us understand the pathophysiology of the disease."

 

As a note: This affects those with a healthy immune system between the ages of 20 and 40.



Edited by KillerFlu.net
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Your own immune system actually kills you.   This virus is truly amazing...

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April,  do you have anything regarding experimental therapies used to prevent/cure the cytokine storm? 
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Yes, What a cytokines storm does to the body is essentially creates an absorbent amount of TNF alpha production, which results in the body having an over stimulated immune system. Cytokines are soluble hormone-like proteins that signal cell to cell. This situation causes the body to have a very negative anti-inflammatory reaction.

This is what Wikipedia states:

 Wikipedia defines a cytokine storm as “a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. When the immune system is fighting pathogens, cytokines signal immune cells such as T-cells and macrophages to travel to the site of infection. In addition, cytokines activate those cells, stimulating them to produce more cytokines. Normally this feedback loop is kept in check by the body. However, in some instances, the reaction becomes uncontrolled, and too many immune cells are activated in a single place. The precise reason for this is not entirely understood. Cytokine storms have potential to do damage to body tissues and organs. If a cytokine storm occurs in the lungs, for example, fluids and immune cells such as macrophages may accumulate and eventually block off the air passageways. It is theorized that cytokine storms were responsible for many of the deaths during the 1918 influenza pandemic, which killed a disproportionate number of young adults. In this case, a healthy immune system may have been a liability rather than an asset. A 2003 report in the Journal of Experimental Medicine demonstrates the possibility of preventing a cytokine storm. A few days after T-cells are activated, they produce a molecule called OX40. OX40 binds to receptors on T-cells, preventing them from dying and increasing cytokine production. A combined protein, OX40-immunoglobin (OX40-Ig), prevents OX40 from reaching the T-cell receptors, thus reducing the T-cell response. Experiments in mice have demonstrated that OX40-Ig can reduce the symptoms associated with an immune overreaction while allowing the immune system to fight off the virus successfully.

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A drug that can combat cytokines storm is prednisone, however many will not have the ability to receive this drug. So you may want to know that research from the University of Texas and the National Institute of Health, it was reported that the use of a lei gong teng preparation showed that the herb has anti-inflammatory and immunosuppressive effect comparable to prednisone. Lei gong teng (radix tripterygii wilfordii) is a native plant that grows in many parts of China and Burma. However, be aware that the entire tripterygium plant of which this herb is derived from is highly toxic. Any adverse reactions generally occur within two to three hours after ingestion of the herb. Early reaction is characterized by headache, dizziness, palpitation, fatigue, severe vomiting (sometimes with blood), chills, fever (up to 40º C), continuous abdominal pain, diarrhea (with dark watery stools), generalized aches and pain, tachycardia and irregular heart rhythms. Other help may come from Inosine which largely suppresses LPS-induced lung inflammation in vivo and reduced the toxicity of cytokines in lung cells in vitro. These data support the proposal that inosine might represent a useful adjunct in the therapy of acute respiratory distress syndrome (ARDS). According PRD Health “Supplemental inosine is contraindicated in those with a history of gouty arthritis with acute attacks. Pregnant women and nursing mothers should avoid supplemental inosine. Those with a history of hyperuricemia should be extremely cautious about use of inosine. Mild gastrointestinal symptoms, such as abdominal discomfort and nausea, have occasionally been reported. No reports of overdosage.” (Read: Effects of prednisone on the cellular responses and release of cytokines and mediators after segmental allergen challenge of asthmatic subjects) Another great aid would be: “Pneumotrophin PMG® which is a special combination formula that supplies nutrients from its principal ingredients of 120 mg of Bovine Lung PMG™ Extract, Calcium Lactate, And Magnesium Citrate. This natural remedy is used for: Pulmonary involvements, respiratory disorders, pulmonary stress, (pollution), pulmonary accidents, inhalation of irritating vapors, pneumonia, dry cough, smokers cough.” Read more here. Dr. Pavel Nyvlt, suggested the following products made by Standard Process.. Pneumotrophin PMG, Dessicated Adrenal, Calcium Lactate, Cataplex ACP... In my research I found that Cat's Claw was an effective antioxidant, but perhaps more importantly a remarkably potent inhibitor of TNFalpha production. The primary mechanism for cat's claw anti-inflammatory actions appears to be immunomodulation via suppression of TNFalpha synthesis. It has also been suggested that 95-percent standardized extract of Curcumin may help against a cytokines storm. This extract is the active anti-inflammatory agent found in the spice turmeric, which inhibits the activity of the 5-lipoxygenase and cyclooxygenase enzymes, blocking the synthesis of pro-inflammatory eicosanoids (PG-2, LTB-4). Suggested dosage (or equivalent): Take four 900-mg capsules once per day.

Author: Shoba G, Joy D, Joseph T, Majeed M, Rajendran R, Srinivas PS
Source: Planta Med. 1998; 64(4):353-356.

Abstract:

The medicinal properties of curcurnin obtained from Curcuma longa L. cannot be utilized because of poor bioavailability due to its rapid metabolism in the liver and intestinal wall. In this study, the effect of combining piperine, a known inhibitor of hepatic and intestinal glucuronidation, was evaluated on the bioavailability of curcumin in rats and healthy human volunteers. When curcumin was given alone, in the dose 2 g/kg to rats, moderate serum concentrations were achieved over a period of 4 h. Concomitant administration of piperine 20 mg/kg increased the serum concentration of curcumin for a short period of 1-2 h post drug. Time to maximum was significantly increased (P < 0.02) while elimination half life and clearance significantly decreased (P < 0.02), and the bioavailability was increased by 154%. On the other hand in humans after a dose of 2 g curcumin alone, serum levels were either undetectable or very low. Concomitant administration of piperine 20 mg produced much higher concentrations from 0.25 to 1 h post drug (P < 0.01 at 0.25 and 0.5 h; P < 0.001 at 1 h), the increase in bioavailability was 2000%. The study shows that in the dosages used, piperine enhances the serum concentration, extent of absorption and bioavailability of curcumin in both rats and humans with no adverse effects.  



Edited by KillerFlu.net
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I also found this that may help:

Corticosteroids

Corticosteroids like prednisone lower TNF, but they also lower resistance to many diseases. Corticosteroids are a prime weapon against the SARS virus (another disease where over-reaction of the immune system seems to do as much damage as the virus itself). The amount of corticosteroids administered is important. Following the recent SARS outbreak, many people in China were given excessive doses of corticosteroids and later developed serious complications.  There has been little discussion on the use of these steroids to blunt the cytokine storm seen in avian flu.

Anti-Viral Infectives: Neuraminidase Inhibitors
There has been much talk about Tamiflu and the possibility that it can curb the reproduction of the H5N1 virus.  Tamiflu works by inhibiting an enzyme called neuraminidase (aka sialidase).  This enzyme is used by many virus particles to attach to cells and invade them.  When a neuraminidase inhibitor like Tamiflu is administered, it can reduce the spread of Type A influenza in the population.  It can also shorten the duration and intensity of Type A influenza if administered in the first 48 hours after symptoms appear (it typically reduces a 5-7 day influenza episode by 1 to 2 days).

The strategic use of neuraminidase inhibitors can probably help keep a lid on small outbreaks of the virus.  But if a larger epidemic occurs, supplies will probably run short.  Viruses have demonstrated the ability to mutate and become resistant to Tamiflu, which could be a problem over time.

There are natural neuramidase inhibitors found in plants: the most widely studied is a compound called 5,7,4'-trihydroxy-8-methoxyflavone, which is found in the herb Scutellaria (commonly called scullcap or skullcap).  In a study on mice cells, bathing the cell cultures in Scutellaria tea inhibited both Type A (H3N2 type) and Type B (Ibaraki/2/85 type) influenza when the flavone was administered 18 hours before the virus challenge.  It was not effective when administered five minutes before the virus.  (
citation)

Many herbalists have suggested that only the Baikal variety of skullcap would be effective, but these  beliefs are not based on evidence.  Common scullcap (S. lateriflora) contains baicalin (40 mg/g) and baicalein (33 mg/g): 
PMID:14692724  Baicalin and baicalein inhibit the neuraminidase/sialidase enzymes: PMID:2717686

I generally use loose skullcap herb to make tea, although there are extracts and capsules available, like these from Nature's Way.

Other hydroxy-flavones are found in plants like Passiflora incarnata (passionflower herb - but not passionflower fruit, Passiflora edulis).   It is not clear whether these flavones also inhibit neuraminidases or influenza viruses  (or the H5N1 virus in particular).  However, both scutellaria and passionflower are also mild tranquilizers (the methoxy-flavone compounds also have a gentle GABAinergic effect and are used by herbalists for anxiety).  These teas have a long history of safe use (on par with chamomile and hibiscus), so it seems logical to first prepare for a possible avian flu epidemic, and stay home and consume relaxing herbs if the epidemic does arrive.

Emodin
A study to find herbal neuraminidase inhibitors discovered that Reynoutria elliptica extract was a strong inhibitor of that enzyme.  The research identified four compounds with significant neuraminidase inhibiting properties: emodin, two emodin derrivatives, and resveratrol.

Emodin and related compounds are also found in the Aloe vera plant. Unfortunately, emodin is an anthraquinone laxative; taking it orally has significant side effects. Emodin is a cathartic known to stimulate muscle contraction in the intestines, and a large dose can result in painful cramping. It is not clear how much is absorbed into the blood where it can fight a virus.  The studies done on the anti-viral properties of emodin were done in cells in a test tube, not in live animals. Many Aloe vera juices on the market are made using only the gel of the plant; they contain very little emodin. The outer part of an aloe leaf contains most of the emodin - it is in the milky sap portion close to the surface. 

The aloe vera juices on the market do contain polysaccharides like acemannan that stimulate the immune system to produce IL-1 and TNF, but those inflammatory cytokines are not in short supply in people infected by H5N1 avian flu. Most of the research conducted on acemannan have involved HIV/AIDS, or related animal viruses like feline leukemia virus.  It is not clear that aloe polysaccharides protect against influenza viruses in general, or the H5N1 virus in particular.

Resveratrol
Resveratrol is a compound found in large amounts in red wine, grape seeds, and Japanese knotweed. Resveratrol is known to be absorbed into the blood, and it is believed to be part of the "French Paradox" where many people in France eat a high fat diet, yet have low rates of heart disease. 

The root of Japanese knotweed (Polygonum multiflorum aka "He Sho Wu") is the richest known source of resveratrol. It has long been used in a variety of herbal medicines in China and Japan, where it is considered a tonic and life prolonging plant.  This plant has spread to many other countries and is naturalized in the US and parts of Europe.

The effects of alcohol on a person infected with avian flu raises obvious concerns - drinking red wine might help prevent an infection, but once an infection does occur, the alcoholic component of wine is probably not desirable. And resveratrol in wine is not stable: After opening a bottle of red wine, the resveratrol begins to oxidize and much of it is degraded within 24-48 hours. 

In addition to inhibiting neuraminidase, resveratrol also sends a message to cells to stop manufacturing viruses. This was described in terms of blocking the "nuclear-cytoplasmic translocation of viral ribonucleoproteins" and reducing the "expression of late viral proteins seemingly related to the inhibition of protein kinase C activity and its dependent pathway." 
PMID:15838800  This study found no toxic effects of resveratrol at levels that significantly inhibited influenza virus.

Resveratrol Supplements are relatively innexpensive, more stable than wine, and lack the alcohol content that might be harmful while fighting a serious infection.

Other Approaches

Cranberry NDM

Some research has shown that the high molecular weight components of cranberry juice can inhibit influenza viruses in a number of ways. This Non-Dialysable Material (NDM) seems to affect the influenza virus in a number of ways, blocking its adhesion to cells, making it less able to invade and multiply.
PMID:15781126

This research is exciting, but some caveats deserve consideration.  The study was done on isolated cells in a petri dish, not in living animals. It is not clear how much  (if any) of the cranberry NDM would be absorbed into the blood, or how long it would circulate in the blood before being metabolized or excreted. Most of the anti-bacterial research on cranberry juice has focused on low molecular weight compounds that block bacteria from adhering to cells in the urinary tract - these clearly are absorbed. Most of the research on the NDM material in cranberry juice focused on the mouth, where absorption was never an issue. 


 N-Acetyl-Cysteine

N-Acetyl-Cysteine (or NAC) is a particular activated form of the amino acid cysteine. It has been shown to reduce lethality of influenza A in a number of animal studies
PMID: 12657201,

NAC led to a modest reduction in the cytokine RANTES (18%), probably by reducing reactive oxygen species that were generated by the inflammatory cascade.
PMID:10706714  NAC also reduced macrophage death due to influenza infection. PMID: 9260892  It does not appear to directly inhibit TNF.

NAC is a hygroscopic material - it soaks up water from the air. Like aspirin, it can break down and release acetic acid, resulting in a vinegary smell. It should be stored in a cool, dry area in a well sealed container.

Elderberry / Sambucol
There is evidence that black elderberry extract (trade name: Sambucol) can reduce the risk of contracting ordinary influenza strains, or shorten the course of disease in those who contract the typical flu.  It does so by increasing the production of inflammatory cytokines like IL-1, IL-6, and TNF! (
citation)  While black elderberry extract be appropriate for ordinary Type A influenza, it could make avian flu more lethal.  Ordinary strains of flu do not trigger massive production of TNF, and ordinary flu viruses are generally susceptible to the action of TNF.  Avian flu, by contrast, does trigger massive production of TNF, while the virus is relatively resistant to the anti-viral effects of TNF.  If TNF is a significant cause of the illness and mortality in avian flu, anything that increases TNF would be undesirable.

It has been pointed out that black elderberry does not just increase TNF and other cytokines. It also may reduce the spread of the virus through inactivation, or exert anti-inflammatory effects as well as contributing to the cytokine storm.  It may be that combining elberberry with other anti-inflammatories may allow it to check the infection without producing tissue destroying levels of cytokines. But there is insufficient evidence to make a solid conclusion, while there are significant red flags that should be raised about the mode of action of elderberry.

Chocolate
Sorry. While most recent research on has suggested that chocolate has health benefits, the TNF stimulating effects of the cocoa flavonoids does not look like it would be healthy for people infected with avian flu virus.
PMID:12885154,PMID:10917928  The flavonoid compounds in chocolate can be compared to beads and short chains of beads; although the individual beads had a slight cooling effect on the immune system, the more numerous chains of 5 to 10 flavonoid groups dramatically increased the production of inflammatory cytokines. While the researchers suggested that this may be beneficial for stimulating circulation or fighting bacterial infection, I believe it may not be good for someone in a severe cytokine storm.

(Side note to migraine researchers: If migraine headaches are associated with elevated cytokines like IL-1, IL-6 and TNF, and cocoa flavonoids can dramatically elevate these cytokines, maybe there is a basis for claims that chocolate can trigger migraines. 
PMID: 15985111)

There are many other compounds that modulate the immune system and which may be of benefit in treating avian flu: a few include melatonin, garlic, green tea, and ginger.  This paper will be expanded to include discussion of these over the next weeks.

Conclusions
If the H5N1 avian flu was spreading in my community and my doctor offered me a pharmaceutical TNF blocker and a neuramidase inhibitor, I would take them.  But it is doubtful that everyone will have that choice if an epidemic does occur.  Although the pharmaceutical agents have not been well tested, and the potential herbal treatments I discussed are based on theory, I think that it is likely that they would reduce mortality ...  taking them would be better than doing nothing.  So I have a bottle of curcumin (which I occasionally take to keep my psoriasis in remission) and a container of scutellaria tea (which I sip at work to keep my nerves from frazzling when there are too many deadlines).  And I am ordering some resveratrol.

Further discussion of these topics at
www.med-owl.com/herbal-antivirals/

info found at: http://www.med-owl.com/health/H5N1-Virus-Therapy.html 



Edited by KillerFlu.net
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 17 2006 at 10:07am
Hope that this helps, I will gather more info and post later.
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I originally invested a lot of money into immune system boosters until I learned about this.  

I heard that statin drugs such as Lipitor (cholesterol medicine) may also be affective for preventing the cytokine storm.

Other natural experimental remedies are Curcumin and Inosine.  

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Originally posted by Albert Albert wrote:

I heard that statin drugs such as Lipitor (cholesterol medicine) may also be affective for preventing the cytokine storm.

You may be interested in knowing that many if not all of the cholesterol lowering drugs are derived and or work like a natural drug called RED YEAST RICE. (same or similar statins)

As a substance, red yeast rice extract has a number of heart-healthy benefits: It seems to help reduce total cholesterol levels, lower levels of LDL ("bad") cholesterol, increase levels of HDL ("good") cholesterol, and lower levels of unhealthy fats called triglycerides. It appears to accomplish this by restricting the liver's production of cholesterol. The compound responsible for this effect--mevinolin--is chemically identical to the cholesterol-lowering compound lovastatin, which is sold as the prescription drug Mevacor. Hence the action by the FDA. Mevinolin is also similar to the active ingredients in other cholesterol medications such as Zocor (simvastatin) and Lipitor (atorvastatin). Unsaturated fatty acids in red yeast rice extract are also believed to be beneficial, possibly by lowering triglycerides.



Edited by KillerFlu.net
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This is what a friend who is well known Doctor who wishes to remain anonymous wrote to me.


The problem seems to arise from the action of some immune cells also signal further immune system response. Hence, as more cytokines and other immune cells enter the lungs, they signal for further activity of the immune system, which creates something of an endless loop to the point at which the immune system is causing more harm than the initial triggering event, such as infection.


This tends to be a problem among those with the healthiest immune systems. If your immune system doesn’t function well enough with signalling and up-regulating, it can’t develop this type of response. Hence the very young and the elderly are less likely to face this problem. That is why 1918 saw a massive unproportionate death rate among 20-40 year olds. This is the group that generally has the strongest immune systems.

Generally, this entire process causes inflammation in the lungs. It’s really not much different that the inflammation you see when you cut yourself. The problem is that when you have this type of response in the lungs, they become so bogged down with fluid that the alveoli (the air sacs in the lungs) lose some of their capacity to bring in air to allow for the passage of oxygen into the capillaries. In essence, you drown very slowly. I don’t think it would be a pleasant way to go at all.


To give you an example, this is an excerpt from a letter written by a physician at Camp Devens (near Boston) in 1918. It was discovered among some other medical papers in a trunk in an attic in Detroit in 1959.


“These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I dont know. My total time is taken up hunting Rales, rales dry or moist, sibilant or crepitant or any other of the hundred things that one may find in the chest, they all mean but one thing here -Pneumonia-and that means in about all cases death.”

A cytokine storm is just one way to develop what is referred to as acute respiratory distress syndrome (ARDS). Even today with our high tech ICU care, the mortality rate from developing something like is around 40-60%. In 1918 is would have been very close to 100%. However, even though we have the technology today, we don’t have the capacity. Even if we did have enough ventilators, we wouldn’t have enough staff to run them and provide care if we had an event of the scale of 1918. I was just interviewed by a reporter from the NY Times this week about this issue.


The best bet is to avoid getting sick and having a cytokine storm develop. This makes me wonder if those with HIV, on chemotherapy, or on immunosuppressives for organ transplant may actually be provided with some protection. (Just a thought)

My notes: 

As a note the side effects of a Cytokine storm is what will kill you. The failing defense mechanism, particularly low levels of lung protomorphogen (determinant factor) which allows such drastic inflammation which leads to bleeding, clotting, DIC  etc..



Edited by KillerFlu.net
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 18 2006 at 1:37pm


The jury is still out on the use of immunostimulants on mature immune systems over 40-years of age. I would suggest for those under 40-years of age to avoid anything that would stimulate cytokines.

Personally I have enough Sambucol for my wife, as a first response to infection, I'm still evaluating the options for my son.
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I agree with you Rick!
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KillerFlu and Rick - Thanks for the excellent information.

I'd like to expand on it with the symptoms of Human H5N1.

High Fever (101+), Chills, Headache, Muscle Aches, Dizziness, Fatigue, Cough (severe), Sore Throat, Runny Nose, Ear Infection, Bloody Diarrhea. Nose Bleeds, Bloody Gums, Blood Tinted Sputum (copious), Chest Congestion, Difficulty Breathing, Pneumonia (viral and bacterial), Respiratory Failure, Multi-Organ Failure.

The fatality rate is currently 55% even with Intensive Care Unit treatment. The time from first symptom to death is 7-10 days. If the patient survives, they should be isolated from non-sick people for 2-3 weeks after symptoms disappear.

The patient should be treated as contageous and care-givers should use isolation techniques and wear appropritate protective clothing.

Also, Universal Precautions (avoiding bodily fluids) should be practiced. This will be difficult since the patient will be expelling fluids from every orifice.

Preppers should become familiar with the above since medical facilities will be over-capacity with patients and about 50% of the medical staff will be away sick or caring for family members.

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re: prednisone, that's good to know. you can get it if you tell your doc that you get a bad reaction to poison oak. i think i'll try that. i've gotten it before for that reason. just tell them you're going hiking.

and i found this piece of information, that's sort of related to the disussion:

Science News (print edition, April 23, 2005) has an interesting piece about work presented earlier this month at the Experimental Biology meeting in San Diego by Melinda Beck and her colleagues at University of North Carolina Chapel Hill. Noticing in a recent trial that heavy people didn't derived less protection from influenza vaccine, Beck and her colleagues fed 70 female mice a normal diet and 70 an especially fattening diet for 22 weeks. They then infected each group with influenza virus.

The disease was much milder in the mice fed a normal diet with mortality only 4%, but disease was severe in the obese mice with 40% mortality. Beck says the obese mice took longer to develop a cytokine response and their natural killer cells were only half as effective at eliminating infected cells.

http://effectmeasure.blogspot.com/2005/05/obesity-and-influe nza.html

so this might be a good time to go on that diet.

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Originally posted by marzantar marzantar wrote:



Beck says the obese mice took longer to develop a cytokine response and their natural killer cells were only half as effective at eliminating infected cells.

so this might be a good time to go on that diet.

The mortality rates in this study not withstanding - I think I'm going to double down on the Pizza!  Slow down those cytokines and manage my prep stress all in one hot pie (make that two!)

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Post Options Post Options   Thanks (0) Thanks(0)   Quote calendula Quote  Post ReplyReply Direct Link To This Post Posted: February 23 2006 at 2:40pm
what does this means that I should get fat?
I am not here to reason, I am here to create"
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Originally posted by calendula calendula wrote:

what does this means that I should get fat?

 

Well...it's kinda ambiguous...on the one hand, the mice that got fat died more, on the other hand, they didn't have a good cytokine response.  

The way I figure it, with the plain old flu, you need those cytokines or the flu might kill you...with the AF, you really want your body to respond just a little more slowly....so, uhm, yea....I'm gonna fatten myself like a goose...uh...pun intended. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Tansau Quote  Post ReplyReply Direct Link To This Post Posted: February 24 2006 at 1:28pm
Should H5N1 become the next pandemic strain, the resultant morbidity
and mortality could rival those of 1918, when more than half the deaths
occurred among largely healthy people between 18 and 40 years of age
and were caused by a virus-induced cytokine storm (see diagram) that led
to the acute respiratory distress syndrome (ARDS).4 The ARDS-related
morbidity and mortality in the pandemic of 1918 was on a different scale
from those of 1957 and 1968 — a fact that highlights the importance of
the virulence of the virus subtype or genotype. Clinical, epidemiologic,
and laboratory evidence suggests that a pandemic caused by the current
H5N1 strain would be more likely to mimic the 1918 pandemic than those
that occurred more recently.5 If we translate the rate of death associated
with the 1918 influenzavirus to that in the current population, there could
be 1.7 million deaths in the United States and 180 million to 360 million
deaths globally. We have an extremely limited armamentarium with which
to handle millions of cases of ARDS — one not much different from that
available to the front-line medical corps in 1918.
-- Michael T. Osterholm, Ph.D., M.P.H.
     Preparing for the Next Pandemic

http://content.nejm.org/cgi/content/full/352/18/1839




The key element in generating the storm is an uncontrolled exuberant
immune response to the virus, in which there is an outpouring of
proinflammatory cytokines and chemoattractants. An animated version of
this figure is available at www.nejm.org (http://content.nejm.org/cgi/
content/full/352/18/1839/DC2).
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