Eculizumab successfully treats E. coli-induced hemolytic-uremic syndrome
MedWire News: Physicians have successfully used the monoclonal antibody eculizumab to treat three young children who were suffering from severe hemolytic-uremic syndrome (HUS) after an infection with Shiga-toxin-producing Escherichia coli (STEC).
STEC (which may also be referred to as enterohemorrhagic E. coli [EHEC]) are the bacteria responsible for the current wave of gastrointestinal infections across Germany and the rest of Europe, and hemolytic-uremic syndrome (HUS), a thrombotic microangiopathy, is a secondary complication of this type of infection, the team explains.
In a letter to the NEJM, Franz Schaefer (Heidelberg University Hospital, Germany) and colleagues describe the successful treatment of three 3-year-old patients with severe HUS caused by STEC (STEC-HUS).
All three patients required dialysis, and developed progressive involvement of the central nervous system despite 5 consecutive days of plasma exchange.
"After several exchanges of blood plasma had no effect, we decided to attempt treatment with eculizumab," said Schaefer.
The team explains that eculizumab is a monoclonal antibody against the terminal complement protein C5, its use inhibits the formation of the terminal complement complex and has recently been reported as a treatment for atypical HUS.
Eculizumab was administered at 7-day intervals, twice in two patients and four times in the third patient. The neurologic status in all three patients improved dramatically within 24 hours after the first eculizumab infusion, Schaefer et al report.
Furthermore, renal function fully recovered in all three patients, and none had sequelae at 6 months after the illness.
"The rapid clinical response to eculizumab in all three children supports the concept that Shiga toxin may activate complement directly, providing a rationale for therapeutic complement blockade in STEC-HUS with severe complications," the authors write.
Schaefer remarked that he hopes the results will help patients affected by the current outbreak, adding that "because of the epidemic in Germany, the publishers of the New England Journal of Medicine decided to accelerate the publishing date of the article."
The article was also sent to all kidney specialists in Germany, and first treatments of adults and children in German hospitals have started.
In addition, the German Society of Nephrologists has issued guidelines that eculizumab may be given if all other standard treatments like dialysis and plasmapheresis have failed.
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By Laura Dean