Korean J Hematol 2011; 46(2):
Published online June 21, 2011
https://doi.org/10.5045/kjh.2011.46.2.139
© The Korean Society of Hematology
1Department of General Medicine, Hokkaido Social Insurance Hospital, Sapporo, Japan.
2Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Correspondence to : Correspondence to Masashi Ohe, M.D., Ph.D. Department of General Medicine, Hokkaido Social Insurance Hospital, 1-8-3-18 Nakanoshima, Toyohira-ku, Sapporo 062-8618, Japan. Tel: +81-11-831-5151, Fax: +81-11-821-3851, masshi@isis.ocn.ne.jp
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Macrolides have both immunomodulatory and antibacterial effects. We report 3 cases of primary immune thrombocytopenia (ITP) patients who were successfully treated with macrolides, irrespective of
Keywords Idiopathic thrombocytopenic purpura, Erythromycin, Macrolide
Macrolides have both immunomodulatory effects and antibacterial effects against organisms such as
An 88-year-old woman who had been suffering from ITP for several years was admitted for resection of a small tumor of the tongue. Platelet count remained at a level of around 20×109/L. Initial laboratory data showed reduced platelet counts (24×109/L). The patient was referred to our department for management of platelet count, which needed to be increased to about 50×109/L before tumor resection. Although a positive result was obtained for anti-
A 61-year-old man was referred with purpura, which had appeared several months before. Initial laboratory data showed a reduced platelet count (14×109/L), so he was admitted for further investigation. Anti-nuclear antibody was positive (titer 1:640, speckled). Testing for anti-dsDNA antibody, anti-SSA antibody, anti-RNP antibody, anti-Sm antibody, and anti-Topo I antibody all yielded negative results, as did testing for anti-
A 75-year-old woman suffering from ITP was admitted with a gradual decrease in platelet count. Prior to admission, platelet count had remained at a level of around 40×109/L. Laboratory data on admission showed reduced platelet counts (18×109/L). Anti-
In Case 1, CAM treatment appeared to be effective temporarily. Re-treatment with CAM proved ineffective. Although the platelet count remained at only about 31-44×109/L with EM treatment, including re-treatment, EM was considered more effective than CAM.
ITP is an autoimmune disease induced by autoantibodies against platelets. Recent studies have suggested that ITP patients infected with
In general, platelet count increases within 4 weeks of starting PSL treatment. Similarly, platelet count increases 3-5 days after starting methylprednisolone pulse therapy. Steroid therapy in Case 2 thus appeared largely ineffective.
As CAM treatment only maintained platelet count, CAM was not considered sufficiently effective in Case 2. However, EM was clearly effective, as could be seen by gradual improvements in platelet counts.
In Case 2, EM treatment was effective for an
In Case 3, CAM treatment appeared to be effective temporarily. The cause of the decrease in platelet count, despite CAM treatment, might suggest that CAM has side effects, as in Case 1.
The fact that EM treatment for a common cold increased the platelet count also suggests the effectiveness of EM for ITP.
In our previous report and in this report, the fact that platelet count increased following macrolide treatment suggests immunomodulatory effects of macrolides.
Immunomodulatory effects from macrolide antibiotics might be obtained by the eradication of bacteria or by modulation of the immune system involving the mucosa on which commensal bacteria reside [7]. Alternatively, these effects might be pharmacological functions of the macrolide itself, independent of antibiotic effects.
Apart from antibacterial effects, macrolides have effects on neutrophil function (decreased oxidant production, apoptosis) and on the production of cytokines involved in the inflammation cascade (decreased production of IL-1, IL-6, IL-8, and TNF and increased production of IL-10 and, possibly, IL-4) [1]. With regard to T lymphocytes, EM and its derivatives inhibit T lymphocyte proliferation and induce T lymphocyte apoptosis [2].
Apart from these immunomodulatory effects, macrolides have steroid-sparing effects via their influence on corticosteroid metabolism [8]. In Case 2, steroid-sparing effects might increase the platelet count.
EM was the first macrolide to be developed. New macrolides such as CAM and azithromycin have since been developed to supersede EM. CAM is a semisynthetic macrolide antibiotic, chemically identified as 6-0-methylerythromycin A [9]. A close analogy exists between CAM and EM. However, in the present report, although only 3 cases were studied, macrolides proved effective for ITP, as in our previous report, and EM was considered more effective than CAM.
As a slight structural change is thought to be advantageous to CAM in terms of antibacterial effects, similarly, a slight change may be advantageous to EM for providing immunomodulatory effects.
For the purpose of clarifying which macrolide is more effective, crossover tests between EM and CAM are needed in the future.
Korean J Hematol 2011; 46(2): 139-142
Published online June 21, 2011 https://doi.org/10.5045/kjh.2011.46.2.139
Copyright © The Korean Society of Hematology.
Masashi Ohe1*, and Satoshi Hashino2
1Department of General Medicine, Hokkaido Social Insurance Hospital, Sapporo, Japan.
2Department of Gastroenterology and Hematology, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Correspondence to: Correspondence to Masashi Ohe, M.D., Ph.D. Department of General Medicine, Hokkaido Social Insurance Hospital, 1-8-3-18 Nakanoshima, Toyohira-ku, Sapporo 062-8618, Japan. Tel: +81-11-831-5151, Fax: +81-11-821-3851, masshi@isis.ocn.ne.jp
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Macrolides have both immunomodulatory and antibacterial effects. We report 3 cases of primary immune thrombocytopenia (ITP) patients who were successfully treated with macrolides, irrespective of
Keywords: Idiopathic thrombocytopenic purpura, Erythromycin, Macrolide
Macrolides have both immunomodulatory effects and antibacterial effects against organisms such as
An 88-year-old woman who had been suffering from ITP for several years was admitted for resection of a small tumor of the tongue. Platelet count remained at a level of around 20×109/L. Initial laboratory data showed reduced platelet counts (24×109/L). The patient was referred to our department for management of platelet count, which needed to be increased to about 50×109/L before tumor resection. Although a positive result was obtained for anti-
A 61-year-old man was referred with purpura, which had appeared several months before. Initial laboratory data showed a reduced platelet count (14×109/L), so he was admitted for further investigation. Anti-nuclear antibody was positive (titer 1:640, speckled). Testing for anti-dsDNA antibody, anti-SSA antibody, anti-RNP antibody, anti-Sm antibody, and anti-Topo I antibody all yielded negative results, as did testing for anti-
A 75-year-old woman suffering from ITP was admitted with a gradual decrease in platelet count. Prior to admission, platelet count had remained at a level of around 40×109/L. Laboratory data on admission showed reduced platelet counts (18×109/L). Anti-
In Case 1, CAM treatment appeared to be effective temporarily. Re-treatment with CAM proved ineffective. Although the platelet count remained at only about 31-44×109/L with EM treatment, including re-treatment, EM was considered more effective than CAM.
ITP is an autoimmune disease induced by autoantibodies against platelets. Recent studies have suggested that ITP patients infected with
In general, platelet count increases within 4 weeks of starting PSL treatment. Similarly, platelet count increases 3-5 days after starting methylprednisolone pulse therapy. Steroid therapy in Case 2 thus appeared largely ineffective.
As CAM treatment only maintained platelet count, CAM was not considered sufficiently effective in Case 2. However, EM was clearly effective, as could be seen by gradual improvements in platelet counts.
In Case 2, EM treatment was effective for an
In Case 3, CAM treatment appeared to be effective temporarily. The cause of the decrease in platelet count, despite CAM treatment, might suggest that CAM has side effects, as in Case 1.
The fact that EM treatment for a common cold increased the platelet count also suggests the effectiveness of EM for ITP.
In our previous report and in this report, the fact that platelet count increased following macrolide treatment suggests immunomodulatory effects of macrolides.
Immunomodulatory effects from macrolide antibiotics might be obtained by the eradication of bacteria or by modulation of the immune system involving the mucosa on which commensal bacteria reside [7]. Alternatively, these effects might be pharmacological functions of the macrolide itself, independent of antibiotic effects.
Apart from antibacterial effects, macrolides have effects on neutrophil function (decreased oxidant production, apoptosis) and on the production of cytokines involved in the inflammation cascade (decreased production of IL-1, IL-6, IL-8, and TNF and increased production of IL-10 and, possibly, IL-4) [1]. With regard to T lymphocytes, EM and its derivatives inhibit T lymphocyte proliferation and induce T lymphocyte apoptosis [2].
Apart from these immunomodulatory effects, macrolides have steroid-sparing effects via their influence on corticosteroid metabolism [8]. In Case 2, steroid-sparing effects might increase the platelet count.
EM was the first macrolide to be developed. New macrolides such as CAM and azithromycin have since been developed to supersede EM. CAM is a semisynthetic macrolide antibiotic, chemically identified as 6-0-methylerythromycin A [9]. A close analogy exists between CAM and EM. However, in the present report, although only 3 cases were studied, macrolides proved effective for ITP, as in our previous report, and EM was considered more effective than CAM.
As a slight structural change is thought to be advantageous to CAM in terms of antibacterial effects, similarly, a slight change may be advantageous to EM for providing immunomodulatory effects.
For the purpose of clarifying which macrolide is more effective, crossover tests between EM and CAM are needed in the future.
Change of platelet counts following clarithromycin (CAM) and erythromycin (EM) treatments.
Change of platelet counts following prednisolone (PSL), methylprednisolone (mPSL), CAM, and EM treatments.
Change of platelet counts following CAM and EM treatments.
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Change of platelet counts following clarithromycin (CAM) and erythromycin (EM) treatments.
|@|~(^,^)~|@|Change of platelet counts following prednisolone (PSL), methylprednisolone (mPSL), CAM, and EM treatments.
|@|~(^,^)~|@|Change of platelet counts following CAM and EM treatments.