Bermejo Martin Jesús Fco, Jimenez José L, Muńoz-Fernández Angeles
Inmunobiología Molecular, Hospital Gregorio Marańón, Madrid, Spain.
Med Sci Monit. 2003 Jun;9(6):SR29-34.
The recent outbreak of Severe Acute Respiratory Syndrome (SARS) as a new viral disease is causing a great concern for health authorities and general population. Very little is known about the infectious agent (a coronavirus) and its etiopathogeny, having no specific treatment yet. Proinflammatory cytokines released by stimulated macrophages in the alveoli could have a prominent role in pathogenesis of SARS. Current treatment of SARS with antiviral agents such as ribavirin and corticosteroids have not achieved very satisfactory results. Corticosteroids exert an antiinflammatory effect and are indicated for the treatment of respiratory distress, but, in the other hand, they exert an immunosuppressor effect on humoral and cellular arms of Immune System. Based on previous reports and on our own experience in HIV, we propose here pentoxifylline (PTX), a drug commonly used in vascular indications, as a possible treatment for SARS due to its interesting properties. PTX would feature a possible antiviral activity along with a well-known cytokine-modulating activity not as immunosuppressant as that of the corticoids, down-regulating proinflammatory cytokines but leaving functional the rest of the immune response. Other effects of PTX are discussed, as bronchodilation.
The antiinflammatory, antiviral, immunomodulatory and bronchodilatory effects of PTX, along with its low cost and toxicity, make it a promising drug to be considered for SARS treatment, alone or as an adjuvant therapy in combination with other drugs. The classical antiviral approach as single treatment for viral diseases should be reviewed in this occasion; immunomodulatory therapies could play an important role in SARS therapy.
近期爆发的严重急性呼吸综合征（SARS）作为一种新型病毒性疾病，引起了卫生当局和公众的极大关注。对于这种致病因子（一种冠状病毒）及其病因知之甚少，目前尚无特效治疗方法。肺泡中受刺激的巨噬细胞释放的促炎细胞因子可能在SARS发病机制中起重要作用。目前用利巴韦林等抗病毒药物和皮质类固醇治疗SARS并未取得非常满意的效果。皮质类固醇具有抗炎作用，可用于治疗呼吸窘迫，但另一方面，它们对免疫系统的体液和细胞分支具有免疫抑制作用。基于先前的报道以及我们在艾滋病方面的经验，我们在此提出己酮可可碱（PTX），一种常用于血管疾病的药物，因其具有有趣的特性，可能是治疗SARS的一种方法。PTX可能具有抗病毒活性以及众所周知的细胞因子调节活性，其免疫抑制作用不如皮质类固醇，可下调促炎细胞因子，同时使其余免疫反应保持功能正常。还讨论了PTX的其他作用，如支气管扩张作用。
PTX的抗炎、抗病毒、免疫调节和支气管扩张作用，以及其低成本和低毒性，使其成为一种有前景的药物，可单独或与其他药物联合作为辅助疗法用于SARS治疗。在这种情况下，应重新审视将经典抗病毒方法作为病毒性疾病单一治疗方法的做法；免疫调节疗法可能在SARS治疗中发挥重要作用。
