Resolution of a steroid-resistant, hypereosinophilic immune diathesis with mepolizumab and concomitant amelioration of a mixed thrombotic microangiopathy

Magro, Cynthia M.; Chadburn, Amy

doi:10.1016/j.bcmd.2017.04.008

Cited by 3 publications

(2 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Mepolizumab improved disease course in a patient with atypical hemolytic uremic syndrome (aHUS), who responded poorly to eculizumab (anti-C5a) alone ( 92 ). Monthly mepolizumab injections were initiated because of associated blood and tissue (colon) eosinophilia, resulting in normalization of eosinophil and platelet counts, increased ADAMTS13 activity, and regression of digestive and neurological manifestations.…”

Section: Anti-il-5 Treatment In Other Inflammatory Disorders Associatmentioning

confidence: 99%

Targeting the Interleukin-5 Pathway for Treatment of Eosinophilic Conditions Other than Asthma

2018

View full text Add to dashboard Cite

Improved understanding of the contribution of eosinophils to various chronic inflammatory conditions, most notably allergic asthma, has encouraged development of monoclonal antibodies specifically targeting mediators and surface receptors involved in eosinophil expansion and activation. The pivotal role of interleukin-5 (IL-5) in eosinophil biology, its high specificity for this leukocyte subset, and its involvement in the majority of eosinophilic conditions make it a very enticing target for treatment of eosinophil-mediated disorders. Two types of antibodies have been developed to target eosinophils: antibodies against IL-5 (mepolizumab and reslizumab), and an antibody against the IL-5-receptor-alpha-chain (IL-5Rα) (benralizumab). Both types of antibodies prevent IL-5 from engaging its receptor and in addition, anti-IL-5Rα antibodies induce target-cell lysis. They have been shown to reduce circulating eosinophil counts rapidly in humans with various disorders. Herein, a brief overview of the role of IL-5 in eosinophil biology will be presented, followed by a description of the development and characteristics of antibodies targeting IL-5 or its receptor. Results of clinical trials evaluating the efficacy and safety of these new antibodies in diseases (other than eosinophilic asthma) with prominent tissue eosinophilia are reviewed, followed by safety considerations and potential future applications.

show abstract

Section: Anti-il-5 Treatment In Other Inflammatory Disorders Associatmentioning

confidence: 99%

Targeting the Interleukin-5 Pathway for Treatment of Eosinophilic Conditions Other than Asthma

2018

View full text Add to dashboard Cite

show abstract

“…Low evidence exists for an association of PBE and thrombotic microangiopathies (TMA). Eight reported cases of TMA with PBE were diagnosed as HES [17,102,103,104,105,106]. Recently, one case of atypical HUS with AIN and PBE was reported and the first two case reports of concomitant atypical HUS and EGPA were published [107,108].…”

Section: Eosinophilia In Kidney Diseasementioning

confidence: 99%

Eosinophilia and Kidney Disease: More than Just an Incidental Finding?

Gauckler

Smıth

Mayer

et al. 2018

JCM

View full text Add to dashboard Cite

Peripheral blood eosinophilia (PBE), defined as 500 eosinophils or above per microliter (µL) blood, is a condition that is not uncommon but often neglected in the management of patients with chronic kidney disease (CKD), acute kidney injury (AKI), or patients on renal replacement therapy (RRT). The nature of PBE in the context of kidney diseases is predominantly secondary or reactive and has to be distinguished from primary eosinophilic disorders. Nonetheless, the finding of persistent PBE can be a useful clue for the differential diagnosis of underdiagnosed entities and overlapping syndromes, such as eosinophilic granulomatosis with polyangiitis (EGPA), IgG4-related disease (IgG4-RD), acute interstitial nephritis (AIN), or the hypereosinophilic syndrome (HES). For patients on RRT, PBE may be an indicator for bio-incompatibility of the dialysis material, acute allograft rejection, or Strongyloides hyperinfection. In a subset of patients with EGPA, eosinophils might even be the driving force in disease pathogenesis. This improved understanding is already being used to facilitate novel therapeutic options. Mepolizumab has been licensed for the management of EGPA and is applied with the aim to abrogate the underlying immunologic process by blocking interleukin-5. The current article provides an overview of different renal pathologies that are associated with PBE. Further scientific effort is required to understand the exact role and function of eosinophils in these disorders which may pave the way to improved interdisciplinary management of such patients.

show abstract

A Tale of Recurrent Strokes due to Hypereosinophilic Syndrome

Raut¹,

Baheti²,

Raut³

et al. 2017

Med Clin Rev

View full text Add to dashboard Cite

Recurrent strokes are a huge cause for concern as with each stroke there is further accumulation of disability. There are various vascular risk factors responsible for recurrent stroke. However patients without any traditional risk factor or recurrence of stroke despite of best medical management should be screened for rare but important causes for stroke recurrence, once such cause being hypereosiniophilia. Although rare, Hypereosinophilic syndrome (HES) can cause recurrent ischemic stroke. Underlying pathogenesis of hypereosinophilic syndrome could be heterogeneous but cardioembolism is the most common etiology for stroke. Also there is eosinophilia mediated cytotoxicity and release of proinflammatory cytokines contributing to tissue damage and multiple organ involvement and recurrent stroke. Here the authors describe a case of a middle aged gentleman presenting with recurrent strokes over a period of 3 years. He had other risk factors like dyslipidemia and despite of dual antiplatelet therapy and statins he continued to get recurrent strokes with increasing severity. Extensive laboratory workup ruled out other etiologies for the strokes and the only possible causative factor which could be identified was hypereosinophilia. Work up for hypereosiniophilia was negative. After starting steroids and normalisation of eosinophil count, there was no further recurrence of stroke.

show abstract

Resolution of a steroid-resistant, hypereosinophilic immune diathesis with mepolizumab and concomitant amelioration of a mixed thrombotic microangiopathy

Cited by 3 publications

References 41 publications

Targeting the Interleukin-5 Pathway for Treatment of Eosinophilic Conditions Other than Asthma

Targeting the Interleukin-5 Pathway for Treatment of Eosinophilic Conditions Other than Asthma

Eosinophilia and Kidney Disease: More than Just an Incidental Finding?

A Tale of Recurrent Strokes due to Hypereosinophilic Syndrome

Contact Info

Product

Resources

About