難治性喘息における ciclosporin の臨床効果とその免疫アレルギー学的研究

Activation of lymphocytes is thought to be an important mechanism in the allergic response in intractable asthma. To establish a new therapy using a selectively suppressive agent for T-Cells, small doses of ciclosporin (Cs) were administered to three patients with intractable asthma. The effects on the clinical courses and immunological parameters were examined. The results were as follows : (1) Clinical improvements were observed at doses above 4mg/kg/day. (2) The percentage of CD3(+) and CD4(+) lymphocyte in peripheral blood showed a tendency to reduce, and lymphocyte blastogenic responses and IL-2 production against specific antigens were suppressed to within or below the normal range. There was significan inverse correlation between whole blood Cs level and IL-2 production against specific antigens (Candida, and house dust)(γ=-0.95p<0.005, and γ=-0.99p<0.005, respectively). 3) Serum IgE level decreased markedly, but there was no significant change in serum levels of IgG, IgA, or IgM. Between the whole blood Cs level and serum IL-4 level, there was a significant inverse correlation (γ=-0.73p<0.05), but a relative correlation between serum IL-4 level and serum IgE level (γ=0.66) was noted. The effects disappeared after medication without Cs. These data indicate that lymphocytes may play an important role in the attack mechanism of intractable asthma and that Cs therapy is beneficial when temporarily administered for the disease, though the potential risks such as infection, nephrotoxicity, liver damage and carcinogensis remain problems in the treatment.

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