Pyrimethamine treatment does not ameliorate lymphoproliferation or autoimmune disease in MRL/Ipr-/- mice or in patients with autoimmune lymphoproliferative syndrome

V. Koneti Rao, Kennichi C. Dowdell, Janet K. Dale, Faith Dugan, Lesley Pesnicak, Lilia L. Bi, Victoria Hoffmann, Scott Penzak, Nilo A. Avila, Thomas A. Fleisher, Jennifer M. Puck, Stephen E. Straus

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15 Scopus citations

Abstract

Autoimmune lymphoproliferative syndrome (ALPS) is an inherited disorder of lymphocyte apoptosis leading to childhood onset of marked lymphadenopathy, hepatosplenomegaly, autoimmune cytopenias, and increased risk of lymphoma. Most cases are associated with heterozygous mutations in the gene encoding Fas protein. Prolonged use of immunosuppressive drugs that do ameliorate its autoimmune complications fail to consistently lessen lymphoproliferation in ALPS. A case series had described children with ALPS, whose spleens (SPL) and lymph nodes decreased in size when treated weekly with pyrimethamine and sulfadoxine; parallel in vitro studies showed only pyrimethamine to promote apoptosis. On the basis of that experience, we undertook additional in vitro lymphocyte apoptosis assays, and measured SPL weights, lymphocyte numbers, and immunophenotypes in Fas-deficient MRL/lpr-/- mice to gain further insights into the utility of combined pyrimethamine/sulfadoxine or pyrimethamine alone. Moreover, seven children with ALPS enrolled in a study of escalating dose of pyrimethamine alone given twice weekly for 12 weeks to determine if their lymphadenopathy and/or splenomegaly would diminish, as assessed by standardized computerized tomography. Neither pyrimethamine alone or with sulfadoxine in the MRL/lpr-/- mice, nor pyrimethamine alone in ALPS patients proved efficacious. We conclude that these drugs do not warrant further use empirically or as part of clinical trials in ALPS Type Ia as a lympholytic agent.

Original languageEnglish
Pages (from-to)1049-1055
Number of pages7
JournalAmerican Journal of Hematology
Volume82
Issue number12
DOIs
StatePublished - Dec 2007

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    Rao, V. K., Dowdell, K. C., Dale, J. K., Dugan, F., Pesnicak, L., Bi, L. L., Hoffmann, V., Penzak, S., Avila, N. A., Fleisher, T. A., Puck, J. M., & Straus, S. E. (2007). Pyrimethamine treatment does not ameliorate lymphoproliferation or autoimmune disease in MRL/Ipr-/- mice or in patients with autoimmune lymphoproliferative syndrome. American Journal of Hematology, 82(12), 1049-1055. https://doi.org/10.1002/ajh.21007