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- Title
Bactericidal/Permeability-Increasing Protein (rBPI<sub>21</sub>) and Fluoroquinolone Mitigate Radiation-Induced Bone Marrow Aplasia and Death.
- Authors
Guinan, Eva C.; Barbon, Christine M.; Kalish, Leslie A.; Parmar, Kalindi; Kutok, Jeff; Mancuso, Christy J.; Stoler-Barak, Liat; Suter, Eugénie E.; Russell, Janice D.; Palmer, Christine D.; Gallington, Leighanne C.; Voskertchian, Annie; Vergilio, Jo-Anne; Cole, Geoffrey; Zhu, Kaya; D'Andrea, Alan; Soiffer, Robert; Weiss, Jerrold P.; Levy, Ofer
- Abstract
Identification of safe, effective treatments to mitigate toxicity after extensive radiation exposure has proven challenging. Only a limited number of candidate approaches have emerged, and the U.S. Food and Drug Administration has yet to approve any agent for a mass-casualty radiation disaster. Because patients undergoing hematopoietic stem cell transplantation undergo radiation treatment that produces toxicities similar to radiation-disaster exposure, we studied patients early after such treatment to identify new approaches to this problem. Patients rapidly developed endotoxemia and reduced plasma bactericidal/permeability-increasing protein (BPI), a potent endotoxinneutralizing protein, in association with neutropenia. We hypothesized that a treatment supplying similar endotoxinneutralizing activity might replace the BPI deficit and mitigate radiation toxicity and tested this idea in mice. A single 7-Gy radiation dose, which killed 95% of the mice by 30 days, was followed 24 hours later by twice-daily, subcutaneous injections of the recombinant BPI fragment rBPI21 or vehicle alone for 14 or 30 days, with or without an oral fluoroquinolone antibiotic with broad-spectrum antibacterial activity, including that against endotoxin-bearing Gramnegative bacteria. Compared to either fluoroquinolone alone or vehicle plus fluoroquinolone, the combined rBPI21 plus fluoroquinolone treatment improved survival, accelerated hematopoietic recovery, and promoted expansion of stem and progenitor cells. The observed efficacy of rBPI21 plus fluoroquinolone initiated 24 hours after lethal irradiation, combined with their established favorable bioactivity and safety profiles in critically ill humans, suggests the potential clinical use of this radiation mitigation strategy and supports its further evaluation.
- Publication
Science Translational Medicine, 2011, Vol 3, Issue 110, p1
- ISSN
1946-6234
- Publication type
Article
- DOI
10.1126/scitranslmed.3003126