Saturday, April 25, 2009

Cytokine storm and the H1N1 swine flu virus

At a time when the flu season should be winding down in North America and Mexico, scary reports are emerging from our Southern neighbor of a new swine flu variant whose victims are primarily young. Not only does this influenza A strain appear to be a previously unknown combination of bird, swine, and human genetic material, but the course of fatal illness caused by this bad actor seems to be marked by a 'cytokine storm' that leads to grave lung damage in those affected.

Well shoot, who wants to be in the eye of a cytokine storm? Cytokines are worthy molecules that various body immune cells make in response to an infectious invasion. This is generally a good thing insofar as these various chemicals amplify the body's attack on unwanted intruders. As is true of so many physiological functions, however, a little is good but a lot is destructive.

At the heart of the stormy matter are macrophages ('first responder' white cells activated by damaged cells or foreign invaders such as bacteria or viruses) and CD8+T-lymphocytes (circulating white cells that leap into killer mode the moment they get a whiff of flu viral proteins nearby). These white knights in cell membrane clothing produce a whole host of cytokines--including Tumor Necrosis Factor (TNF)-alpha, Interferon (IFN)-gamma, IFN-alpha/beta, Interleukin (IL)-6, IL-1, MIP-1 (Macrophage Inflammatory Protein), MIG (Monokine Induced by IFN-gamma), IP-10 (Interferon-gamma-Inducible Protein), and MCP-1 (Monocyte Chemoattractant Protein) to name a few. H5N1 influenza (bird flu) happens to be a particularly strong inducer of this cytokine over-production due to the virulence and enthusiasm with which it enters human tissues. Whether or not swine flu and this newest swine version causes this kind of cytokine mess is still not known.

So the human lung and too many cytokines is way too much of a good thing, causing swelling, hemorrhage, and tissue death which are, ironically, more a result of the body's defense mode than a primary flu-generated injury. Scientists theorize that young people may have a more robust cytokine response and less H1N1 immunity from previous exposure compared with older populations.

As of today, 8 cases have been reported in the US from California and Mexico that have been identified as the swinish H1N1 flu but mild and self-limited illnesses in those affected. Remember, increasing evidence suggests that robust body levels of vitamin D are flu-protective, so this might be a good time to get your blood tested for vitamin D and step up your supplements under advisement with your physician.

For up-dated information on the H1N1 flu, see Triple Reassortment Swine Influenza, H1N1 flu shots, Why should I get a flu shot?, and What's a Phase 6 Pandemic?


Anonymous said...

Does elderberry increase the chances of a cytokine storm?

denverdoc said...

Interesting question Anon. Elderberry is purported to have antiviral properties, specifically anti-influenza protection in deactivating the ability of the virus to penetrate cells. Per an article in the European Cytokine Network(1), this herb also is a potent stimulator of inflammatory cytokines which, as I've noted, can be a good thing while too much can be a bad thing. I am unfamiliar with the net effect of elderberry in the face of an overwhelming--read storm-producing--case of the flu. I'll send an e-mail to the article's author to see if he has an opinion which I will post here if he responds.
(1)Barak V et al. The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines.
European Cytokine Network. Volume 12, Number 2, 290-6, June 2001.

Anonymous said...

Is it an outbreak now in mexico?
ask a nurse

Anonymous said...

I too would like to know about Sambucol's (elder berry) effect on creating a worse "storm". Thanks!

Anonymous said...

what size particulate is the avian flu virus, and swine flu virus for effective masks wear?

Anonymous said...

According to my research including the european cytokine network, the elderberry DOES increase the cytokine storm, echinecia does NOT.... so I will be interested in hearing what the author say about it..
According to one of the top herbalists in the world , dr. subhuti Dharmananda, people should stick with western medicine if they have concerns about the herbs, and his most logical guess is that the herbal protocol he knows of , the cytokine response would be mild.....that no one has spent the money necessary to study this properly...
Also, that curcumin and piperine, revesterol, skull cap and passion flower are used to reduce cytokines, and the seven forests products, Ilex 15, Isatis, Bidens, Forsythia18,anemarhenna, and others have proven effective against viral /bacterial infections and their prevention... this is reported by most practioners of TCM traditional chinese medicine....
Alcohol and bleach , external protection...
I am using the n95 mask as i was told that would be effective against all this... dont know, because i have heard otherwise, also...

素人 said...

You'd think that they would have identified whether or not H1N1 produces a cytokine storm or not by now but perhaps the problem is that any flu increase cytokines, and the question as to when a storm is a storm is rather vague. One of the experimental blockers of cytokines (I can't remember which pathway) touted itself as a cure for seasonal flu, presumably because it could "calm the [mini] storm" produced by seasonal flu.

It is strange that young people should be dying of H1N1. Mexico has about the same incidence and fatality of seasonal flu as the USA (about 10% get it, 1% of those die). It is not as if Mexico is so backward that young people die of the flu there and only there.

Someone suggested on the net, that the dose of the flu was critical. If one got a small amount of flue virus then one would react in a controlled way. If one was in a crowded train and some one ceased in your face then the storm might brew. And Mexico City is a particulaly crowded place.

Or another suggestion might be that it takes time to brew the storm. Apparntly the only people to die in Mexico were those that self-medicated and did not go to hospitals. Perhaps hence, H1N1 does produce a storm, but only very slowly, and only those that ignore it get it badly. And Mexico city is a fairly poor place, where people might want to avoid purchase of Tamiflu.

Anonymous said...

Is there any more evidence now that suggests that Black elderberry is bad to take as a daily regimen to prvent the swine flu? It is very contradicting on the web some people seem to be a fan as others warn against it, and if elderberry is not good, can you suggest something that is?


Hello doctor.
I'm a 19 years old normal University students in Malaysia and I'm scare of this H1N1 disease.
I have several questions to ask and please forgive me if I asked stupid questions.

1. Is H1N1 can kill a people ? I heard some secondary resources said that it can but yet some people said secondary resources such as newspaper wrote it just for making profit. So it's true that H1N1 can kill people ?

2.Many peoples also having the symptoms of H1N1 but not all , isn't need to having all the symptoms which are fever,flu,headache,body tiredness,cough,sore throat only can said it's H1N1 affected?
Because I'm having some of the symptoms but not all .


3.How long does H1N1 can kill a person after the people are affected ? If H1N1 do can kill .

denverdoc said...

Dear Said,

Yes, the H1N1 flu can kill people just like regular flu. So far, it doesn't seem any worse than the regular flu but it is worrisome that more young people than old people have died as a result of this disease.

Just like any flu, some people get terribly ill with H1N1 and others have such a mild disease (and fewer symptoms) that they don't even think to visit the doctor.

I am hopeful that a good vaccine will be available soon. More on that in future blog posts.

Sujan Patricia said...

People with regular exposure to pigs are at increased risk of swine flu. More than 1100 people worldwide have died from swine flu since it emerged in Mexico and the US in April, according to the latest figures from the World.

Government whistleblower said...
This comment has been removed by a blog administrator.
Michal said...

Hi, I was wondering if you had any follow up about whether it is good or bad to take elderberry in the case of suspected h1n1 infection?

I only ask because I thought that one of the reasons cited for the efficacy of elderberry is that the flavonoids stimulate the immune system by enhancing production of cytokines.

Given that, at least according to local media, there is concern that h1n1 might be associated with a "cytokine storm," where does this leave the verdict on the use of elderberry?

Anonymous said...

I have NOTHING to do with the medical profession. But here are my two cents.

I decided that the classic cytokine storm seen in the Spanish Flu was not appropriate to the current swine flu.
In the Spanish flu people in their twenties, and these those that had survived the trenches, with the very best immune systems died like flies.
This is not the case in the current epidemic.

I have a good immune response and it alarmed me that this might cause me problems. But, in the current epidemic, people with other ailments (such as diabetes, respiratory problems, obesity), and infants with as yet undeveloped immune systems (rather than 20-something-year-olds) are occasionally dying.

It seems pertinent to note that cytokine response is a problem in all forms of flu. Respond too much and you are in for problems. Respond too little likewise.

I have NO IDEA, but if you are a 20 something year old then perhaps increasing your immune response might not be a good idea, but if you are a stressed, or frail person or have a respiratory problems (that are not immune system related, such as allergies) then perhaps an immune response activator might be a good idea?

I have no idea. But, the only homeopathic medicine that I purchased is an immune system repressor (I forget its name...rotten red rice) because I consider myself to be someone with no underlying complications, so if I get really ill, then I will atttempt to supress, not increase, my immune response. Apparently those that die (usually infants were I am) die pretty quickly so I am not sure that I will be able to eat my rotten red rice powder in time!

All the same, I like to be proactive, so having some rotten red rice powder in the fridge is a little empowering.

Here is the stuff I bought (kinda the opposite of elderberry??!)

WordDoc said...

Dear Readers,

As of now, I have received the H1N1 shot AND am taking elderberry juice concentrate. Here's my clinical experience with swine flu thus far:

Adults, young and old, are coming down with this strain and, on average, are miserable but not dreadfully ill with it. The few with underlying conditions for whom I've prescribed Tamiflu have gotten much better very quickly. One 70-something year old lady with asthma got pneumonia but recovered quickly.

So, not wishing to be miserable for a week nor wanting to pass the illness along with others, I started elderberry juice several weeks ago. The evidence that flavonoids in the extract bind to flu particles and render them unable to penetrate host cells is compelling. The course of this epidemic, as anonymous the last suggests, does not include cytokine storms, so whether or not elderberry extract exaggerates such a complication is not pertinent at this time.

When the vaccine, all 20 shots!, was made available to our office, due to my high level of exposure I decided to get that as well while continuing to take elderberry juice.

I think the main instructive outcome of this outbreak is how inefficient our public health departments are at addressing a major epidemic.

Femail Doc

Anonymous said...

I know that this is an old post, but I was kind of excited to find it for the following reason. I think that I may have had a cytokine storm induced by h1n1. I'm not a Dr. and I was not officially tested for h1n1.

Around last thanksgiving, I started getting flu-like symptoms. I then developed swelling in my face, especially the lips. Next I got a nasty case of the hives that moved rapidly over my whole body. Then my throat started swelling so I couldn't swallow solid foods. I went to the hospital, and they gave me a pretty heavy dose of solumedrol. I felt significantly better within a couple of hours. They also sent me home with 10 days of prednisone. They told me that it was either allergies or a weird response to a virus. I was concerned that the prednisone might interfere w/ my recovery from a virus, but they said not to worry about it. What do you think Dr?