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Blood, 15 August 2000, Vol. 96, No. 4, pp. 1465-1473
IMMUNOBIOLOGY
Coadministration of interleukin-18 and interleukin-12 induces a
fatal inflammatory response in mice: critical role of natural killer
cell interferon- production and STAT-mediated signal
transduction
William E. Carson,
Julie E. Dierksheide,
Saad Jabbour,
Mirela Anghelina,
Page Bouchard,
George Ku,
Haixin Yu,
Heinz Baumann,
Manisha H. Shah,
Megan A. Cooper,
Joan Durbin, and
Michael A. Caligiuri
From the Departments of Pathology, Medicine, and
Surgery, Arthur G. James Comprehensive Cancer Center, The Ohio State
University, Columbus, OH; Children's Hospital, Columbus, OH; Vertex
Pharmaceuticals, Cambridge, MA; Genetics Institute, Andover, MA; and
Roswell Park Cancer Institute, Buffalo, NY.
The administration of therapeutic doses of recombinant cytokines to
patients with malignant disease can be complicated by systemic
toxicities, which in their most severe form may present as a systemic
inflammatory response. The combination of interleukin (IL)-18 and
IL-12 has synergistic antitumor activity in vivo yet has been
associated with significant toxicity. The effects of IL-18 plus IL-12
were examined in a murine model, and it was found that the daily,
simultaneous administration of IL-18 and IL-12 resulted in systemic
inflammation and 100% mortality within 4 to 8 days depending on the
strain employed. Mice treated with IL-18 plus IL-12 exhibited unique
pathologic findings as well as elevated serum levels of proinflammatory
cytokines and acute-phase reactants. The actions of tumor necrosis
factor- did not contribute to the observed toxicity, nor did T or B
cells. However, toxicity and death from treatment with IL-18 plus IL-12
could be completely abrogated by elimination of natural killer (NK)
cells or macrophages. Subsequent studies in genetically altered mice
revealed that NK-cell interferon- mediated the fatal toxicity via
the signal transducer and activator of transcription pathway of
signal transduction. These data may provide insights into methods of
ameliorating cytokine-induced shock in humans.

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