EHEC: How the HUS syndrome was defeated

EHEC: How the HUS syndrome was defeated

How HUS was Defeated with Antibodies

According to the Robert Koch Institute, more than 3,500 people in the early summer of this year were sometimes seriously ill from the effects of the EHEC germ. The majority of adults, including women, fall ill. 855 people suffered from severe kidney failure or acute brain damage. In the University Clinic Hamburg-Eppendorf (UKE) in particular, there was a medical emergency for weeks. Conventional therapies with antibiotic drugs failed, so that the treating physicians had no choice but to test a new type of drug with an antibody. In addition to the Hamburg University Hospital, seven other German clinics participated in testing the drug. As it turned out, the antibody called "Eculizumab" brought the decisive therapeutic breakthrough. A study from 2010 initiated this.

A recently evaluated study involving 148 patients with EHEC showed that the antibody eculizumab is adequate to treat patients with haemolytic uraemic syndrome (HUS). This is the conclusion reached by doctors and researchers from the University Medical Center Hamburg-Eppendorf. The study results were presented to a wider public yesterday during a presentation. HUS syndrome had caused serious health complications in around a quarter of EHEC patients. As a result, sufferers suffered from acute kidney failure and significant brain function disorders.

Active ingredient brought about the breakthrough in HUS treatment The team of doctors around the kidney specialist Prof. Dr. Rolf Stahl and the neurologist Prof. Christian Gerloff had evaluated the data from a total of 148 treated HUS patients during the study work. All patients came from Northern Germany and were treated with the antibodies eculizumab. The health status of 95 percent of the treated had improved significantly over a period of eight weeks. In 61 percent of those treated with neurological disorders, the recovery was complete. According to the data, the remaining symptoms were still mild, such as slight disorientation, but overall there was improved well-being, as Prof. Gerloff said during the presentation of the study.

21 subjects who developed epilepsy due to HUS no longer complained of epileptic seizures. The vast majority of patients (19) no longer need medication. However, further conclusive results will not be available until the middle of next year. By mid-2012, 120 patients will come to the UKE Clinic for follow-up and follow-up examinations. The internist Stahl emphasized that treatment with antibodies "is not a miracle cure, but a medically rational therapy".

HUS-generated domino effect The most exciting question was, of course, how the antibody therapy works. To do this, the researchers first had to find out how bacterial EHEC germs and, as a result, HUS could trigger such massive disorders. In order to clarify why the central nervous system, blood count and kidneys are attacked, Professor Stahl explained the chain reaction using a domino game. The first stone in the "game" is the so-called Shiga toxin. This toxin triggers a chain reaction, at the end of which there is severe kidney damage and brain function disorders. The active ingredient eculizumab used in the treatment removes a few “dominoes” from this series, so that there is no further damage to the body. The organism then has the opportunity to regenerate itself. The symptoms improve and the patient is on the healing path. Dr. can contact a HUS patient Remember Gerloff very well. The man was a marathon runner and was seriously ill with HUS. "He was in a coma - and today, after being treated with eculizumab, he is already running 20 kilometers - a sensational success."

Antibody was initially not the method of choice At the beginning of the EHEC epidemic, doctors only used the antibody in isolated cases in very serious patient cases. At the Klinikum Hamburg-Eppendorf, patients received the medication for the first time on May 27th. At that time, the EHEC germ was only known in the media for a week and the first cases increased in Hamburg and Lower Saxony. At that time, eculizumab was by no means the “first choice”, but was only used when nothing else helped and the patients were already in acute danger to life. A medical report on treatment with eculizumab gave the idea of ​​using the novel therapeutic agent. In the web edition of the "New England Journal of Medicine", scientists from Heidelberg, Paris and Montreal published the first successes of treating three seriously ill children with eculizumab. The young patients had been infected with EHEC bacteria in 2010 and subsequently contracted HUS syndrome. The drug saved the three children and brought about a significant relief from the symptoms. The report was only supposed to appear in the print medium, but was published online in May 2011 due to the emerging EHEC epidemic so that researchers could access the state of knowledge. All specialists in Germany's university hospitals had access to it.

The UKE doctors then used eculizumab for the seriously ill for the first time. When the patients were on the mend in a relatively short time, the drug has been used as a standard medication throughout Germany in almost all HUS patients since June 2011. In addition to eculizumab therapy, a blood plasma exchange (medical: plasmapheresis) was undertaken. "The data strongly suggest that this is related to the antibody," said neurologist Christian Gerloff. However, without any remaining doubt, this cannot be proven. Further studies would have to follow.

Study is an aid for upcoming EHEC epidemics The data analysis of the experts from Hamburg could help with possibly future HUS syndromes. Now the medical profession is better positioned, emphasized the neurologist Dr. Christian Gerloff. The antibody drug has not yet been approved as a standard agent. The European Medicines Agency (EMA) decides on this. For this reason, "the application must be discussed before each treatment," said the UKE doctors. The doctors were unable to estimate when the approval process was completed.

Accusations against sprout cultivation company Scientists raise serious accusations against the sprout cultivation company. The farm was closed by the health authorities because it was considered the place of origin for the EHEC distributors. The hygiene professor Martin Exner told the news magazine "Focus" that a survey of the farm found massive deficiencies in hygiene on site. For example, the toilets for the staff were too close to the well, which was used for the irrigation of the sprouts. The sprout producer has now filed a lawsuit against the closure of his plant. A decision is still pending. (sb)

Also read:
Positive assessment of the EHEC epidemic
Symptoms of an EHEC infection
EHEC epidemic survived
Neurological disorders as EHEC symptoms

Image: Gerd Altmann /

Author and source information

Video: what is HUS? (October 2020).