Painful monthly penicillin injections could be a thing of the past with Griffith University researchers, in collaboration with researchers at the University of New England, investigating the benefits of an alternative therapy for children diagnosed with rheumatic fever.
A new study, published today in mBio, employed a novel strategy to halt progression of rheumatic heart disease in a preclinical model by using low-dose interleukin 2 (LD-IL-2).
IL-2 is a hormone of the immune system which can alter the balance of inflammatory and anti-inflammatory responses following a Strep A infection, with inflammatory signals having the potential to cause rheumatic heart disease.
Until a vaccine to prevent Strep A infections is licensed, the only way currently to halt progression of rheumatic heart disease is with monthly injections of penicillin to prevent subsequent Strep A infections.
These injections need to be given for more than 10 years.
Professor Michael Good from Griffith's Institute for Biomedicine and Glycomics said there was a need to look for alternatives to monthly penicillin injections due to poor compliance, and as IL-2 therapy has the potential to be a gamechanger.
"For school-aged children with rheumatic fever, monthly intramuscular penicillin injections for around 10 years can be painful and traumatic if they have a fear of needles, and some people may have limited access to penicillin or to healthcare facilities," said Professor Good.
"Australia's First Nations children suffer one of the highest rates of rheumatic heart disease in the world and we have a responsibility to find better treatments and preventions.
"Our proposed approach involves treating patients who are at high risk of developing rheumatic fever, with a five-day course of IL-2 therapy to prevent the abnormal inflammatory responses which could trigger autoimmune reactions and tissue damage."
Dr Ailin Lepletier hopes a single course of LD-IL-2 therapy, given subcutaneously, could have the potential to replace the need for monthly prophylactic antibiotics.
"With the generous support of the Heart Foundation, we are embarking on new studies to investigate whether a single course of low-dose IL-2, given subcutaneously, can elicit long-term immunoregulatory responses capable of preventing recurrent rheumatic fever," said Dr Lepletier.
"Subcutaneous injections are less painful than intramuscular penicillin needles, and the therapy has the added benefit of ensuring children can maintain regular school attendance without the need for regular hospital or clinic visits."
Associate Professor Manisha Pandey said it was imperative to find an alternative to help slow the progression of rheumatic fever to rheumatic heart disease, and ease the health and economic burden.
"The disease burden is most severe in low-income countries and among First Nations peoples in high-income countries, with more than 40 million people effected worldwide," she said.
Professor Paul Clarke, Executive Director of the Institute for Biomedicine and Glycomics said: "I am thrilled to see the results of this study which ultimately aims to find a better alternative to painful injections for children."
"The Institute and its researchers collectively work on translational research to deliver real and immediate impacts both in Australia, and globally to transform lives and help those in disadvantaged communities."
Heart Foundation National Manager of Population Health and Wellbeing, Le Smith said: "The Heart Foundation is proud to support advances in research that prevent progression and complications of acute rheumatic fever and rheumatic heart disease, conditions that disproportionally affect First Nations communities in Australia."
"Alternative therapies that reduce the need for painful monthly injections will be a major step forward for children and families experiencing rheumatic fever."
Studies are planned to commence in February in collaboration with Dr Rukshan Rafeek and Professor Natkunam Ketheesan at the University of New England.
The paper 'Low-dose interleukin 2 therapy halts the progression of post-streptococcal autoimmune complications in a rat model of rheumatic heart disease' has been published in mBio.
