Editor’s Note: This is part two of the discussion on TH1 and TH2. Part one appeared in last week’s bulletin (12/20/00).
How to balance TH1 & TH2
"If you get really threatened (by one of the things above), all you have is RNase L and that will really put you down. Or worse than that, is that you have no RNase L to defend you, because you're growth hormone deficient. No growth hormone, no RNase L. It's a very scary problem.
You're activated here (TH2) and suppressed here (TH1). These (things on the left side) come out and there's nothing to stop them. No TH1, no Rnase L. What you really need is to balance the system out. To push the system a little more towards this direction (pointing toward the TH1 line.) That way you'll lose some of the over reaction here (TH2) and gain some control here (TH1)."
"And these are the things that will move you. We call them right to left shifters. Three of them are published or about to be published." (Below the diagram he fills the remaining space with six horizontal arrows, each of which start under "TH2" and ends under "TH1".
The following treatments are written on the arrows.
1) Kutapressin / Ampligen (both published, by prescription only) "Kutapressin is an immune modulator. And it's a broad spectrum anti-viral. I have a strong suspicion Ampligen is a right-to-left shifter as well." (Ampligen was sort of an after thought, though I should mention that he's told me Kutapressin is sort of like a weak form of Ampligen."
2) Isoprinosine (published, by prescription) (whole separate section on this coming up)
3) Pine Cone Extract "They make a tea from this in Southern Japan and they have significantly reduced cancer rates. It's thought to work at the gene level in lympho- cytes, where it turns IL-12 on. It also shuts down IL-10 at the gene level, and that will shift you this way (towards TH1)."
4) Earth Dragon Peptides "Earth Dragon is round worm peptides. (Yuck!) It shifts you to the left, and we suspect it's like IL-12. There has been a huge surge in the use of ED peptides to treat Inflammatory Bowel Disease, specifically Crohn's Disease, because Crohn's is a TH(?) problem. Crohn's Disease isn't seen in Third World countries. If you have parasites you don't get Crohn's. You've got a parasite problem, but no Crohn's. There's a professor at UNC who treats all his Crohn's Disease patients with Earth Dragon. It's very non-toxic, very safe."
5) Heparin (by prescription only) "Believe it or not, heparin - a natural substance - is a TH2 - TH1 shifter. The additional advantage for many CFIDS patients is that it's also an anticoagulant."
6) Transfer Factor is an immune modulator. "If you get a shift from TH2 towards TH1, then NK levels will rise. So before beginning one of these products it's best to get a baseline NK level first. We use the University of Miami, where Nancy Klimas is, for NK testing. Specifically we use Mary Ann Fletcher, an NK specialist. Her lab is no more expensive than commercial labs, and is top quality. You have to have a quality lab do this. Don't use just any lab." (Contact info for NK test: Univ. of Miami; Dept of Medicine -R41; RSMB Room 8168; 1600 NW 10th Ave; Miami FL 33136; phone: 305-243-6288; fax: 305-243-4674. The test is called "Natural Killer Cell Function Assay", costs $350, requires one small EDTA purple tube and one medium heparin green top tube, drawn in the afternoon and shipped immediately overnight air freight ambient temperature with AM delivery. It must get there within 24 hours.)
"Which of these things could we use? Well, pick one and see what it does to your NK function. It's a question of whether it will work and how much it costs. Take the NK test from Miami to establish a baseline, pick a product and try it, then retest and see if the NK level has risen. That would indicate a successful rebalancing of your immune system. If it's not rebalanced, the product is not working and you should try something else." Transfer Factor is an especially neat product. I like it.”
"Heparin I wouldn't use unless you had a coagulopathy." (ISAC test, www.hemex.com) "I wouldn't use Earth Dragon if I were you, because you don't have enough GI problems." (It wouldn't hurt me, but the added benefit to the GI tract would be wasted. Cost/benefit thing. Earth Dragon is about $36 for 150 caps, take two a day.) "Pine Cone extract is expensive, but at 10 drops a day, of all the possibilities, it's probably the cheapest per day. (It's called PineExtra and 1oz is about $60.) Though of course some of the others are prescription and might be covered." (I think only Kutapressin and Heparin might be covered. Isoprinosine is by prescription, but since it's not approved in the US, it's not covered.)
Isoprinosine & Kutapressin
"I propose that you might try Isoprinosine, based on several features that I like." (Note that this is Cheney's recommendation for me, given my specific symptoms. His recommendation varies from person to person.) "It's been published for use in CFIDS, specifically enhancing NK function." (It was presented in May at the Immunology 2000 Conference in Seattle. The abstract is at www.faseb.org/aai00t/f977.html )
"I would predict that it would shift you towards TH1, and help you feel better generally. I also predict, although it isn't indicated in the literature, that it would be good against the intracellular bacteria since it is a TH2 - TH1 shifter. It appears to raise IL-12 and lower IL-10, which turns off TH2 and turns on TH1." "It's also called Imunovir. It's very nontoxic, very safe. It's approved in Europe and Canada for just about any viral infection. It's not approved in the US, but it's easy to get from Canada with a prescription."
Dosing of Isoprinosine
"Now the dosing (of Isoprinosine) is interesting. This medicine works best when you don't treat regularly. If you treat continuously at the same dose, it stops working. It's an immune modulator. You have to vary the dose so your immune system never knows what you're going to do. Keep it off balance. Take 6 on Mondays, Wednesdays, and Fridays, 2 on Tuesdays and Thursdays, and none on Saturday and Sunday. And you don't treat every month. Do two months on and then one month off."
(I later faxed Cheney the protocol that Dr. Byron Hyde uses, which Jim posted to this list and I found in the archives - thanks Jim - and Cheney liked it even better. So the final protocol approved by Cheney is: Week One, Mon - Fri take 6 each day and Sat - Sun take none; Week Two, Mon - Fri take 2 each day and Sat - Sun take none. Repeat cycle. Still do two months on then one off.)
"I bet all immunomodulators are like that. If taken continuously they stop working. Like Kutapressin. One patient who did great on Kutapressin varied the dose. He took 2 to 4 cc's when he felt sicker, and when he felt better he took 1 cc. But he was always varying the dose." (I think this is the patient Cheney mentioned at another visit who was able to return to work because of Kutapressin, and became ill when he stopped it, and regained his health when on it again.)
We, or you, can fax the prescription to the Canadian distributor, Rivex Pharma and they'll ship it to you, with the prescription on top, because US Customs may open the package. It's approximately $170 for a bottle of 100 tabs. (I found I could order the same bottle of 100 tabs from a company in Ireland for about $53. I sent Cheney all the info and he thought this Irish source was great. At 80 tabs a month, it costs me less than $43 a month. It's Newport Pharmaceuticals, www.newport-pharma.com, newport@i..., a bottle of 100 tabs at 500 mg each costs 125 Irish Pounds. Go to yahoo.com and click on their stock link to get a quick conversion at current exchange rates. They sell 3 bottle paks or 6 bottle paks. The only difference is a small savings in the courier charge on the larger quantity.)
"It's been approved in Canada for 18 years.”
(Much earlier in my visit we had discussed Kutapressin. I took it for over two years and at first it stopped my fever. But it seemed to quit working at some point, and eventually I stopped taking it. I mentioned restarting it, and Cheney said that might be worth trying.) If you're considering using both Isoprinosine and Kutapressin, you might want to do the baseline NK test, then take Isoprinosine for 30 days, retest the NK, take neither for 30 days, then do 90 days of Kutapressin.
"My clinical sense is that Kutapressin doesn't work as quickly as Isoprinosine. It may take 2 or 3 months on Kutapressin. But after the NK tests you'll know which is better. Of course you could use both, but I'd want to know which was best. And if the Isoprinosine makes a difference and the second NK test shows it worked, you might not want to go on to Kutapressin."
The difference between Isoprinosine and Kutapressin
"The difference between Isoprinosine and Kutapressin? Kutapressin kills HHV6 in test tubes without any human immune system around, so it has real anti-viral properties. Isoprinosine doesn't do that. It works only through your immune system. It enables your immune system to kill the virus. But Kutapressin also has the same immunomodulatory effect (that Isoprinosine does) - it does both - kills the virus directly and also enables your immune system to kill the virus. As does Ampligen. We call it a bifurcated warhead. (two pronged) Kutapressin and Ampligen do both: in vitro (in test tube) because they're anti-virals, and in vivo (in live body) because they're immunomodulators." "Isoprinosine has just in vivo, that's why putting them (Kutapressin and Isoprinosine) together might make sense."
I asked Cheney about antibiotics. He said he isn't totally against antibiotics by any means - sometimes they're absolutely necessary. Whenever possible he prefers to try other options, though. For regular extracellular bacterial infections (extracellular meaning outside the cells, unlike mycoplasma and chlamydia pneumonia and lyme, which are all intracellular - inside the cells), Cheney really likes the drug zithromax. Unlike most antibiotics, this one ends up concentrated in white cells, which rush to the site of infection, right where the drug is needed.
Since it goes right into white cells, the blood level of this antibiotic is only one-tenth of most other antibiotics. This maximizes the effectiveness of the drug and minimizes the side effects. (The side effects of antibiotics include wrecking our good gut flora, since antibiotics kill bacteria indiscriminately, both good and bad. And most CFIDS patients already have fragile guts.) But Zithromax is useless against the intracellular bacteria - they don't attract white cells.
Regarding the more unusual intracellular bacteria like myco and chlamydia pneum and lyme, Cheney says that he's concerned by the pattern he's seen over the years. The treatment protocol keeps expanding to longer and longer time periods. It the beginning it was one month, then it was six weeks, then two months, then six. Now it's up to two years. He doesn't feel the antibiotic protocol is addressing the real problem. They keep finding that when they stop the treatment the bug eventually comes back.
Cheney believes that many patients treated with these current protocols will discover they have to be on them for life. And the side effects do not make that a good option. The real, underlying problem is that we are TH1 suppressed, and these bacteria are supposed to be dealt with by our TH1 immune defenses. Since we are TH2 activated, we don't have the immune system to keep them dormant or to fight them when they come out, or when they invade. I suspect that's why these things are a problem for us, but not a problem for many otherwise healthy people. Their immune systems can handle them. Ours can't. Perhaps even the antibiotic protocols presume our immune system is going to jump in there and do its part. And it doesn't.
Cheney said "That's why they have to keep extending the length of time. You just can't get there with antibiotics. And then you've exposed your poor gut to the implications of heavy antibiotic usage. I believe the appropriate approach is to rebalance the (TH1/TH2) problem you have (using one of the six previously mentioned products), measuring and then remeasuring NK functio,n to see if what you did in fact rebalanced it."
See Part 1.
--Click here to read Part 1.