AIDS TREATMENT NEWS No. 092 - December 1, 1989
Denny Smith
The most extensive HIV-related clinical work with Iscador has been conducted by two physicians in San Francisco; both are European-educated. Immaculada Marti, M. D., from Spain, is a staff physician at Davies Hospital in San Francisco, and treats many people with HIV in her practice. Robert Gorter, M. D. from The Netherlands, is an Associate Professor at the University of California in San Francisco.
We asked Dr. Marti to share her impressions of Iscador's usefulness. Although her experience, and Dr. Gorter's as well, has been encouraging, she feels that it cannot be described as conclusive. The last report of their work appeared a year ago, in the November '88 issue of BETA, a treatment bulletin of the San Francisco AIDS Foundation.
At least thirty seven different components have been isolated from Viscum album, characterized as polysaccharides, viscotoxins and lectins. The latter two are under study for antitumor and immunomodulatory properties. Iscador is available in two preparations: the useful lectins are preserved in unfermented extract of Viscum album, while the fermented version loses an important lectin. As a semi-parasitic organism, mistletoe requires life on a host plant, often apple, oak, elm, or pine trees. Interestingly, the chemical properties of the parasite plant vary somewhat depending on which host tree it grows.
Dr. Taseem A. Khwaja, Director of the Comprehensive Cancer Research Center of the University of Southern California has observed that Iscador blocks in vitro syncytia formation, the clumping of cells which provides HIV an efficient passage from cell to cell. He suggests that Iscador may also inhibit the binding of free virus to the receptors of uninfected cells, as well as inhibit reverse transcriptase within infected cells. In spite of its apparent potential, Viscum album actually demonstrates little ability to directly harm HIV particles, but Dr. Khwaja is investigating another species of mistletoe, Viscum coloratum, which may be superior in this regard.
In her clinical experience, Dr. Marti has seen Iscador enhancement of five specific immune responses:
* An increase in the number and activity of neutrophils; * Increase in T4-helper cells; * Increased number and activity of Natural Killer cells; * Enhanced anti-body dependant cell-mediated cytotoxicity (ADCC); * Increased lymphocyte mitogenicity, or immune cell multiplication.
Some of these responses are similar to those obtained with alpha interferon treatments, and in fact Iscador appears to facilitate the immune system's own production of interferon. Related improvements in Dr. Marti's patients included weight gain, reduction of KS lesions, decreased lymphadenopathy, increased hemoglobin, and decreases in beta 2 microglobulin and p24 antigenemia. She notes, however, that the positive KS response does not appear to result directly from the effect of Viscum album on KS lesions, but rather from an indirect enhancement of the body's immune response to KS.
Iscador is administered by subcutaneous injection two or three times a week, beginning with a low dose, 0.01 mg. As it is presently formulated, Iscador is less effective taken orally, since some components are inactivated in the gastrointestinal tract. The dosage is gradually increased, and doses approaching 15 to 20 mg resulted in blood work improvements for asymptomatic patients. However, people who are currently fighting an opportunistic infection or who have low helper cell counts seem to have a lower dose tolerance, above which the drug may become useless or detrimental. So the dosage must be tailored depending on these factors. (A similar observation was made in the results of Project Inform's recent study of Compound Q.) Many people experience redness and tenderness at the injection site, but no serious or permanent toxicity has been attributed to Iscador. Reactions in some people to high doses caused fever, insomnia, fatigue and loss of appetite. Temporarily discontinuing the injections resolved the reaction.
No other medications are contraindicated with the use of Iscador, and in fact Dr. Marti has combined it successfully with AZT, chemotherapy and ddI. She has found that Iscador helps counter the bone marrow suppression induced by long-term use of AZT. In addition to the objective improvements in blood markers, her patients have reported improved appetite and sleep, vivid dreams, and relief from HIV-associated fatigue and depression.
All of these observations would seem to make Iscador, or some future Viscum preparation, a very pursuable treatment possibility. As a prescription drug in Switzerland, Iscador costs about $4 an ampule, or $12 a week, and personal use requests can be sent with a physician's prescription directly to the manufacturer: Institut Hiscia, CH-4144 Arlesheim, Kirschweg 9, Switzerland. Drs. Gorter and Marti continue to monitor their patients' response to Iscador, and are interested in conducting formal trials to expand their study.
(For more information about Iscador in HIV treatment, physicians can call Dr. Marti at 415/255-7941.)
References
Holtskog, R and others. Characterization of a toxic lectin in Iscador, a mistletoe preparation with alleged cancerostatic properties. Oncology, volume 45, number 3, pages 172-179, 1988.
Kuttan, G and others. Isolation and identification of a tumor reducing component from mistletoe extract (Iscador). Cancer Letters, volume 41, number3, pages 307-314, 1988.
Hamprecht, K and others. Mediation of human NK-activity by components in extracts of Viscum album. International Journal of Immunopharmacology, volume 9, number 2, pages 199-209, 1987.
Metzner, G and others. Effects of lectin I from mistletoe (ML I) and its isolated A and B chains on human mononuclear cells: mitogenic activity and lymphokine release. Pharmazie, volume 42, number 5, pages 337-340, 1987. Oncology, (entire issue devoted to Viscum album) supplement 1 of volume 43, 1986.
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