Immunologic and clinical investigation on a bovine thymic extract. Therapeutic applications in primary immunoedificiencies.

Thirteen patients with primary immunodeficiencies (eight with T-cell deficiency, one with Wiskott-Aldrich (W-A) syndrome, two with common variable agammaglobulinemia (CVA), and two with severe combined immunodeficiency (SCID) were treated with a calf thymus extract, called thymostimulin (TS). It has been shown that this extract causes in vitro differentiation of T-cell precursors in patients with T-cell defect. Five of eight patients with pure T-cell defect showed immunologic recovery and clinical remission lasting for several months after interruption of the therapy; one had only transient reconstitution, one had slight increase in T-cells (clinical conditions not yet estimated), and two patients soon died from severe infections after showing a slight increase of T-cells. Immune recovery was assess by an increase of the absolute number of E-rosettes forming cells, of human T-lymphocyte antigen positive cells and of PHA responsiveness in the peripheral blood, and by a positive delayed hypersensitivity reaction to antigens. In five patients, there was also B-cell increase after TS treatment. Clinical remission consisted of disappearance of infections, weight gain, and in improvement in general conditions. No effect was observed in one patient with W-A syndrome, in two with CVA, and in two with SCID. Several hypotheses on the mechanisms involved in immune reconstitution are discussed. It seems likely that TS acts on prethymic cells or on the epithelial cells of hypoplastic thymuses. TS was not effective, either in vitro or in vivo, in patients with SCID probably because of a defect in stem cells.