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that an overactive or otherwise dysfunctional researchers are also collaborating with a
immune response may be to blame. Taiwanese team to identify a genetic
SARS last year claimed nearly 800 lives predisposition to SARS.
© 2004 Nature Publishing Group http://www.nature.com/naturemedicine
worldwide. Many researchers initially suggested Others are still pursuing the idea of an
that those who die have an overactive immune overactive immune response. Haichao Wang
system that triggers a destructive inflammatory and his colleagues are investigating the role
response. of HMGB1, a late-stage cytokine that
The theory was supported by anecdotal Scientists are baffled by how SARS, which claimed mediates lung injury and inflammation.
nearly 800 lives last year, affects the immune system.
reports that at a hospital in Guangzhou, the Wang, chief of basic science research at the
southern Chinese city where SARS originated, North Shore University Hospital in New
AIDS patients—who presumably have weak immune response in SARS patients,”says David York, is testing the effect of Chinese herbal
immune systems—were resistant to SARS Kelvin, head of experimental therapeutics at recipes used as SARS treatments during the
infection. University Health Network in Toronto. outbreaks. He has found preliminary
Scientists were also intrigued that children, Kelvin and his colleagues collected samples evidence that some of the herbs can block
prime candidates for most respiratory illnesses, from 110 patients—35 of them within the first HMGB1 and prevent the toxic inflammatory
seemed to escape the brunt of the epidemic. 24 hours after symptoms appeared—and fol- cascade seen in SARS.
“The whole mechanism of disease causation in lowed them approximately every five days; 45 Peiris is also following molecular leads on the
SARS is quite an enigma,” says Malik Peiris, patients were tracked for more than a year. The immune response to SARS, but declined to
professor of microbiology at Hong Kong researchers looked at gene expression profiles of reveal details. “We still don’t have an exact idea
University. various immune cells and markers to study both of what the immune system is doing,” he says.
Several teams are now trying to solve the the immediate, or innate, immune response and “Maybe it’s not functioning well or maybe it’s
puzzle at a molecular level, but have had to rely the later adaptive immune response. functioning too well.”
on animal models and samples from previous Based on their observations, Kelvin says, Apoorva Mandavilli, New York
outbreaks. “Everyone wants a glimpse of the those who become severely ill are predisposed With additional reporting by David Cyranoski