Recombinant cytokines in augmentation and immunomodulation of host defenses against Candida spp.

Invasive candidiasis is one of the leading causes of morbidity and mortality in immunocompromised and critically ill patients. Clinical and experimental observations have demonstrated that phagocytic immunity is central in the outcome of deeply invasive candidiasis. Quantitative and qualitative modulation of anticandidal host defenses by the use of cytokines as an adjunct to antifungal drug therapy against Candida infections has been supported by extensive in vitro and in vivo preclinical data. Modulation of Th1/Th2 balance and use of combinations of antifungal agents together with cytokines also have shown promising preclinical results. However, clinical studies of the prevention or of adjunctive therapy in combination with antifungal agents are limited and do not allow specific recommendations for their cost effective use in patients. Thus, there is an urgent need of well-structured, randomized clinical trials to determine the safety, efficacy, optimal dose, duration and timing for different combinations of immunotherapy and antifungal agents in high-risk patients.