Successful Treatment of Invasive Pulmonary Aspergillosis by Transbronchial Injection of Urinary Trypsin Inhibitor and Amphotericin B

Accessible online at: www.karger.com/aha Invasive pulmonary aspergillosis is one of the fatal complications in immunocompromised hosts. Although amphotericin B (AmB) is effective against invasive aspergillosis, its systemic use is often limited by severe drugrelated adverse events. Other new agents, such as AmB colloidal dispersion and voriconazole, have shown better results [1, 2], but sometimes it takes such a long time to achieve complete cure that patients under chemotherapy cannot receive the next course. We report dramatic improvement of invasive pulmonary aspergillosis in 4 patients with hematological malignancies who were treated with urinary trypsin inhibitor (UTI) in combination with AmB administered via bronchoscopic fiber. UTI is a Kunitz-type protease inhibitor which inhibits trypsin, plasmin and granulocyte elastase [3]. UTI also decreases the production of TNF-·, IL-6 and IL-8 from leukocytes [4]. In addition, we verified that aspergillus species cannot grow on a plate containing UTI. Based on these observa-