The Effectiveness of Immunotherapy in Treating Exercise-Induced Pulmonary Hemorrhage

Inflammatory airway disease has been linked to exercise-induced pulmonary hemorrhage (EIPH), and consequently, we hypothesized that immunomodulation via concentrated equine serum (CES) treatment would reduce EIPH as evidenced by red blood cell (RBC) concentrations in bronchoalveolar lavage fluid (BALF). Separate trials were conducted on Thoroughbred horses treated with either CES (n = 6) or placebo (0.9% saline; n = 4). All horses completed pre-treatment and post-treatment (2 and 4 weeks after initiating treatment) maximal exercise tests on a 10% inclined treadmill (1 m/s/min increments to fatigue) over a 10-week period (2−3 weeks between tests), with bronchoalveolar lavage (BAL) performed 30 minutes after exercise. Treatment ensued 10 days after the pre-treatment exercise test, with horses receiving a series of five CES or placebo injections 24 hours apart (20 mL intratracheal and 10 mL intravenously), with subsequent weekly injections for 5 weeks thereafter. After CES treatment, both EIPH (RBC in BALF) and inflammation (white blood cell concentration WBC] in BALF) were significantly diminished by the 4-week posttreatment run, demonstrating 46 ± 12% and 24 ± 11% decreases, respectively (P < 0.05). In contrast, EIPH was elevated significantly at the 4-week time point, and inflammation remained constant in the placebo trial. In conclusion, these preliminary data suggest that therapeutic intervention involving immunomodulation may represent a viable approach to reducing the severity of EIPH.