Extracorporeal Whole Body Hyperthermia

              A  compendium  of  current  knowledge

Section 1            Section 2        Section 3  

 Section 4      Section 5      Section 6      Section 7

Section 7

Glossary

Glossary

AIDS (Acquired Immune Deficiency Syndrome)

       The late stage of the illness triggered by infection with Human Immunodeficiency Virus (HIV). According to the official definition published by the Centers for Disease Control, a person receives an AIDS diagnosis when he or she has a CD4 lymphocyte (helper T cell) count of less than 200 and/or certain opportunistic infections common with advanced immune deficiency.

Antibody

       A disease-fighting protein in the blood created by the B cells of the immune system, and also known as immunoglobulin. Antibodies coat, mark for immune destruction, or render harmless, foreign particles like bacteria, viruses, or harmful toxins. Antibodies also tag infected cells, making them vulnerable to attack by the immune system. Each antibody attaches itself to a single, specific chemical sequence on an antigen.

Antigen

       A foreign substance, usually a protein, that stimulates an immune response. An antigen contains several sub-units called epitopes (see entry) that are targets of specific antibodies and cytotoxic T-lymphocytes.

Cachexia

       A profound and marked state of constitutional disorder; general iii health and malnutrition, wasting.

Cardiac index

       A measurement of the amount of blood pumped out by each ventricle in one minute (cardiac output) divided by the body surface area.

Cardiac output

       The amount of blood pumped out by each ventricle in one minute. It is the product of the heart rate multiplied by the stroke volume (the volume of blood pumped out by a ventricle with each heartbeat).

Catheter

       A tube inserted into a vessel or cavity for both acute or long-term applications. Often used to provide temporary access to arteries or veins for the administration of drugs, for blood sampling, or pressure measurement.

CD4

       The protein structure on the surface of a human cell that allows HIV to attach, enter, and consequently infect a cell. CD4 receptors are present on CD4 lymphocytes (helper T cells), macrophages and dendritic cells, among others. Normally, CD4 acts as an accessory molecule, forming part of larger structures (such as the T cell receptor) through which T cells and other cells signal each other.

CD4 Lymphocyte cell

       A type of T cell involved in protecting against viral, fungal, and protozoal infections. The CD4 lymphocyte modulates the immune response to an infection through a complex series of interactions with antigen-presenting cells and other types of lymphocytes. The CD4 lymphocyte is also known as a T helper cell or helper T cell. The T4 cell is the field marshal of the immune system.

CD4 Cell count

       Also called the CD4 lymphocyte count, this is the most commonly used surrogate marker for assessing the state of the immune system. As the CD4 cell count declines, the risk of developing opportunistic infections increases. The normal range for CD4 cell counts is 800 to 1500 per cubic millimeter of blood.

Chemotherapy

       The use of chemical agents (drugs) in the treatment of a disease. The term commonly, but not always, refers to cancer treatment.

Chronic

       Persisting for a long time. Refers to symptoms and diseases that last for an extended period of time without noticeable change.

Clinical

       Refers to physical signs and symptoms directly observable in the human body. Pertaining to or founded on the actual observation and treatment of patients, as distinguished from theoretical or basic sciences.

Clinical trial

       A study to test an experimental medicine or treatment to see if it is safe and effective (see Phase I, Phase II, Phase III).

Cytokine

       One of the proteins produced by white blood cells.

Cytomegalovirus (CMV)

       Any of a group of highly host-specific herpes viruses that infect man, monkeys, or rodents, producing unique large cells with intracellular inclusion bodies. The virus can cause a variety of clinical syndromes. Though most are mild or sub-clinical, CMV can cause cardiomyopathy and CMV retinitis causes blindness.

Cytotoxicity

       The ability to kill cells.

Efficacy

       Strength, effectiveness. The ability of an intervention to produce the desired beneficial effect in expert hands and under ideal circumstances.

Effector

       An organ, gland, or muscle which is capable of being activated by nerve endings.

Envelope

       The outer covering of a virus, sometimes called the coat.

Epitope

       A unique molecular shape or sequence carried on a microorganism that triggers a specific antibody or cellular immune response.

FDA (Food and Drug Administration)

       The FDA is an agency of the U.S. Department of Health and Human Services that regulates the testing of experimental drugs and medical products. Using evidence of safety, efficacy or equivalence, the FDA approves and regulates the marketing of medical products.

Helper T cell

       The type of T lymphocyte that orchestrates cellular immunity by direct contact with other immune cells and by releasing chemicals called lymphokines; also helps to mediate the humoral response (see humoral immunity) by interacting with B cells (antibodies). Also known as the CD4 cell or CD4 lymphoctye T4 cell.

Hepatitis

       Inflammation of the liver caused by microbes or chemicals. Often accompanied by jaundice, enlarged liver, fever, fatigue and nausea, and high levels of liver enzymes in the blood. Can become a chronic disease (e.g., cirrhosis).

Homeostasis

       A tendency to stability in the normal physiological state of the organism. Maintenance of the body's internal environment.

HIV-1

       Human Immunodeficiency Virus type l, the retrovirus recognized as the agent that induces AIDS.

Humoral immunity

       Immunity provided by antibodies released by sensitized B cells and their plasma cell progeny. Also called antibody-mediated immunity.

Hyperthermia

       Elevated body temperature.

Hyperthermia, Extracorporeal Whole Body (EWB H)

       Elevation of the core body temperature by removing blood from the patient's body, passing it through an external heater, and returning it to the patient's circulation.

Hyperthermia, local

       Hyperthermia as applied to contained, localized volumes of tissue such as individual metastasis, tumors of the breast, or the prostrate. The size of the treatment area and depth of penetration depend on the method of applying heat and the application technique.

Hyperthermia, regional

       Hyperthermia as applied to treat cancers in larger portions of the patient's body, such as the pelvis, stomach, or limbs. The bones, air, and fat in the region affect the dispersion of heat in the area.

Hyperthermia, Whole Body (WBH)

       A procedure that involves the temporary elevation of the patient's core body temperature to about 42℃ (107.6⁰F). Whole Body Hyperthermia is a systemic procedure (affecting the whole body) and is being used to treat a variety of chronic illnesses, primarily in the fields of oncology and infectious diseases. Both extracorporeal and non-invasive (e.g., radiant heat) methods have been used to induce WBH.

Hyperventilation

       Abnormally increased pulmonary ventilation (rapid, deep breathing), resulting in reduction of carbonic acid, which, if prolonged, may lead to alkalosis.

Interferon

       A small protein secreted by virus-infected cells. Interferon molecules diffuse to nearby cells and bind to membrane receptors to inhibit the ability of viruses to multiply within these cells.

Intractable

       Unstoppable. For example, intractable pain.

Kaposi's sarcoma (KS)

       An AIDS-defining illness consisting of individual cancerous lesions caused by an overgrowth of blood vessels. KS typically appears as pink or purple painless spots or nodules on the surface of the skin or oral cavity. KS can occur internally as lesions in the throat, lungs, and throughout the digestive system.

Karnofsky's score

       An assessment of a person's ability to carry on normal activities. For instance: normal activity with no complaints would be scored 100; in bed 50 percent of the time and requiring considerable assistance and frequent medical care would be scored 50; moribund would be scored 10.

Latency

       A quiescent period during a disease process. In the HIV/AIDS disease process, clinical latency is an asymptomatic period in the early years of HIV infection. The period of latency is characterized in the peripheral blood by near-normal CD4 counts and HIV levels. Recent research indicates the HIV remains quite active in the lymph nodes during this period. Cellular latency is the period after HIV has integrated its genome into a cell's DNA but has not yet begun to replicate.

Leukoplakia

       A white patch on a mucous membrane that will not rub off.

Local hyperthermia

       See Hyperthermia, local

Mitogen

       A substance that induces mitosis.

Mitosis

       The division of the cell nucleus, followed by division of the cytoplasm of the cell, 1.e., cell duplication.

Monocyte

       A white blood cell, it is also a CD4 receptor, i.e., it is infected by HIV. It is a phagocyte cell, which can migrate out of the blood stream into tissue, where it becomes known as a macrophage.

Monokine

       A general term for soluble mediators of immune responses that are not antibodies or complement components and that are produced by mononuclear phagocytes (monocytes or macrophages).

Mucosa

       Mucous membrane.

Myoglobin

       Iron-containing protein found in muscle cells, related to hemoglobin in structure and function.

Natural killer (NK) cells

       Natural killer (NK) cells guard the blood and lymphatic system. They are a unique group of defensive cells that can disintegrate and kill cancer cells and virus-infected body cells.

Neutrophil

       Protective white blood cells.

Norepinephrine

       A neurotransmitter related to dopamine and adrenaline. As a peripheral vasoconstrictor, it helps restore blood pressure during states of low blood pressure.

Phase I clinical trial

       The earliest stage of a trial for studying a new therapy. Phase I trials are generally small. They provide an initial evaluation of the safety of the therapy and, depending on the therapy, preliminary indications of dosage, duration and other basic information for use in later studies.

Phase II clinical trial

       A more advanced stage of a clinical trial, following a Phase I trial. A Phase II trial gathers preliminary information on the efficacy of the therapy. In Phase II trials patients are randomly assigned to receive the therapy or they are randomly assigned to a control group which gets the standard treatment or no treatment at all.

Phase III clinical trial

       An advanced-stage clinical trial that should conclusively show how well a therapy works in comparison to other treatments. Phase III trials can be longer and are usually larger than Phase II trials, and frequently involve multiple test sites. Their goal is the statistical measurement of how well a therapy extends the survival of patients or otherwise clinically improves the health of patients under treatment.

Protocol

       The explicit, detailed plan of an experiment, procedure, or test.

Pyrogenic

       Fever inducing.

Remission

       Diminution or abatement of the symptoms of a disease; the period during which such diminution occurs.

Respiratory quotient (RQ)

       A measurement of metabolism. Different biochemical pathways break down different food components, such as fat, protein and primary glucose (CHO). Based on the pathway or combination, the O₂ consumed and the CO₂ produced are measured. Primary glucose (CHO) metabolism is equal to or greater than an RQ of 1.0.

Regional hyperthermia

       See Hyperthermia, regional

Retrovirus

       A virus that, when not infecting a cell, stores its genetic information on a singlestranded RNA molecule instead of the more usual double-stranded DNA. HIV is an example. After a retrovirus penetrates a cell, it constructs a DNA version of its genes using reverse transcriptase, an enzyme. The DNA then becomes part of the cell's genetic material.

Rhabdomyolysis

       Disintegration of striated muscle fibers, with excretions of myoglobin in the urine.

Rosetting

       Formation of clusters of polymorphonuclear leukocytes around a globule of lipid nuclear material.

Sarcoma

       Any of a group of tumors usually arising from connective tissue. Most are malignant.

Splanchnic vessels

       Any of the vessels of the abdominal organs.

Systemic

       Pertaining to the whole body.

Systemic therapy

       Treatment that reaches cells throughout the body by travelling through the bloodstream.

T cell (T lymphocyte)

       Lymphocytes that mediate cellular immunity. They include helper, killer, suppressor, and memory cells.

Tumoricidal

       Any agent that destroys tumor cells.

Tumor necrosis factor alpha (TNF α)

       A cell toxin released by activated macrophages. Attracts granulocytes, and activates T cells and macrophages.

Vasoconstriction

       A tightening of the smooth muscles of blood vessels, resulting in a decrease in their inner diameter (caliber).

Vasodilation

       Relaxation of the smooth muscles of blood vessels, resulting in an increase in their inner diameter (caliber).

Veno-venous

       A vein-to-vein shunt. Used with First Circle Medical's Temet system for Extracorporeal Whole Body Hyperthermia to provide a way to remove blood from the body, heat it, and return it to the body without the need for an oxygenator.

Viral load

       The number of viral particles found in a sample of blood plasma. When used to measure HIV viral particles, it is viewed as a predictor in a patient's progression to AIDS and subsequent death. This measure has also been used to evaluate the effectiveness of certain HIV/AIDS treatments. However, it usually reflects only the viral particles present in the blood, and does not measure the amount of virus in tissue. The viral load of tissue can be assessed with a lymphoid tissue biopsy.

Whole Body Hyperthermia (WBH)

       See Hyperthermia, Whole Body