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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2006.01.015 Byline: Gokhan M. Mutlu (a), Ece A. Mutlu (b), Amy Bellmeyer (a), Israel Rubinstein (c) Keywords: Rheumatoid arthritis; Crohn's disease; Sarcoidosis; Tuberculosis; Fungi Abstract: It is well established that anti-tumor necrosis factor-[alpha] (TNF[alpha]) antibody is an efficacious disease-modifying drug for rheumatoid arthritis and Crohn's disease. Unfortunately, its long-term use can be associated with ominous pulmonary adverse events, most notably mycobacterial and fungal lung infections. To this end, reactivation of latent tuberculosis infection represents a serious concern of anti-TNF[alpha] antibody therapy. Given the anticipated increase in the approved indications for these drugs, community-based physicians should be made aware of these events for implementation of better patient selection for anti-TNF[alpha] antibody therapy and initiation of appropriate measures once these adverse events are observed. This review will address this issue by outlining: 1) the role of TNF[alpha] in host inflammatory response to injury, particularly during mycobacterial and fungal infections; 2) the salutary effects of anti-TNF[alpha] antibody therapy in human diseases; and 3) the ominous pulmonary adverse events associated with these drugs. Author Affiliation: (a) Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Ill (b) Departments of Gastroenterology and Nutrition, Rush University Medical College, Chicago, Ill (c) Pulmonary, Critical Care and Sleep Medicine, University of Illinois at Chicago and Jesse Brown Veterans Administration Medical Center, Chicago, Ill Article Note: (footnote) This work was supported in part by the American Lung Association, and the American Lung Association of Metropolitan Chicago (G.M.M.), National Institute of Diabetes & Digestive & Kidney Diseases (E.A.M.), National Institute on Aging and Veterans Administration (I.R.).

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Abbreviations: adβ-gal = first-generation human type 5 recombinant adenovirus that expresses an e. coli lac z gene; adnull = first generatoin human type 5 recombinant adenovirus that expresses no cDNA; [...]