Prograf (tacrolimus) vs hydroxychloroquine for stubborn high Cytokines and NK


1 Posts
Reply Posted on: Jul 20, 2017 at 6:51am
I am looking for any information and feedback re persistent immune issues (persistently high cytokines (TH1/Th2) and high NK cells). I have always had Cytokines (Tnf/IL10) over 35 (even 42) with correspondingly high IFN/IL10 (20+) and NK cells (also high CD56). I took Humira, however, after two shots in May/June my Cytokines shot up to over 51 (!) and all other markers too (I understand this is a Humira flare-up effect). I now took a second 2x shots of Humira (+ intralipids) and awaiting test results for my cytokines test. If they dont get below 30 for (Tnf/IL10) and below 20 for IFN/IL10 then we need to go to next steps -- which is either hydroxychloroquine (Plaquenil) OR Prograf (tacrolimus). (My KIR is normal, am MTHFR C665c&amp;gt;T heterozygote, PAI 4G/5G Polymorphism Homozygous mutated 4G/4G genotype, but all other immunology negative (thrombophilic ratios, Factor V Leiden, ANA, Antiphospholipid, etc)). I am 43, <u>using donor sperm</u>, never been pregnant, never had an embryo transfer because in last 3 years over 5 IVFs, having produced 45 eggs and 26 Day 5 blastocysts only 1 (!) was euploid (all were NGS tested). I then managed to get another euplouid embryo using some frozen eggs from when I was 37, so today have 2 euploid embryos ready for FET). I also had an ERA test done (endometrial receptivity test) and it was normal for Day 5 transfers, lining at 9.5mm was normal at this mock-FET transfer.

Dear Dr Braverman, can you please share your experience on either or both of these drugs? how do you take them? How often/how long? with what effect/success in lowering cytokines/NK cells? What are the side effects and are there any studies on long term results/pregnancy/baby effects? do you take them during pregnancy too? I understand Prograf works faster than hydroxychloroquine - do you have any preference and why? Due to my work and other issues I would like to move faster (been trying to resolve the high cytokines for last two years already - e.g. was diagnosed with chronic Lyme, went through huge antibiotics and alternative program, incl Ayurveda, etc - some success re Lyme results, but zero re lowering inflammatory markers which fluctuate mainly with my stress levels, but are always high or very high. I suffer from persistent, unexplained lower back pain and terrible insomnia (adrenal exhaustion), but otherwise am "healthy" (e.g. no obvious auto-immune issues like Hashimotos (only mildly underactive Thyroid), IBS, etc), sporty, active, eat extremely healthy, non-smoker, etc). Obviously for the FET we will add all of the other cocktail of drugs (clexane/lovenox, prednisol, progesterone, etc and also IVIG as I already had intralipids). IS THERE ANYTHING ELSE in the arsenal of inflammation lowering drugs other than the above which could be available to me? (I understand HLA-DQ Alpha and LAD testing and LIT isnt that relevant for me, because I am using donor sperm (and never been pregnant), but I appreciate your thoughts on that please.)

I only have 2 euploid embryos (frozen) and cant produce anymore new ones, so I HAVE to do all I can to have the best chances for implantation and successful pregnancy at my first FET. If that is unsuccesfful I would consider using a surrogate for the second embryo but that is extremely difficult as a single woman in UK and I also cant afford it. So I need to get it right at the first shot. Any suggestions and feedback welcome.

Thank you

Dr. Braverman

2026 Posts
RE: Prograf (tacrolimus) vs hydroxychloroquine for stubborn high Cytokines and NK Posted on: Jul 20, 2017 at 7:35am
The immune testing you have had to date is far to inadequate to draw any conclusions about correct treatment. Based on this testing treatments are merely speculation and I beleive other important issues are being missed. I suggest you fill out a consult form on my website and we can schedule a free phone or SKYPE consult so I can reveiw your case in detail. I can assist you in the UK and have many patients there. But the immunology care in the UK at this point is many years behind current knowledge.
Dr. Jeffrey Braverman MD FACOG
Medical Director
Braverman Reproductive Immunology P.C.