Role of hematopoietic growth factors in non-neutropenic infections and sepsis.
Therapy with colony-stimulating factors has been extended beyond their use in accelerating myeloid cell recovery to take advantage of their immune function-enhancing properties. Studies in animal models and with human subjects suggest a potential role as adjunctive therapy in infections of non-neutropenic hosts, including those with sepsis. Granulocyte colony-stimulating factor may play a pivotal role in the induction of lipopolysaccharide desensitization by nontoxic lipid A analogues proposed for the prevention of sepsis; granulocyte macrophage colony-stimulating factor may be useful in reversing the immune paralysis described in later stages of sepsis. Significant issues of exogenous colony-stimulating factor therapy must be addressed, however: the optimal timing, dose, and clinical context (e.g., type of immunosuppression, duration of infection-inciting stimulus) as well as tissue-specificity of the activities and net effect of potentially conflicting responses (e.g., immune restorative and procoagulant effects of granulocyte macrophage colony-stimulating factor). Resolution of these issues will require carefully designed clinical studies with meticulous monitoring of immunologic parameters.
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Klinik für Innere Medizin mit Schwepunkt Hämatologic und Onkologie, Charite, Berlin, Germany.
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D000818:Animals; D001424:Bacterial Infections / Q000517:prevention & control*; D016179:Granulocyte Colony-Stimulating Factor / Q000502:physiology; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000502:physiology; D016298:Hematopoietic Cell Growth Factors / Q000502:physiology*; D006801:Humans; D016173:Macrophage Colony-Stimulating Factor / Q000502:physiology; D009503:Neutropenia / Q000517:prevention & control; D018805:Sepsis / Q000517:prevention & control*
D016298:Hematopoietic Cell Growth Factors; D016179:Granulocyte Colony-Stimulating Factor; D016173:Macrophage Colony-Stimulating Factor; D016178:Granulocyte-Macrophage Colony-Stimulating Factor