Immunotherapy in the management of sepsis.
This work presents the role of Gram-negative bacteria endotoxins, pro- and anti-inflammatory cytokines and reactive oxygen species (ROS) in the complex and not fully explained pathogenesis of sepsis. The so-called "respiratory burst" of neutrophils and the antioxidant mechanisms of the host are also discussed. The work focuses on possible approaches to the management of sepsis connected with immunotherapy. Neutralization of endotoxin lipopolysaccharide (LPS), anti-tumor necrosis factor alpha (TNF-alpha) therapy with monoclonal antibodies or pentoxifylline (PTXF), as well as soluble recombinant cytokine agonists and antagonists used in clinical trials are taken into consideration. In addition, cytokine manipulation therapy, anti-adhesion techniques, glucocorticoides and antioxidant barrier interference are also described. So far there has been no immunotherapy of sepsis in children of proven clinical efficacy, which prompts an aggressive examination of the immune system aimed at affecting its function.
Sikora
Janusz Piotr
JP
Department of Pediatric Propedeutics, Institute of Pediatrics, Medical University of Lódź, Sporna 36/50, 91-738 Lódź, Poland.
D000818:Animals; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D002448:Cell Adhesion / Q000187:drug effects; D002648:Child; D016207:Cytokines / Q000819:agonists / Q000037:antagonists & inhibitors; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007167:Immunotherapy / Q000379:methods*; D010431:Pentoxifylline / Q000627:therapeutic use; D017382:Reactive Oxygen Species / Q000378:metabolism; D018805:Sepsis / Q000209:etiology / Q000276:immunology / Q000628:therapy*
D000911:Antibodies, Monoclonal; D000975:Antioxidants; D016207:Cytokines; D005938:Glucocorticoids; D017382:Reactive Oxygen Species; D010431:Pentoxifylline