Experimental therapeutic strategies for severe sepsis: mediators and mechanisms.
Severe sepsis is the leading cause of mortality in intensive care units. The limited ability of current therapies to reduce sepsis mortality rates has fueled research efforts for the development of novel treatment strategies. Through the close collaboration between clinicians and scientists, progress can be seen in the struggle to develop effective therapeutic approaches for the treatment of sepsis and other immune and inflammatory disorders. Indeed, significant advances in intensive care, such as lung protective mechanical ventilation, improved antibiotics, and superior monitoring of systemic perfusion, are improving patient survival. Nonetheless, specific strategies that target the pathophysiological disorders in sepsis patients are essential to further improve clinical outcomes. This article reviews current clinical management approaches and experimental interventions that target pleiotropic or late-acting inflammatory mediators like caspases, C5a, MIF, and HMGB1, or the body's endogenous inflammatory control mechanisms such as the cholinergic anti-inflammatory pathway. These inflammatory mediators and anti-inflammatory mechanisms, respectively, show significant potential for the development of new experimental therapies for the treatment of severe sepsis and other infectious and inflammatory disorders.
Parrish
William R
WR
The Feinstein Institute for Medical Research, Manhasset, NY 11030, USA.
Gallowitsch-Puerta
Margot
M
Czura
Christopher J
CJ
Tracey
Kevin J
KJ
D000818:Animals; D017209:Apoptosis; D015936:Complement C5a / Q000378:metabolism; D005938:Glucocorticoids / Q000494:pharmacology; D024243:HMGB1 Protein / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000378:metabolism; D008263:Macrophage Migration-Inhibitory Factors / Q000378:metabolism; D008954:Models, Biological; D011486:Protein C / Q000378:metabolism; D018805:Sepsis / Q000188:drug therapy* / Q000378:metabolism
D005938:Glucocorticoids; D024243:HMGB1 Protein; D007328:Insulin; D008263:Macrophage Migration-Inhibitory Factors; D011486:Protein C; D015936:Complement C5a