Revisiting steroid treatment for septic shock: molecular actions and clinical effects--a review.
Corticosteroids are widely used to treat a diversity of pathological conditions including allergic, autoimmune and some infectious diseases. These drugs have complex mechanisms of action involving both genomic and non-genomic mechanisms and interfere with different signal transduction pathways in the cell. The use of corticosteroids to treat critically ill patients with acute respiratory distress syndrome and severe infections, such as sepsis and pneumonia, is still a matter of intense debate in the scientific and medical community with evidence both for and against its use in these patients. Here, we review the basic molecular mechanisms important for corticosteroid action as well as current evidence for their use, or not, in septic patients. We also present an analysis of the reasons why this is still such a controversial point in the literature.
Japiassú
André M
AM
Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz, Unidade de Terapia Intensiva, Instituto de Pesquisa Clínica Evandro Chagas-Fiocruz, 21045-900 Rio de Janeiro, Brasil.
Salluh
Jorge I F
JI
Bozza
Patrícia T
PT
Bozza
Fernando A
FA
Castro-Faria-Neto
Hugo C
HC
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D023281:Genomics; D006801:Humans; D007113:Immunity, Innate / Q000187:drug effects / Q000235:genetics; D018832:Molecular Chaperones / Q000187:drug effects / Q000235:genetics; D011965:Receptors, Glucocorticoid / Q000187:drug effects* / Q000235:genetics; D012128:Respiratory Distress Syndrome / Q000188:drug therapy*; D012772:Shock, Septic / Q000188:drug therapy*; D015533:Transcriptional Activation / Q000187:drug effects / Q000235:genetics
D000305:Adrenal Cortex Hormones; D018832:Molecular Chaperones; D011965:Receptors, Glucocorticoid