title: Immunotherapy of Sepsis: Blind Alley or Call for Personalized Assessment?
abstract: Sepsis is the most frequent cause of death in noncoronary intensive care units. In the past 10 years, progress has been made in the early identification of septic patients and their treatment. These improvements in support and therapy mean that mortality is gradually decreasing, however, the rate of death from sepsis remains unacceptably high. Immunotherapy is not currently part of the routine treatment of sepsis. Despite experimental successes, the administration of agents to block the effect of sepsis mediators failed to show evidence for improved outcome in a multitude of clinical trials. The following survey summarizes the current knowledge and results of clinical trials on the immunotherapy of sepsis and describes the limitations of our knowledge of the pathogenesis of sepsis. Administration of immunomodulatory drugs should be linked to the current immune status assessed by both clinical and molecular patterns. Thus, a careful daily review of the patient's immune status needs to be introduced into routine clinical practice giving the opportunity for effective and tailored use of immunomodulatory therapy.
authors.affiliation: Department of Clinical Biochemistry, Hematology and Immunology, Hospital Na Homolce, Prague, Czech Republic. miroslav.prucha@homolka.cz.
authors.forename: Miroslav
authors.initials: M
authors.lastname: Prucha
authors.affiliation: Department of Anesthesiology and Intensive Care, First Faculty of Medicine, Charles University in Prague and Thomayer Hospital, Prague, Czech Republic.
authors.forename: Roman
authors.initials: R
authors.lastname: Zazula
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital, Jena, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Russwurm
mesh_terms: D000305:Adrenal Cortex Hormones / Q000378:metabolism; D000818:Animals; D017209:Apoptosis; D015415:Biomarkers / Q000737:chemistry; D016207:Cytokines / Q000037:antagonists & inhibitors; D023281:Genomics / Q000379:methods; D005838:Genotype; D006801:Humans; D007107:Immune System; D016756:Immunoglobulins, Intravenous / Q000276:immunology / Q000627:therapeutic use; D007165:Immunosuppression Therapy; D007167:Immunotherapy / Q000379:methods*; D007249:Inflammation; D007362:Intensive Care Units; D036341:Intercellular Signaling Peptides and Proteins / Q000378:metabolism; D010641:Phenotype; D057285:Precision Medicine / Q000379:methods*; D040901:Proteomics / Q000379:methods; D018805:Sepsis / Q000276:immunology* / Q000503:physiopathology / Q000628:therapy; D051193:Toll-Like Receptors / Q000378:metabolism
chemical_list: D000305:Adrenal Cortex Hormones; D015415:Biomarkers; D016207:Cytokines; D016756:Immunoglobulins, Intravenous; D036341:Intercellular Signaling Peptides and Proteins; D051193:Toll-Like Receptors
keywords: Genomics; Immune mechanisms; Immunomodulatory therapy; Immunosuppression; Proteomics; Sepsis