Journal List > J Korean Med Assoc > v.49(7) > 1080670

Kim and Kim: The Efficacy of Immunomodulators in the Treatment of Sepsis

Abstract

Sepsis is defined as the presence of pathogenic microorganisms or their toxins in tissues or in the blood. It can be accompanied by multi-organ failure and can potentially lead to death if not treated properly. The pathogenesis of sepsis is related not only to the activation of inflammatory pathways but also to an immunodepressed state. The modulation of the host response to infection has been studied as an adjunctive therapeutic approach in many preclinical investigations and clinical trials. However, there are several limitations of immunomodulators currently in use for those studies. A review of the major clinical trials of immunomodulatory therapies in sepsis provides a perspective on the reasons why such approaches have failed to show benefits. Above all, the criteria for patient inclusion have not considered the timing of administration of immunomodulators, the infected organisms, the site of infections, and the monitoring of immune competence. These might have contributed to the negative results of clinical trials conducted thus far. Therefore, future studies addressing these factors may demonstrate a beneficial role of immunomodulatory therapies in well-defined groups of patients with severe infection.

Figures and Tables

Figure 1
Proinflammatory and anti-inflammatory events during sepsis
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Figure 2
Proinflammatory and anti-inflammatory mechanisms during infection
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Table 1
Immunomodulatory therapies examined in sepsis
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References

1. Masihi KN. Immunomodulatory agents for prophylaxis and therapy of infections. Int J Antimicrob Agents. 2000. 14:181–191.
crossref
2. Van der Poll T. Immunotherapy of sepsis. Lancet Infect Dis. 2001. 1:165–174.
crossref
3. Abraham E. Why immunomodulatory therapies have not worked in sepsis. Intensive Care Med. 1999. 25:556–566.
crossref
4. Kox WJ, Volk T, Kox SN, Volk HD. Immunomodulatory therapies in sepsis. Intensive Care Med. 2000. 26:Suppl 1. S124–S128.
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