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Removal of circulating tumor necrosis factor. Its role in septic shock treatment
B Janbon1, J P Vuillez, F Carpentier
1Service de Réanimation Médicale, CHU, BP 217X, Grenoble.
Abstract:
The tumor necrosis factor (TNF) is a polypeptide secreted by macrophages in response to endotoxins, especially from Gram-negative bacteria. Previous investigations suggest that TNF plays a prominent role in septic shock and meningococcal disease toxicity. A positive correlation was found between the initial serum TNF level and the patient's outcome. Despite the progress made in intensive care management and antibiotic therapy, the prognosis of septic shock remains very poor. Because of the implication of TNF in the pathogenesis of septic shock, we suggest that neutralization or elimination of this cytokine by plasma or blood exchanges could contribute to the treatment of severe forms of this syndrome. Five plasma exchanges and two blood exchanges were performed in 6 patients admitted for septic shock or purpura fulminans. Serum TNF levels were measured by immunoradiometric assay (Medgenix, ERIA Pasteur) before and after exchange. Serum TNF levels were found to be decreased by an average of 62% after the exchange. We conclude that exchange therapies are efficient in removing plasma TNF. Nevertheless, because of the limited number of patients treated, it is not possible to evaluate the clinical efficacy of such techniques.
Insights
Exchange therapies effectively reduced tumor necrosis factor (TNF) levels in patients with severe septic shock. This cytokine removal may offer a new treatment avenue for this critical condition.
Area of Science:
- Immunology
- Critical Care Medicine
- Infectious Diseases
Background:
- Tumor necrosis factor (TNF) is a key inflammatory cytokine implicated in septic shock pathogenesis.
- High initial serum TNF levels correlate with poor patient outcomes in sepsis.
- Current intensive care and antibiotic therapies offer limited improvement for septic shock prognosis.
Purpose of the Study:
- To investigate the efficacy of plasma and blood exchanges in reducing serum TNF levels in patients with severe septic shock.
- To explore exchange therapy as a potential treatment for severe septic shock and purpura fulminans.
Main Methods:
- Six patients with septic shock or purpura fulminans underwent a total of five plasma exchanges and two blood exchanges.
- Serum TNF levels were quantified using an immunoradiometric assay before and after each exchange procedure.
Main Results:
- Exchange therapies resulted in a significant average reduction of 62% in serum TNF levels.
- The procedures demonstrated efficiency in removing TNF from the plasma.
Conclusions:
- Plasma and blood exchanges are effective in reducing circulating TNF levels.
- While efficient in TNF removal, the clinical efficacy of exchange therapies for septic shock requires further investigation due to the small patient cohort.