Immunotherapy after trauma: timing is essential

To address and summarize some key issues and recent insights into the use of immunomodulating interventions to prevent and treat inflammatory complications in trauma patients.

Immunomodulatory therapies are aimed at altering the systemic inflammatory response after trauma to prevent and treat the inflammatory complications a patient can develop after sustaining injuries. This inflammatory response induced by injury is a complex and dynamic process with multiple humoral and cellular cascades involved, which leads to large heterogeneity in clinical outcome. Effective solutions are, therefore, expected to influence all involved facets. Over the years, a large body of evidence has accumulated testing over a hundred of monoclonal antibodies, antiendotoxins and antioxidants. However recently, intervention studies testing such agents in a clinical setting have become sparse. The majority of the promising experimental therapeutic approaches for inflammatory complications that target the inflammatory response did not lead to changes in clinical practice.

More insight is needed in the pathology of systemic inflammation after trauma for selection of patients, optimal timing and therapy to address the mechanism underlying inflammatory complications.