[Mediators and antagonists in therapy of multiple trauma. Reliable outcome or wishful thinking?]

The response of the immune system to any trauma starts at the moment of injury. Macrophages are activated and produce proinflammatory mediators. All the stimuli of the cytokine system lead to a final common pathway where a therapeutic approach might start. However, any strategy of cytokine therapy cuts both ways. There are a lot of data derived from in vitro and animal studies. Both the classification and the clinical application of these results are rather difficult. Some therapeutic concepts seem promising, but the advantages and disadvantages have to be carefully considered. The aim of all strategies must be to improve or adjust the patient's immune defence system. First of all, the patient, the disease or the specific injury has to be treated, not only the mediators and cytokines. The philosopher's stone has not been found yet. There are several approaches, but it is still a long and difficult process to find new insights and effective treatments.