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[Special therapeutic approaches for interrupting the cascade--from systemic inflammatory response syndrome to
H Bartels1, N Zantl, B Holzmann
1Chirurgische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München.
Abstract:
SIRS, sepsis and MOF are clinical sequelae related to persistent, uncontrolled inflammation. Therefore, different strategies for treatment were designed to block the cascade from SIRS to MOF (anti-inflammatory therapies). However, clinical trials using these agents have failed to demonstrate any benefit. In sepsis the body also mounts an anti-inflammatory response, which has been largely ignored. If the anti-inflammatory reaction is sufficiently severe, we might increase the susceptibility to infection or even exacerbate immunosuppression by using anti-inflammatory agents. In contrast, agents to stimulate the immune system--like IFN-gamma or G-SCF--may prove beneficial.
Insights
Treating severe systemic inflammation (SIRS) and sepsis with anti-inflammatory drugs has failed. Stimulating the immune system may be a more effective strategy for treating these inflammatory conditions.
Area of Science:
- Immunology
- Critical Care Medicine
Context:
- Systemic inflammatory response syndrome (SIRS), sepsis, and multiple organ failure (MOF) are critical conditions stemming from uncontrolled inflammation.
- Current therapeutic strategies focus on anti-inflammatory treatments to halt the progression from SIRS to MOF.
- Clinical trials of anti-inflammatory agents have yielded disappointing results, indicating a need for alternative approaches.
Purpose:
- To re-evaluate the role of the anti-inflammatory response in sepsis.
- To explore the potential of immune-stimulating agents as a therapeutic strategy for SIRS and sepsis.
Summary:
- The body's own anti-inflammatory response during sepsis has been largely overlooked.
- Overly aggressive anti-inflammatory therapies may worsen immunosuppression and increase infection susceptibility.
- Immune-stimulating agents, such as interferon-gamma (IFN-gamma) and granulocyte colony-stimulating factor (G-CSF), show promise for treating sepsis.
Impact:
- This research suggests a paradigm shift in sepsis treatment, moving away from broad anti-inflammatory approaches.
- Identifying the benefits of immune stimulation could lead to novel therapeutic agents for critical inflammatory conditions.
- Understanding the dual inflammatory and anti-inflammatory responses in sepsis is crucial for developing effective treatments.