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McBride MA, Patil TK, Bohannon JK, Hernandez A, Sherwood ER, Patil NK. Immune Checkpoints: Novel Therapeutic Targets to Attenuate Sepsis-Induced Immunosuppression. Front Immunol 2021; 11:624272. [PMID: 33613563 PMCID: PMC7886986 DOI: 10.3389/fimmu.2020.624272] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Sepsis is a leading cause of death in intensive care units and survivors develop prolonged immunosuppression and a high incidence of recurrent infections. No definitive therapy exists to treat sepsis and physicians rely on supportive care including antibiotics, intravenous fluids, and vasopressors. With the rising incidence of antibiotic resistant microbes, it is becoming increasingly critical to discover novel therapeutics. Sepsis-induced leukocyte dysfunction and immunosuppression is recognized as an important contributor towards increased morbidity and mortality. Pre-clinical and clinical studies show that specific cell surface inhibitory immune checkpoint receptors and ligands including PD-1, PD-L1, CTLA4, BTLA, TIM3, OX40, and 2B4 play important roles in the pathophysiology of sepsis by mediating a fine balance between host immune competency and immunosuppression. Pre-clinical studies targeting the inhibitory effects of these immune checkpoints have demonstrated reversal of leukocyte dysfunction and improved host resistance of infection. Measurement of immune checkpoint expression on peripheral blood leukocytes may serve as a means of stratifying patients to direct individualized therapy. This review focuses on advances in our understanding of the role of immune checkpoints in the host response to infections, and the potential clinical application of therapeutics targeting the inhibitory immune checkpoint pathways for the management of septic patients.
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Affiliation(s)
- Margaret A. McBride
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Tazeen K. Patil
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Julia K. Bohannon
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Edward R. Sherwood
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, United States
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Naeem K. Patil
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, United States
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Nazareth R, Chasqueira MJ, Rodrigues ML, Paulino C, Conceição C, Lêdo L, Segura Ú, Santos M, Messias A, Póvoa P, Paixão P. Respiratory viruses in mechanically ventilated patients: a pilot study. BMC Pulm Med 2020; 20:39. [PMID: 32054471 PMCID: PMC7020345 DOI: 10.1186/s12890-020-1082-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 02/07/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Respiratory virome is an integral part of the human microbiome and its characterization may contribute to a better understanding of the changes that arise in the disease and, consequently, influence the approach and treatment of patients with acute lower respiratory infections. The aim of this study was to evaluate the presence of respiratory viruses in the lower airways of individuals undergoing invasive mechanical ventilation, with and without acute lower respiratory infection (respectively WRI and WORI groups). METHODS We studied 44 mini-bronchoalveolar lavage samples (collected with a double catheter, Combicath® kit) from patients with mean age in the seventh decade, 20 from WORI group and 24 from WRI group, who were hospitalized for acute respiratory failure in Intensive Care Units of two hospitals in the Lisbon area. Real-time PCR was applied to verify analyse the presence of 15 common respiratory viruses (adenovirus, human bocavirus, influenza virus A and B, repiratory syncytial virus, human parainfluenza virus types 1, 2, 3 and 4, human enterovirus, human rhinovirus, human metapneumovirus, human coronavirus group 1 (229E, NL63) and 2 (OC43, HKU1). RESULTS Respiratory viruses were detected in six of the 20 patients in the WORI group: influenza AH3 (n = 2), parainfluenza virus 1/3 (n = 2), human rhinovirus (n = 2), respiratory syncytial virus (n = 1) and human metapneumovirus (n = 1). In the WRI group, respiratory viruses were detected in 12 of the 24 patients: influenza AH3 (n = 3), human rhinovirus (n = 3), respiratory syncytial virus (n = 3), human metapneumovirus (n = 3), human bocavirus (n = 2) and human enterovirus (n = 1). Simultaneous detection of two viruses was recorded in two samples in both groups. CONCLUSIONS The results of this study suggest the presence of common respiratory viruses in the lower respiratory tract without causing symptomatic infection, even in carefully collected lower samples. This may have important implications on the interpretation of the results on the diagnostic setting.
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Affiliation(s)
- Raquel Nazareth
- Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal. .,Centro de Estudos de Doenças Crónicas, CEDOC, Faculdade de Ciências Médicas
- NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.
| | - Maria-Jesus Chasqueira
- Centro de Estudos de Doenças Crónicas, CEDOC, Faculdade de Ciências Médicas
- NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Maria-Lúcia Rodrigues
- Centro de Estudos de Doenças Crónicas, CEDOC, Faculdade de Ciências Médicas
- NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal
| | - Carolina Paulino
- Hospital São Francisco de Xavier, Estrada Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Catarina Conceição
- Hospital São Francisco de Xavier, Estrada Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Lia Lêdo
- Hospital São Francisco de Xavier, Estrada Forte do Alto Duque, 1449-005, Lisbon, Portugal
| | - Úrsula Segura
- Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal
| | - Madalena Santos
- Hospital Curry Cabral, Centro Hospitalar de Lisboa Central, Rua da Beneficiência n° 8, 1069-166, Lisbon, Portugal
| | - António Messias
- Hospital Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514, Loures, Portugal
| | - Pedro Póvoa
- Centro de Estudos de Doenças Crónicas, CEDOC, Faculdade de Ciências Médicas
- NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Hospital São Francisco de Xavier, Estrada Forte do Alto Duque, 1449-005, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Paulo Paixão
- Centro de Estudos de Doenças Crónicas, CEDOC, Faculdade de Ciências Médicas
- NOVA Medical School, Campo Mártires da Pátria, 130, 1169-056, Lisbon, Portugal.,Clinical Pathology Laboratory (Synlab), Hospital da Luz, Av Lusíada, 100, 1500-650, Lisbon, Portugal
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Patil NK, Guo Y, Luan L, Sherwood ER. Targeting Immune Cell Checkpoints during Sepsis. Int J Mol Sci 2017; 18:ijms18112413. [PMID: 29135922 PMCID: PMC5713381 DOI: 10.3390/ijms18112413] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 11/10/2017] [Accepted: 11/12/2017] [Indexed: 12/17/2022] Open
Abstract
Immunosuppression is increasingly being recognized as one of the causes of increased morbidity and mortality during sepsis. Both innate and adaptive immune system dysfunction have been shown to cause an impaired ability to eradicate the primary infection and also lead to frequent occurrence of secondary opportunistic infections. Pre-clinical and clinical studies have shown that inhibitory immune checkpoint molecules, including programmed death-1 (PD-1), programmed death ligand-1 (PD-L1), cytotoxic T lymphocyte antigen-4 (CTLA-4), T cell membrane protein-3 (TIM-3), Lymphocyte activation-gene-3 (LAG-3) and 2B4, are upregulated during the course of sepsis. Engagement of these inhibitory molecules on various immune cells has been consistently shown to inhibit innate immune cell functions (e.g., phagocytosis, cytokine production and pathogen clearance) and also lead to impaired T cell competence. In numerous pre-clinical models of sepsis, therapeutic agents aimed at blocking engagement of inhibitory immune checkpoints on immune cells have been shown to improve innate and adaptive immune cell functions, increase host resistance to infection and significantly improve survival. Therefore, immunotherapy with immune cell checkpoint inhibitors holds significant potential for the future of sepsis therapy and merits further investigation.
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Affiliation(s)
- Naeem K Patil
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Yin Guo
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Liming Luan
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Edward R Sherwood
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Shin J, Jin M. Potential Immunotherapeutics for Immunosuppression in Sepsis. Biomol Ther (Seoul) 2017; 25:569-577. [PMID: 29081088 PMCID: PMC5685425 DOI: 10.4062/biomolther.2017.193] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 10/10/2017] [Accepted: 10/10/2017] [Indexed: 12/14/2022] Open
Abstract
Sepsis is a syndrome characterized by systemic inflammatory responses to a severe
infection. Acute hyper-inflammatory reactions in the acute phase of sepsis have been
considered as a primary reason for organ dysfunction and mortality, and advances in
emergency intervention and improved intensive care management have reduced
mortalities in the early phase. However it has been recognized that increased deaths
in the late phase still maintain sepsis mortality high worldwide. Patients recovered
from early severe illness are unable to control immune system with sepsis-induced
immunosuppression such as immunological tolerance, exhaustion and apoptosis, which
make them vulnerable to nosocomial and opportunistic infections ultimately leading to
threat to life. Based on strategies to reverse immunosuppression, recent developments
in sepsis therapy are focused on molecules having immune enhancing activities. These
efforts are focused on defining and revising the immunocompromised status associated
with long-term mortality.
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Affiliation(s)
- Jinwook Shin
- Department of Microbiology, College of Medicine, Inha University, Incheon 22212, Republic of Korea
| | - Mirim Jin
- Department of Microbiology, College of Medicine, Gachon University, Incheon 21999, Republic of Korea
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Patil NK, Bohannon JK, Sherwood ER. Immunotherapy: A promising approach to reverse sepsis-induced immunosuppression. Pharmacol Res 2016; 111:688-702. [PMID: 27468649 DOI: 10.1016/j.phrs.2016.07.019] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 07/14/2016] [Indexed: 12/11/2022]
Abstract
Sepsis is defined as life-threatening organ dysfunction caused by dysregulated host responses to infection (Third International Consensus definition for Sepsis and septic shock). Despite decades of research, sepsis remains the leading cause of death in intensive care units. More than 40 clinical trials, most of which have targeted the sepsis-associated pro-inflammatory response, have failed. Thus, antibiotics and fluid resuscitation remain the mainstays of supportive care and there is intense need to discover and develop novel, targeted therapies to treat sepsis. Both pre-clinical and clinical studies over the past decade demonstrate unequivocally that sepsis not only causes hyper-inflammation, but also leads to simultaneous adaptive immune system dysfunction and impaired antimicrobial immunity. Evidences for immunosuppression include immune cell depletion (T cells most affected), compromised T cell effector functions, T cell exhaustion, impaired antigen presentation, increased susceptibility to opportunistic nosocomial infections, dysregulated cytokine secretion, and reactivation of latent viruses. Therefore, targeting immunosuppression provides a logical approach to treat protracted sepsis. Numerous pre-clinical studies using immunomodulatory agents such as interleukin-7, anti-programmed cell death 1 antibody (anti-PD-1), anti-programmed cell death 1 ligand antibody (anti-PD-L1), and others have demonstrated reversal of T cell dysfunction and improved survival. Therefore, identifying immunosuppressed patients with the help of specific biomarkers and administering specific immunomodulators holds significant potential for sepsis therapy in the future. This review focusses on T cell dysfunction during sepsis and discusses the potential immunotherapeutic agents to boost T cell function during sepsis and improve host resistance to infection.
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Affiliation(s)
- Naeem K Patil
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Julia K Bohannon
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Edward R Sherwood
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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Viitanen SJ, Lappalainen A, Rajamäki MM. Co-infections with respiratory viruses in dogs with bacterial pneumonia. J Vet Intern Med 2015; 29:544-51. [PMID: 25818209 PMCID: PMC4895503 DOI: 10.1111/jvim.12553] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Revised: 12/27/2014] [Accepted: 01/19/2015] [Indexed: 12/15/2022] Open
Abstract
Background Bacterial pneumonia (BP) is an inflammation of the lower airways and lung parenchyma secondary to bacterial infection. The pathogenesis of BP in dogs is complex and the role of canine respiratory viruses has not been fully evaluated. Objectives The aim of this study was to investigate the occurrence of viral co‐infections in dogs with BP and to assess demographic or clinical variables as well as disease severity associated with viral co‐infections. Animals Twenty household dogs with BP caused by opportunistic bacteria and 13 dogs with chronic (>30 days) tracheobronchitis caused by Bordetella bronchiseptica (BBTB). Methods Prospective cross‐sectional observational study. Diagnosis was confirmed by clinical and laboratory findings, diagnostic imaging, and cytologic and microbiologic analysis of bronchoalveolar lavage or transtracheal wash fluid. Canine parainfluenza virus (CPIV), canine adenovirus, canine herpes virus, canine influenzavirus, canine distemper virus, canine respiratory coronavirus (CRCoV) and canine pneumovirus, as well as B. bronchiseptica and Mycoplasma spp. were analyzed in respiratory samples using PCR assays. Results CPIV was detected in 7/20 and CRCoV in 1/20 dogs with BP. Respiratory viruses were not detected in dogs with BBTB. There were no significant differences in clinical variables between BP dogs with and without a viral co‐infection. Conclusion and Clinical Importance Respiratory viruses were found frequently in dogs with BP and may therefore play an important role in the etiology and pathogenesis of BP. Clinical variables and disease severity did not differ between BP dogs with and without viral co‐infection.
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Affiliation(s)
- S J Viitanen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Ahn MY, Choi SH, Chung JW, Kim HR. Utilization of the respiratory virus multiplex reverse transcription-polymerase chain reaction test for adult patients at a Korean tertiary care center. Korean J Intern Med 2015; 30:96-103. [PMID: 25589841 PMCID: PMC4293570 DOI: 10.3904/kjim.2015.30.1.96] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 04/13/2014] [Accepted: 04/30/2014] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIMS Respiratory viruses (RVs) are considered to be important respiratory pathogens in adult patients, and the multiplex reverse transcription-polymerase chain reaction (RT-PCR) test is used frequently in adult patients with respiratory infections. However, clinical data regarding utilization of the multiplex RT-PCR test for RVs are lacking. METHODS We investigated the utilization of the multiplex RT-PCR test for RVs at Chung-Ang University Hospital in Seoul, Korea, between January 2012 and April 2013. RESULTS During the study period, the multiplex RT-PCR test was performed for 291 adult patients. The test frequency was 4.9% of rapid influenza antigen detection tests and 0.8% of respiratory bacterial culture studies. A turnaround time of < 48 hours was observed in 25.9% of positive tests. Most of the tests were performed for admitted patients (97.9%) with a community-acquired infection (84.2%) during the flu season (82.5%). RVs were detected in 81 of 291 cases (27.8%). The RV positivity rates for community- and hospital-acquired infections did not differ (28.6% vs. 23.9%, p = 0.52). Of 166 patients with pneumonia, 44 (26.5%) had a viral infection. Among the patients with RV-associated pneumonia, an RV other than influenza was detected in 20 patients (45.4%). CONCLUSIONS The multiplex RT-PCR test for RVs was infrequently performed at a tertiary care center, and the test results were often reported late. The test was most often performed for admitted adult patients with community-acquired infections during the flu season. The utilization of multiplex RT-PCR testing for RVs in current clinical practice should be improved.
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Affiliation(s)
- Mi Young Ahn
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Seong-Ho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jin-Won Chung
- Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hye Ryoun Kim
- Department of Laboratory Medicine, Chung-Ang University Hospital, Seoul, Korea
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8
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Lucena CM, Torres A, Rovira M, Marcos MA, de la Bellacasa JP, Sánchez M, Domingo R, Gabarrus A, Mensa J, Agustí C. Pulmonary complications in hematopoietic SCT: a prospective study. Bone Marrow Transplant 2014; 49:1293-9. [PMID: 25046219 PMCID: PMC7094728 DOI: 10.1038/bmt.2014.151] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 05/25/2014] [Accepted: 06/03/2014] [Indexed: 01/04/2023]
Abstract
Pulmonary complications are common and often lethal in hematopoietic SCT recipients. The objective of this prospective interventional study was to evaluate the etiology, diagnostic procedures, risk factors and outcome of pulmonary complications in a cohort of hematopoietic SCT recipients followed up for 1 year. For patients suffering from a pulmonary complication, a diagnostic algorithm that included non-invasive and bronchoscopic procedures was performed. We identified 73 pulmonary complications in 169 patients: 50 (68%) were pneumonias; 21 (29%) were non-infectious complications and 2 (3%) were undiagnosed. Viruses (particularly Rhinovirus) and bacteria (particularly P. aeruginosa) (28 and 26%, respectively) were the most common causes of pneumonia. A specific diagnosis was obtained in 83% of the cases. A non-invasive test gave a specific diagnosis in 59% of the episodes. The diagnostic yield of bronchoscopy was 67 and 78% in pulmonary infections. Early bronchoscopy (⩽5 days) had higher diagnostic yield than late bronchoscopy (78 vs 23%; P=0.02) for pulmonary infections. Overall mortality was 22 and 32% of all fatalities were due to pulmonary complications. Pulmonary complications are common and constitute an independent risk factor for mortality, stressing the importance of an appropriate clinical management.
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Affiliation(s)
- C M Lucena
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Torres
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [3] University of Barcelona, Barcelona, Spain [4] Centro de Investigación Biomédica En Red de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - M Rovira
- 1] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [2] HSCT unit, Hematology Department, Hospital Clínic, Barcelona, Spain
| | - M A Marcos
- Microbiology Department, Hospital Clínic, Barcelona, Spain
| | | | - M Sánchez
- 1] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [2] Radiology Department, Hospital Clínic, Barcelona, Spain
| | - R Domingo
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - A Gabarrus
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - J Mensa
- 1] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain [2] Infectious Diseases Department, Hospital Clínic, Barcelona, Spain
| | - C Agustí
- 1] Pneumology Department, Hospital Clínic, Barcelona, Spain [2] Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Hutchins NA, Unsinger J, Hotchkiss RS, Ayala A. The new normal: immunomodulatory agents against sepsis immune suppression. Trends Mol Med 2014; 20:224-33. [PMID: 24485901 DOI: 10.1016/j.molmed.2014.01.002] [Citation(s) in RCA: 180] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 12/30/2013] [Accepted: 01/03/2014] [Indexed: 12/15/2022]
Abstract
Sepsis is the leading cause of death among critically ill patients in intensive care units, and treatment options are limited. Therapies developed against the proinflammatory stage have failed clinically; therefore, new approaches that target the host immune response in sepsis are necessary. Increasing evidence suggests that a major pathophysiological event in sepsis is immune suppression, often resulting in secondary fungal, bacterial, or viral infections. Recent studies from animal sepsis models and patient samples suggest that cytokines such as interleukin-7 (IL-7), IL-15, granulocyte macrophage colony-stimulating factor (GM-CSF), as well as co-inhibitory molecule blockade, such as anti-programmed cell death receptor-1 (anti-PD-1) and anti-B and T lymphocyte attenuator (anti-BTLA), may have utility in alleviating the clinical morbidity associated with sustained sepsis. This review discusses some of these novel immunomodulatory agents and evaluates their potential use as therapeutics.
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Affiliation(s)
- Noelle A Hutchins
- Division of Surgical Research, Rhode Island Hospital, Providence, RI 02903, USA
| | - Jacqueline Unsinger
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Richard S Hotchkiss
- Department of Anesthesiology, Washington University in St Louis, St Louis, MO 63110, USA
| | - Alfred Ayala
- Division of Surgical Research, Rhode Island Hospital, Providence, RI 02903, USA.
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Hess DR, Thompson BT, Slutsky AS. Update in acute respiratory distress syndrome and mechanical ventilation 2012. Am J Respir Crit Care Med 2013; 188:285-92. [PMID: 23905523 DOI: 10.1164/rccm.201304-0786up] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dean R Hess
- Respiratory Care, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA.
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Affiliation(s)
- Jordi Rello
- Critical Care Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institute of Research, CIBERES, Universitat Autonoma de Barcelona, Barcelona, Spain
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