Koike Kaoru, Sekine Kazuhiko, Endo Tomoyuki, Nomura Ryosuke, Shinozawa Yotaro
Department of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
Nihon Geka Gakkai Zasshi. 2003 Nov;104(11):800-4.
When new immunomodulatory agents are developed for the treatment of sepsis, the efficacy is usually tested in animal models before going to clinical trials. However, despite promising preclinical evidence, dozens of new agents have failed to demonstrate clinical efficacy. One of the reasons may be that the preclinical trials were conducted using animal models that did not adequately reflect clinical realities. Various kinds of experiments utilized for the development of new agents were carried where bolus or short term continuous infusions of large doses of bacteria or endotoxin were administered intravenously. Massive i.v. bolus models using bacteria or endotoxin generally produce a rapid hypodynamic cardiovascular response with the animals dying within hours. The serum cytokine response is transient and is much greater in magnitude than that observed in septic patients. For the preclinical testing of agents, 1) i.v. bacteria and endotoxin models in which the total challenge dose of adequate bacteria or endotoxin is reduced and/or the length of administration time is increased, and 2) peritonitis models, e.g., cecal ligation and puncture and peritoneal implantation of bacteria or endotoxin, will become reasonable choices. The animals are also required to receive volume resuscitation and adjuvant antibiotic therapy.
当开发用于治疗脓毒症的新型免疫调节药物时,通常会在进行临床试验之前在动物模型中测试其疗效。然而,尽管临床前证据很有前景,但数十种新型药物未能证明其临床疗效。原因之一可能是临床前试验是使用不能充分反映临床实际情况的动物模型进行的。在开发新型药物的过程中进行了各种实验,其中静脉内给予大剂量细菌或内毒素的推注或短期持续输注。使用细菌或内毒素的大量静脉推注模型通常会产生快速的低动力心血管反应,动物会在数小时内死亡。血清细胞因子反应是短暂的,其强度比脓毒症患者中观察到的要大得多。对于药物的临床前测试,1)静脉内细菌和内毒素模型,其中适当细菌或内毒素的总挑战剂量降低和/或给药时间延长,以及2)腹膜炎模型,例如盲肠结扎和穿刺以及细菌或内毒素的腹膜植入,将成为合理的选择。动物还需要接受容量复苏和辅助抗生素治疗。