Harjai M, Bogra J, Kohli M, Pant A B
Department of Anesthesilogy, Chhatrapati Shahuji Maharaj Medical University, Lucknow, Uttar Pradesh, India.
Anaesth Intensive Care. 2013 Mar;41(2):175-83. doi: 10.1177/0310057X1304100207.
Sepsis remains as a leading cause of death in critically ill patients. Unfortunately, there have been very few successful specific therapeutic agents that can significantly reduce the attributable mortality and morbidity of sepsis. Developing novel therapeutic strategies to improve outcomes of sepsis remains an important focus of ongoing research in the field of critical care medicine. Apoptosis has recently been identified as an important mechanism of cell death and evidence suggests that prevention of cell apoptosis can improve survival in animal models of sepsis and endotoxaemia. In this review article, we summarise the critical role of apoptosis of the immune cells in the pathophysiology of sepsis and propose that blocking cell-signaling pathways leading to apoptosis may present a promising specific therapy for sepsis. Various methods to inhibit apoptosis including the cell surface Fas receptor pathway inhibitors, caspase inhibitors, over-expression of anti-apoptotic genes and small interfering ribonucleic acid therapy are discussed.
脓毒症仍然是重症患者死亡的主要原因。不幸的是，很少有成功的特异性治疗药物能够显著降低脓毒症的归因死亡率和发病率。开发新的治疗策略以改善脓毒症的预后仍然是重症医学领域正在进行的研究的重要重点。细胞凋亡最近被确定为细胞死亡的重要机制，有证据表明，预防细胞凋亡可提高脓毒症和内毒素血症动物模型的存活率。在这篇综述文章中，我们总结了免疫细胞凋亡在脓毒症病理生理学中的关键作用，并提出阻断导致细胞凋亡的细胞信号通路可能为脓毒症提供一种有前景的特异性治疗方法。文中讨论了多种抑制细胞凋亡的方法，包括细胞表面Fas受体途径抑制剂、半胱天冬酶抑制剂、抗凋亡基因的过表达以及小干扰核糖核酸疗法。
