Infection and Immunity Medical Investigation Unit (IMI), Hospital Clínico Universitario de Valladolid, SACYL/IECSCYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
Grupo de Investigación Biomédica en Cuidados Críticos (BioCritic), Hospital Clínico Universitario de Valladolid, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain; Servicio de Medicina Intensiva, Hospital Clínico Universitario de Valladolid, SACYL, Avenida Ramón y Cajal, 3, 47005 Valladolid, Spain.
J Infect. 2016 May;72(5):525-36. doi: 10.1016/j.jinf.2016.01.010. Epub 2016 Feb 3.
Immunological dysregulation is now recognised as a major pathogenic event in sepsis. Stimulation of immune response and immuno-modulation are emerging approaches for the treatment of this disease. Defining the underlying immunological alterations in sepsis is important for the design of future therapies with immuno-modulatory drugs.
Clinical studies evaluating the immunological response in adult patients with Sepsis and published in PubMed were reviewed to identify features of immunological dysfunction. For this study we used key words related with innate and adaptive immunity.
Ten major features of immunological dysfunction (FID) were identified involving quantitative and qualitative alterations of antigen presentation, [T and B lymphocytes] (FID2), [natural killer cells] (FID3), [relative increase in T regulatory cells] (FID4), increased expression of PD-1 and PD-ligand1, low levels of immunoglobulins, low circulating counts of neutrophils and/or increased immature forms in non survivors, [hyper-cytokinemia] (FID8), [complement consumption] (FID9), defective bacterial killing by neutrophil extracellular traps.
This review article identified ten major features associated with immunosuppression and immunological dysregulation in sepsis. Assessment of these features could help in utilizing precision medicine for the treatment of sepsis with immuno-modulatory drugs.
免疫失调现被认为是脓毒症的主要发病机制之一。刺激免疫反应和免疫调节是治疗这种疾病的新兴方法。明确脓毒症中潜在的免疫改变对于设计具有免疫调节作用的药物的未来疗法非常重要。
我们查阅了在 PubMed 上发表的评估成人脓毒症患者免疫反应的临床研究，以确定免疫功能障碍的特征。为此，我们使用了与固有免疫和适应性免疫相关的关键词。
确定了 10 种主要的免疫功能障碍特征（FID），涉及抗原呈递、T 和 B 淋巴细胞、自然杀伤细胞、T 调节细胞相对增加、PD-1 和 PD-配体 1 表达增加、免疫球蛋白水平降低、中性粒细胞循环计数降低和/或非幸存者中不成熟形式增加、细胞因子过度产生、补体消耗、中性粒细胞细胞外陷阱杀菌功能缺陷等方面的数量和质量改变。
本文综述了脓毒症中与免疫抑制和免疫失调相关的 10 个主要特征。评估这些特征可以帮助利用精准医学用免疫调节药物治疗脓毒症。
