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脓毒症-3登场:它对临床前脓毒症模型意味着什么?

Sepsis-3 on the Block: What Does It Mean for Preclinical Sepsis Modeling?

作者信息

Osuchowski Marcin F, Thiemermann Christoph, Remick Daniel G

机构信息

*Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Research Center, Vienna, Austria †The William Harvey Research Institute, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK ‡Boston University School of Medicine, Boston, Massachusetts.

出版信息

Shock. 2017 May;47(5):658-660. doi: 10.1097/SHK.0000000000000775.

Abstract

To effectively improve outcomes of septic patients, we first need to elucidate the multifaceted pathogenesis of sepsis syndromes and related inflammatory conditions. In fulfillment of such needs, in February 2016, new definitions for sepsis and septic shock were published under the acronym Sepsis-3. Although aimed at the clinical area, Sepsis-3 will have an inevitable influence upon the field of translational research as well. Sepsis-3 brings a considerable shift regarding the experimental focal point: from inflammatory states (SIRS/CARS) to organ failure (single and multiple) as the decisive factor. This shift exposes several shortcomings of the current in vivo sepsis modeling including lack of uniform scoring system for sepsis severity and organ dysfunction/failure; high variability of organ dysfunction phenotypes among animal species/strains; difficulty in reproducing severe, intensive care unit grade of organ dysfunction due to high resistance of experimental animals and others. It is intuitive that clinical Sepsis-3 should also serve as an incentive for developing a global standardized approach in sepsis modeling to maximize its translational potential. This could be achieved, for example, by generating consensus guidelines that would support scientists in their study design and optimal sepsis modeling decision-making. An implementation of such hypothetical "Minimum Quality Threshold in Preclinical Sepsis Studies" guidelines across different species has a strong potential for making sepsis studies more reliable and transpolatable. We strongly believe that an internationally coordinated standardization effort in sepsis modeling will certainly serve the above purposes well.

摘要

为有效改善脓毒症患者的治疗效果,我们首先需要阐明脓毒症综合征及相关炎症状态的多方面发病机制。为满足这一需求,2016年2月,脓毒症和脓毒性休克的新定义以Sepsis-3为缩写形式发布。尽管Sepsis-3针对临床领域,但它也将不可避免地对转化研究领域产生影响。Sepsis-3在实验焦点方面带来了相当大的转变:从炎症状态(全身炎症反应综合征/代偿性抗炎反应综合征)转变为以器官衰竭(单个和多个器官)作为决定性因素。这一转变揭示了当前体内脓毒症模型的几个缺点,包括缺乏统一的脓毒症严重程度和器官功能障碍/衰竭评分系统;动物物种/品系之间器官功能障碍表型的高度变异性;由于实验动物的高耐受性等原因,难以再现重症监护病房级别的严重器官功能障碍。直观地说,临床Sepsis-3也应激励在脓毒症模型中开发一种全球标准化方法,以最大限度地发挥其转化潜力。例如,可以通过制定共识指南来实现这一点,这些指南将支持科学家进行研究设计和做出最佳的脓毒症模型决策。在不同物种中实施这种假设的“临床前脓毒症研究的最低质量阈值”指南,极有可能使脓毒症研究更可靠且更具可转化性。我们坚信,在脓毒症模型方面进行国际协调的标准化努力肯定能很好地实现上述目标。

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