Fedson David S
57, chemin du Lavoir, Sergy Haut, France.
Evol Med Public Health. 2018 Oct 3;2018(1):260-269. doi: 10.1093/emph/eoy027. eCollection 2018.
Mortality rates in influenza appear to have been shaped by evolution. During the 1918 pandemic, mortality rates were lower in children compared with adults. This mortality difference occurs in a wide variety of infectious diseases. It has been replicated in mice and might be due to greater tolerance of infection, not greater resistance. Importantly, combination treatment with inexpensive and widely available generic drugs (e.g. statins and angiotensin receptor blockers) might change the damaging host response in adults to a more tolerant response in children. These drugs might work by modifying endothelial dysfunction, mitochondrial biogenesis and immunometabolism. Treating the host response might be the only practical way to reduce global mortality during the next influenza pandemic. It might also help reduce mortality due to seasonal influenza and other forms of acute critical illness. To realize these benefits, we need laboratory and clinical studies of host response treatment before and after puberty.
流感的死亡率似乎受到了进化的影响。在1918年大流行期间，儿童的死亡率低于成年人。这种死亡率差异在多种传染病中都存在。它在小鼠身上也得到了验证，可能是由于对感染的耐受性更强，而非抵抗力更强。重要的是，使用廉价且广泛可得的非专利药物（如他汀类药物和血管紧张素受体阻滞剂）进行联合治疗，可能会将成年人中具有破坏性的宿主反应转变为儿童中更具耐受性的反应。这些药物可能通过改善内皮功能障碍、线粒体生物合成和免疫代谢来发挥作用。治疗宿主反应可能是降低下一次流感大流行期间全球死亡率的唯一可行方法。它也可能有助于降低季节性流感和其他形式急性危重病导致的死亡率。为了实现这些益处，我们需要对青春期前后宿主反应治疗进行实验室和临床研究。
