Treatment of septic shock with antibodies to tumour necrosis factor.

The high mortality associated with septic shock has prompted intensive study of the pathophysiological basis of this syndrome in an effort to better understand the processes that lead to tissue injury. One important outcome of this work has been the recognition that the cytokine tumour necrosis factor (TNF) is an important mediator of endotoxin-induced lethality. Accordingly, studies were done which showed that antibodies to TNF could protect animals from death in a variety of model systems, and based on these findings, clinical studies were initiated. This paper reviews the present status of clinical trials of anti-TNF in sepsis. These antibodies appear to be safe, and preliminary experience suggests that they may be effective in some patients with the sepsis syndrome. A final assessment of efficacy must await the large, placebo-controlled trials that are now in progress.