New Frontiers in Immunological Therapeutics in the Critically Ill Patient: From Immunosuppression to Immunomodulation

Authors

DOI:

https://doi.org/10.54034/mic.e1976

Keywords:

immunomodulation, immunosuppression, critical patient

Abstract

TSince the onset of the SARS-CoV-2 pandemic, there has been a significant advancement in our ability to intervene in specific immunological pathways, supported by compelling evidence. Autoinflammatory and autoimmune responses represent deregulations of innate and adaptive immunity, respectively, and are common in critically ill patients, occurring primarily or secondarily. Immunosuppression entails the global inhibition of immune responses, while immunomodulation involves the regulation or activation of specific pathways through selective activation or inhibition of molecules and their receptors. A structured search was conducted using the MeSH terms "immunomodulation," "immunosuppression," and "critical patient" in the MEDLINE, SCOPUS, and WoS databases. The objective of this review is to explore how immunomodulation offers a rational approach to counter immunoparalysis processes and modulate excessive proinflammatory responses, ultimately leading to improved clinical outcomes.

References

Gordo Vidal F, Delgado Arnaiz C, Calvo Herranz E. Lesión pulmonar inducida por la ventilación mecánica [Mechanical ventilation induced lung injury]. Med Intensiva. 2007 Jan-Feb;31(1):18-26. Spanish. doi: 10.1016/s0210-5691(07)74765-4. PMID: 17306136.

Vélez, Jorge Luis, Montalvo, Mario, Aguayo, Santiago, Vélez, Pablo Andrés, Velarde, Gustavo, Jara González, Fernando E., & Barboza-Meca, Joshuan. (2019). Glicocálix endotelial: relevancia clínica y enfoque traslacional. Horizonte Médico (Lima), 19(4), 84-9. doi: 10.24265/horizmed.2019.v19n4.12

Meduri GU, Muthiah MP, Carratu P, Eltorky M, Chrousos GP. Nuclear factor-kappaB- and glucocorticoid receptor alpha- mediated mechanisms in the regulation of systemic and pulmonary inflammation during sepsis and acute respiratory distress syndrome. Evidence for inflammation-induced target tissue resistance to glucocorticoids. Neuroimmunomodulation. 2005;12(6):321-38. doi: 10.1159/000091126. PMID: 16557033.

Meduri GU, Carratu P, Freire AX. Evidence of biological efficacy for prolonged glucocorticoid treatment in patients with unresolving ARDS. Eur Respir J Suppl. 2003 Aug;42:57s-64s. doi: 10.1183/09031936.03.00420903. PMID: 12946002.

Meduri GU, Tolley EA, Chinn A, Stentz F, Postlethwaite A. Procollagen types I and III aminoterminal propeptide levels during acute respiratory distress syndrome and in response to methylprednisolone treatment. Am J Respir Crit Care Med. 1998 Nov;158(5 Pt 1):1432-41. doi: 10.1164/ajrccm.158.5.9801107. Erratum in: Am J Respir Crit Care Med. 2013 Dec 15;188(12):1477. PMID: 9817690.

Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967 Aug 12;2(7511):319-23. doi: 10.1016/s0140-6736(67)90168-7. PMID: 4143721.

Slutsky AS. History of Mechanical Ventilation. From Vesalius to Ventilator-induced Lung Injury. Am J Respir Crit Care Med. 2015 May 15;191(10):1106-15. doi: 10.1164/rccm.201503-0421PP. PMID: 25844759.

Chaudhuri D, Sasaki K, Karkar A, Sharif S, Lewis K, Mammen MJ, Alexander P, Ye Z, Lozano LEC, Munch MW, Perner A, Du B, Mbuagbaw L, Alhazzani W, Pastores SM, Marshall J, Lamontagne F, Annane D, Meduri GU, Rochwerg B. Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis. Intensive Care Med. 2021 May;47(5):521-537. doi: 10.1007/s00134-021-06394-2. Epub 2021 Apr 19. PMID: 33876268; PMCID: PMC8054852.)

Villar J, Ferrando C, Martínez D, Ambrós A, Muñoz T, Soler JA, Aguilar G, Alba F, González-Higueras E, Conesa LA, Martín-Rodríguez C, Díaz-Domínguez FJ, Serna-Grande P, Rivas R, Ferreres J, Belda J, Capilla L, Tallet A, Añón JM, Fernández RL, González-Martín JM; dexamethasone in ARDS network. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir Med. 2020 Mar;8(3):267-276. doi: 10.1016/S2213-2600(19)30417-5. Epub 2020 Feb 7. PMID: 32043986.

RECOVERY Collaborative Group. Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2021 May 1;397(10285):1637-1645. doi: 10.1016/S0140-6736(21)00676-0. PMID: 33933206; PMCID: PMC8084355.

RECOVERY Collaborative Group. Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis. Lancet. 2022 Jul 30;400(10349):359-368. doi: 10.1016/S0140-6736(22)01109-6. Erratum in: Lancet. 2022 Oct 1;400(10358):1102. PMID: 35908569; PMCID: PMC9333998.

Janssen M, Endeman H, Bos LDJ. Targeted immunomodulation: a primer for intensivists. Intensive Care Med. 2023 Apr;49(4):462-464. doi: 10.1007/s00134-023-07009-8. Epub 2023 Mar 3. PMID: 36867231; PMCID: PMC9982766.)

Aguayo S. et al. Quiescencia y senescencia: enfoque traslacional al paciente oncológico y críticamente enfermo. Revista científica INSPILIP V. (4), Número 1, Guayaquil, Ecuador.

Lusczek ER, Ingraham NE, Karam BS, Proper J, Siegel L, Helgeson ES, Lotfi-Emran S, Zolfaghari EJ, Jones E, Usher MG, Chipman JG, Dudley RA, Benson B, Melton GB, Charles A, Lupei MI, Tignanelli CJ. Characterizing COVID-19 clinical phenotypes and associated comorbidities and complication profiles. PLoS One. 2021 Mar 31; 16(3): e0248956. doi: 10.1371/journal.pone.0248956. PMID: 33788884; PMCID: PMC8011766.

Leventogiannis K, Kyriazopoulou E, Antonakos N, Kotsaki A, Tsangaris I, Markopoulou D, Grondman I, Rovina N, Theodorou V, Antoniadou E, Koutsodimitropoulos I, Dalekos G, Vlachogianni G, Akinosoglou K, Koulouras V, Komnos A, Kontopoulou T, Prekates A, Koutsoukou A, van der Meer JWM, Dimopoulos G, Kyprianou M, Netea MG, Giamarellos-Bourboulis EJ. Toward personalized immunotherapy in sepsis: The PROVIDE randomized clinical trial. Cell Rep Med. 2022 Nov 15;3(11):100817. doi: 10.1016/j.xcrm.2022.100817. PMID: 36384100; PMCID: PMC9729870.

Published

2023-10-20

How to Cite

1.
Vélez-Paez JL. New Frontiers in Immunological Therapeutics in the Critically Ill Patient: From Immunosuppression to Immunomodulation. Microbes Infect. Chemother. [Internet]. 2023 Oct. 20 [cited 2024 Dec. 2];3:e1976. Available from: https://revistas.unheval.edu.pe/index.php/mic/article/view/1976

Issue

Section

REVIEW ARTICLE

Most read articles by the same author(s)