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Highly Accessed Commentary

Immunotherapy - a potential new way forward in the treatment of sepsis

Didier Payen1*, Guillaume Monneret23 and Richard Hotchkiss4

Author Affiliations

1 AP-HP Département d'Anesthésie-Réanimation, Hôpital Lariboisière, Université Paris 7 Diderot, EA 3509, 2 rue Ambroise Paré, 75010 Paris, France

2 Laboratoire d'Immunologie - Hôp. E, Herriot, Hospices Civils de Lyon, 69003 Lyon, France

3 Université Lyon I, Hospices Civils de Lyon, EAM 4174, 69008 Lyon, France

4 Department of Anesthesiology, Medicine, and Surgery, Washington University School of Medicine, 660 S. Euclid, St Louis, MO 63110, USA

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Critical Care 2013, 17:118  doi:10.1186/cc12490


See related research by Wu et al., http://ccforum.com/content/17/1/R8

Published: 20 February 2013

Abstract

A recent randomized controlled clinical trial of the immunostimulatory agent thymosin alpha-1 was conducted and showed a trend toward improved survival in patients receiving the drug (P = 0.06). Although this was a relatively small study and the exact mechanism of action of thymosin alpha-1 is not known, the present results further support the evolving concept that, as sepsis persists, a hypoinflammatory and immunosuppressive condition ensues and therapy that augments host immunity may be advantageous. Other immunomodulatory agents including granulocyte-macrophage colony-stimulating factor have shown promise in small trials in sepsis. In addition, there are a number of new immunoadjuvant agents such as IL-7 and anti-programmed cell death-1 that are showing remarkable abilities to enhance host immunity and improve outcomes in a variety of clinical disorders, including cancer and chronic viral infections. Animal studies show that these new immunoadjuvant agents improve survival in several clinically relevant models of sepsis. Given the relative safety of thymosin alpha-1 and these other new immunomodulatory agents as well as the persisting high mortality of sepsis, a strong case can be made for larger well-designed trials using immunoadjuvant therapy in patients who have documented immune suppression. Immunotherapy offers new hope in the treatment of sepsis and may dramatically change the face of the disease.