CYTOKINE INHIBITORS - IN INTENSIVE-CARE

Objective. To examine three typical disease slates seen in intensive c are, sepsis, Fulminant purpura and acute respiratory distress syndrome (ARDS) to assess the implication of cytokines in their pathogenesis a nd particularly in the clinical applications of possible cytokine inhi bitors. Source of data. The data bank of MedLine and the Index Medicus 1985-1993 and the first part of 1994. These sources have enabled us t o consult publications in French and English and to include informatio n on both animals and humans. The publications issued from Intensive C are Congresses have also been scrutinised; the Societe de Reanimation de Langue Francaise, The American Thoracic Society and the 13th and 14 th International Symposium on Intensive Case and Emergency Medicine, B russels. Selection of data. This review emphasizes certain areas of wo rk including recognised work which has been published on the immunothe rapy of sepsis in man, on those papers, which have been published as a preliminary communication in the from of a summary and on certain pap ers relating to animal work which are regularly cited in Intensive Car e literature. Discussion. The relationship between cytokines and the t hree selected disease states have been briefly described. The greater part of those papers which have either been published or are in the pr ocess of being published present pharmacotherapeutic data in phase 2 o r phase 3 in relationship to anticytokines and sepsis. As for the trea tment of Fulminant purpura and ARDS, using anticytokine antibodies in 1994 we are still in the stage of hypothesis and speculation. Conclusi ons. Future clinical strategies designed to combat. Future clinical st rategies designed to fight against the most critical diseases in inten sive care medicine require some use of any kind of immunotherapy. In a nimal studies, convincing data are available showing that immunotherap y improves the prognosis of sepsis, whereas in humans, to date, the re sults appear to be deceiving. Future research in this direction is man datory, in sep sis and in other disease states, like ARDS, because no other hope for treating these patients seems to appear in a near futur e.