Unintended immunomodulation: Part I. Effects of common clinical conditionson cytokine biosynthesis

Citation
Km. Alkarfy et al., Unintended immunomodulation: Part I. Effects of common clinical conditionson cytokine biosynthesis, SHOCK, 13(5), 2000, pp. 333-345
Citations number
111
Categorie Soggetti
Cardiovascular & Hematology Research
Journal title
SHOCK
ISSN journal
10732322 → ACNP
Volume
13
Issue
5
Year of publication
2000
Pages
333 - 345
Database
ISI
SICI code
1073-2322(200005)13:5<333:UIPIEO>2.0.ZU;2-Z
Abstract
Cytokines are low molecular weight proteins that act in an autocrine, parac rine and endocrine fashion to regulate and integrate immune effector cell f unction. Cytokine production is tightly controlled by a complex network of co-stimulatory and feedback loops. The systemic concentrations of some cyto kines, most notably tumor necrosis factor and various interleukins, correla te with the extent of inflammation, and the severity of critical illness an d patient outcome. Thus, cytokine expression is often monitored and/or mani pulated as a therapeutic target in studies of sepsis and other inflammatory conditions. Unfortunately, some therapies designed to modify cytokine resp onse have failed to improve outcomes in sepsis, and some of these therapies have actually been harmful. Several common clinical conditions, as well as , therapeutic interventions significantly influence cytokine expression. Fu rthermore, the magnitude and extent of these effects may be greater than th ose produced by immunomodulating therapies. In contrast, other conditions m ay not produce clinically significant changes in cytokine expression, and m ust simply be considered when interpreting studies designed to determine th e effects of immunomodulation. Some conditions may even result in changes i n the inflammatory response and may thus add to the inflammatory burden of a critically ill patient. This review provides intensivists and other clini cians with an overview of the effects of altered physiologic conditions on cytokine expression. This information is important so that studies measurin g cytokines can be correctly interpreted and clinical circumstances in whic h cytokine manipulation is undesirable can perhaps be avoided.