Sepsis, a life threating syndrome characterized by organ failure after infection, is the most common cause of death in hospitalized patients. The treatment of sepsis is generally supportive in nature, involving the administration of intravenous fluids, vasoactive substances and oxygen plus antibiotics to eliminate the pathogen. No drugs have been approved specifically for the treatment of sepsis, and clinical trials of potential therapies have failed to reduce mortality - suggesting that new approaches are needed. Abnormalities in the immune response elicited by the pathogen, ranging from excessive inflammation to immunosuppression, contribute to disease pathogenesis. Although hundreds of immunomodulatory agents are potentially available, it remains unclear which patient benefits from which immune therapy at a given time point. Results indicate the importance of personalized therapy, specifically the need to identify the type of intervention required by each individual patient at a given point in the disease process. To address this issue will require using biomarkers to stratify patients based on their individual immune status. This article reviews recent and ongoing clinical investigations using immunostimulatory or immunosuppressive therapies against sepsis including non-pharmacological and novel preclinical approaches.

中文翻译：

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脓毒症的免疫疗法-刹车还是加速？

败血症是一种威胁生命的综合征，其特征是感染后器官衰竭，是住院患者最常见的死亡原因。败血症的治疗本质上通常是支持性的，包括静脉内输注液体，血管活性物质和氧气以及抗生素以消除病原体。还没有专门批准用于治疗败血症的药物，并且潜在疗法的临床试验未能降低死亡率-这表明需要新的方法。由病原体引起的免疫反应异常，从过度炎症到免疫抑制，都导致了疾病的发病机理。尽管可能有数百种免疫调节剂，但仍不清楚在给定的时间点上哪个患者可以从哪种免疫疗法中受益。结果表明了个性化治疗的重要性，特别是需要确定每个个体患者在疾病过程中给定时间点所需的干预类型。为了解决这个问题，将需要使用生物标记物根据患者的个体免疫状况对其进行分层。本文回顾了最近和正在进行的针对脓毒症的免疫刺激或免疫抑制疗法的临床研究，包括非药理学和新型临床前方法。