ABSTRACT

Introduction: This review aims to summarize current progress of the last ten years in the development of biomarkers used for classifying the immune response of the septic host and for monitoring the efficacy of the applied adjunctive immunotherapy.

Areas covered: An extensive search of the literature was performed. In this review the authors discuss available biomarkers of host immune response in sepsis toward two directions; immunosuppression and hyperinflammation. Ferritin, sCD163, sIL-2 ra, and IL-18 may help in the diagnosis of macrophage activation syndrome (MAS) complicating sepsis whereas lymphopenia, decreased HLA-DR expression on monocytes, overexpression of Programmed cell death protein-1 (PD-1)/Programmed death-ligand 1 (PD-L1) and IL-10 are indicators of sepsis-induced immunosuppression. Novel approaches in the classification of immune state in sepsis include Myeloid-Derived Suppressor Cells (MDSC) and specific endotypes, defined by gene expression and molecular techniques.

Expert opinion: HLA-DR and ferritin are the most commonly used biomarkers to monitor immunomodulation in clinical practice whereas developing specific sepsis endotypes is the future target. New immunotherapy trials in sepsis need to incorporate biomarkers for a personalized treatment.

摘要

简介：本综述旨在总结过去十年在用于分类脓毒症宿主免疫反应和监测应用辅助免疫疗法疗效的生物标志物开发方面的当前进展。

涵盖的领域：对文献进行了广泛的搜索。在这篇综述中，作者从两个方向讨论了脓毒症中宿主免疫反应的可用生物标志物；免疫抑制和过度炎症。铁蛋白、sCD163、sIL-2 ra 和 IL-18 可能有助于诊断巨噬细胞活化综合征 (MAS) 并发脓毒症，而淋巴细胞减少、单核细胞上 HLA-DR 表达降低、程序性细胞死亡蛋白-1 (PD-1 )/程序性死亡配体 1 (PD-L1) 和 IL-10 是败血症诱导的免疫抑制的指标。脓毒症免疫状态分类的新方法包括髓源性抑制细胞 (MDSC) 和特定内型，由基因表达和分子技术定义。

专家意见：HLA-DR 和铁蛋白是临床实践中监测免疫调节最常用的生物标志物，而开发特定的脓毒症内型是未来的目标。脓毒症的新免疫治疗试验需要结合生物标志物进行个性化治疗。