Review Article

The Role of Adjunctive Therapies in Septic Shock by Gram Negative MDR/XDR Infections

Table 1

The rationale and the possible adverse reactions of adjunctive immune-modulatory therapies in patients with sepsis.

Potential advantagesPotential adverse effects

Extracorporeal blood purification techniques(i) Removal of endotoxin
(ii) Removal of middle molecular weight molecules (e.g., cytokines)
(iii) Increase in HLA-DR expression on monocytes
(iv) Restoration of TNF-α production
(i) Decrease of blood pressure
(ii) Bleeding due to anticoagulant use
(iii) Removal of drugs (e.g., amines, antibiotics)
(iv) Possible removal of useful molecules (e.g., immune mediators)

Granulocytes-macrophage colony stimulating factor
Interferon-γ
(i) Proliferation and maturation of granulocyte and monocyte precursor cells
(ii) Stimulation of antigen presenting cells
(iii) Increase in mHLA-DR expression
(iv) Production of proinflammatory cytokines
(i) Fever
(ii) Headache
(iii) Edema
(iv) Bone pain
(v) Shortness of breath

PD-1/PD-L pathway(i) Antiapoptotic effect
(ii) Blockade of negative regulatory molecules
(i) Rare autoimmune reactions for long-term administration

Interleukin-7(i) Stimulation of proliferation, maturation, and survival of T cells
(ii) Increase of TCR repertoire diversity
(iii) Production of proinflammatory cytokines
(i) Rare induction of fever and capillary leak syndrome

Interleukin-15(i) Antiapoptotic effect on T cells and NK cells
(ii) Expansion and activation of NK cells and CD8 memory T cells
(iii) Stimulation of NK cells-dendritic cells crosstalk
(iv) Antiapoptotic effect on dendritic cells
(v) Production of proinflammatory cytokines
(i) Fever
(ii) Rigor
(iii) Hypotension
(iv) Capillary leak syndrome
(v) Nausea

Intravenous immunoglobulins(i) Pathogen and apoptotic cells clearance
(ii) Scavenging of toxins and mediators
(iii) Anti-inflammatory effects
(iv) Antiapoptotic effects on immune cells
(i) Rare allergic reactions