Balance entre citocinas pro y antiinflamatorias en estados sépticos

Medicina Intensiva

The participation of citokines with a predomi- nant pro-inflammatory function (TNF-α, IL-1 ß, IL-12, INF-γ, IL-6) is necessary for the effective beginning of defense mechanisms against infec- tion. Initial pro-inflammatory response is contro- lled by anti-inflammatoriy molecules (IL-1 recep- tor antagonist [IL-1 ra], transforming growth factor-beta [TGF-ß], interleukins 4, 6, 10, 11 and 13), and the specific receptors for IL-1, TNF, and interleukin 18. In physiological conditions, all these molecules serve as immunemodulators and as a result they limit the potentially harmful effect of the inflammatory reaction. However, in pathological conditions anti-inflammatory res- ponse can be insufficient in order to counteract the inflammatory activity or, on the contrary, can be excesive with immune system inhibition so that fails to help the host faced with the infec- tion. From the start of sepsis symptomatology until the day 28, and when clinical disturbances of SIRS are already gone, the global balance among the pro- inflammatory and anti-inflammatory molecules studied aims at a very important increase of anti-inflammatory molecules. The role of TNF- α and IL-1 ß in sepsis seems to be that of trigge- ring factors, but subsequently both lack of pat- hogenic role. sTNFR-I, sTNFR-II and IL-1 ar have great prognostic value and their levels are rela- ted to the development of MODS and to the failu- re of every organ system. Higher levels of IL-10 and TFR-ß are also related to mortality, although in late phases. Future therapeutic interventions should take into account the fact that sepsis is a dynamic process.