Immuntherapie bei Sepsis: Immunglobuline, Endotoxinantikörper

  • K. Werdan
  • G. Pilz

Zusammenfassung

Sepsis und septischer Schock stellen auf unseren Intensivstationen die häufigste Todesursache dar; in den Vereinigten Staaten sterben daran jährlich mindestens 100000 Patienten, und in Europa dürften es zumindest ebenso viele sein.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Andersson JP, Andersson UG (1990) Human intravenous immunoglobulin modulates monokine production in vitro. Immunology 71: 372–376PubMedGoogle Scholar
  2. 2.
    Andersson UG, Bjork L, Skansén-Saphir U, Andersson JP (1993) Down-regulation of cytokine production and interleukin-2 receptor expression by pooled human IgG. Immunology 79: 211–216PubMedGoogle Scholar
  3. 3.
    Baumgartner JD (1990) Arguments for the administration of immunoglobulins in critically-ill patients. In: Peter K, Lawin P, Bein T, Briegel J (Hrsg) Intensivmedizin 1990. Thieme, Stuttgart New York (Intensivmedizin Notfallmedizin Anästhesie, Bd 81), S 152–157Google Scholar
  4. 4.
    Baumgartner JD (1992) Antiendotoxin antibodies: a critical appraisal. In: Lamy M, Thijs LG (eds) Update in intensive care and emergency medicine, Bd 16: Mediators of sepsis. Springer, Berlin Heidelberg New York Tokyo, pp 315–328Google Scholar
  5. 5.
    Baumgartner J-D, McCutchan JA, Melle G van, Vogt M, Luethy R, Glauser MP, Ziegler EJ, Klauber MR, Muehlen E, Chiolero R, Geroulanos S (1985) Prevention of Gram-negative shock and death in surgical patients by antibody to endotoxin core glycolipid. Lancet 8446: 59–63CrossRefGoogle Scholar
  6. 6.
    Bhakdi S, Mannhardt U, Muhly M, Hugo F, Ronneberger H, Hungerer K-D (1989) Human hyperimmune globulin protects against the cytotoxic action of staphylococcal alpha-toxin in vitro and in vivo. Infect Imunol 57: 3214–3220Google Scholar
  7. 7.
    Boekstegers P, Weidenhöfer S, Pilz G, Holler E, Kempeni J, Werdan K (1992) Response to TNF-antibody therapy (MAK 195F) in patients with severe sepsis: comparison to polyvalent IgG-therapy. Eur Cytokine Netw 3: 215Google Scholar
  8. 8.
    Boekstegers P, Weidenhöfer S, Kapsner T, Werdan K (1993) Kontinuierliche Messungen der peripheren Sauerstoffverfügbarkeit im Skelettmuskel bei Patienten mit Sepsis. Infusionsther Transfusionsmed 20 [Suppl 1]: 21–28PubMedGoogle Scholar
  9. 9.
    Boekstegers P, Weidenhöfer S, Zell R, Holler E, Kapsner T, Redl H, Schlag G, Kaul M, Kempeni J, Werdan K (1994) Changes in skeletal muscle pO2 after administration of anti-TNFα-antibody in patients with severe sepsis: comparison to interleukin-6 serum levels, APACHE II and Elebute scores. Shock 1: 246–253PubMedCrossRefGoogle Scholar
  10. 9a.
    Bone RC, Balk RA, Fein AM, Perl TM, Wenzel RP, Reines HD, Quenzer RW, Iberti TJ, Macintyre N, Schein RMH, The E5 sepsis study group (1995) A second large controlled clinical study of E5, A monoclonal antibody to endotoxin: results of a prospective, multicenter, randomized, controlled trial. Cr it Care Med 23: 994–1006CrossRefGoogle Scholar
  11. 10.
    Burd RS, Cody CS, Dunn DL (1992) Immunotherapy of Gram-negative bacterial sepsis. Landes, AustinGoogle Scholar
  12. 11.
    Cafiero F, Gipponi M, Bonalumi U, Piccardo A, Sguotti C, Corbetta G (1992) Prophylaxis of infection with intravenous immunoglobulins plus antibiotic for patients at risk for sepsis undergoing surgery for colorectal cancer: Results of a randomized, multicenter clinical trial. Surgery 112: 24–31PubMedGoogle Scholar
  13. 12.
    Calandra T, Baumgartner JD (1995) Antiendotoxin therapy. In: Sibbald WJ, Vincent JL (eds) Clinical trials for the treatment of sepsis. Update in intensive care and emergency medicine, vol 19. Springer, Berlin Heidelberg New York Tokyo, pp 237–250CrossRefGoogle Scholar
  14. 13.
    Calandra T, Glauser M, Schellekens J, Verhoef Jand the Swiss-Dutch J5 Immunoglobulin Study Group (1988) Treatment of gram-negative septic shock with human IgG antibody to Escherichia coli J5: a prospective, double blind, randomized trial. J Infect Dis 158: 312–319PubMedCrossRefGoogle Scholar
  15. 14.
    Class I, Schorer R (1989) Adjuvante Therapie mit Pseudomonas-Immunglobulin bei beatmeten Patienten einer operativen Intensivstation. Anästh Intensivther Not-fallmed 24: 167–171CrossRefGoogle Scholar
  16. 15.
    Collins MS, Mehton NS, Edwards AA, Ladehoff DK (1989) Der Therapieeffekt von Immunglobulin bei der experimentellen bakteriellen Pneumonie durch Pseudomonas aeruginosa korreliert mit der In-vitro-Opsonin-Aktivität und der In-vivo-Neutralisa-tion von Exotoxin A. Intensivmedizin 26 [Suppl 1]: 97–101Google Scholar
  17. 16.
    Darville T, Tabor D, Simpson K, Jacobs RF (1994) Intravenous immunoglobulin modulates human mononuclear phagocyte tumor necrosis factor-a production in vitro. Pediatr Res 35: 397–403PubMedCrossRefGoogle Scholar
  18. 17.
    De Simone C, Delogu G, Corbetta G (1988) Intravenous immunoglobulins in association with antibiotics: a therapeutic trial in septic intensive care unit patients. Crit Care Med 16: 23–26PubMedCrossRefGoogle Scholar
  19. 18.
    Dominioni L, Dionigi R, Zanello M, Chiaranda M, Dionigi R, Acquarolo A, Ballabio A, Sguotti C (1991) Effects of high-dose IgG on survival of surgical patients with sepsis scores of 20 or greater. Arch Surg 126: 236–240PubMedCrossRefGoogle Scholar
  20. 19.
    Duswald KH, Müller K, Seifert J, Ring J (1980) Wirksamkeit von i. v. Gammaglobulin gegen bakterielle Infektionen chirurgischer Patienten — Ergebnisse einer kontrollierten, randomisierten klinischen Studie. Münch Med Wochenschr 122: 832–836Google Scholar
  21. 20.
    Ellie E, Combe C, Ferrer X (1992) High-dose intravenous immune globulin and acute renal failure (letter to the editor). N Engl J Med 327: 1032–1033PubMedGoogle Scholar
  22. 21.
    Fateh-Moghadam A, Wick M (1989) Therapie mit polyvalenten Immunglobulinprä-paraten. Auswahlkriterien und Anwendungsbereiche. Intensivmedizin 26 [Suppl 1]: 81–89Google Scholar
  23. 21a.
    Fink MP (1995) Another negative clinical trial of a new agent for the treatment of sepsis: rethinking the process of developing adjuvant treatments for serious infections. Crit Care Med 23: 989–991 Immuntherapie bei Sepsis: Immunglobuline, Endotoxinantikörper 121PubMedCrossRefGoogle Scholar
  24. 22.
    Fomsgaard A, Baek L, Fomsgaard JS, Engquist A (1989) Preliminary study on treatment of septic shock patients with antilipopolysaccharide IgG from blood donors. Scand J Infect Dis 21: 697–708PubMedCrossRefGoogle Scholar
  25. 23.
    Glinz W, Grob PJ, Nydegger UE, Ricklin T, Stamm F, Stoffel D, Lasance A (1985) Polyvalent immunoglobulins for prophylaxis of bacterial infections in patients following multiple trauma — a randomized, placebo-controlled study. Intensive Care Med 11:288–294PubMedCrossRefGoogle Scholar
  26. 24.
    Greenman RL, Schein RMH, Martin MA, Wenzel RP, Maclntyre NR, Emmanuel G, Chmel H, Köhler RB, McCarthy M, Plouffe J, Rüssel JA, and the XOMA Sepsis Study Group (1991) A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of Gram-negative sepsis. JAMA 266: 1097–1102PubMedCrossRefGoogle Scholar
  27. 25.
    Hoffman WD (1994) Antiendotoxin therapies in septic shock, pp 772–775. In: Natanson C (moderator) Selected treatment strategies for septic shock based on proposed mechanisms of pathogenesis. Arch Intern Med 120: 771–783Google Scholar
  28. 26.
    IICSG, The Intravenous Immunoglobulin Collaborative Study Group (1992) Prophylactic intravenous administration of standard immune globulin as compared with corelipopolysaccharide immune globulin in patients at high risk of postsurgical infection. N Engl J Med 327: 234–240CrossRefGoogle Scholar
  29. 27.
    Jaspers L, Marget W, Mar PJ, Hoffmann K, Laugecker P, Ruchdeschel G, Obermeier A, Kastenbauer E (1987) Antikörper gegen Lipoid A in der Behandlung des septischen Schocks. Infection 15: 146–152PubMedCrossRefGoogle Scholar
  30. 28.
    Jesdinsky HJ, Tempel G, Castrup HJ, Seifert J (1987) Cooperative group of additional immunoglobulin therapy in severe bacterial infections: results of a multicenter randomized controlled trial in cases of diffuse fibrinopurulent peritonitis. Klin Wochen-schr 65: 1132–1138CrossRefGoogle Scholar
  31. 29.
    Just H-M, Metzger M, Vogel W, Pelka RB (1986) Einfluß einer adjuvanten Immunglo-bulintherapie auf Infektionen bei Patienten einer operativen Intensiv-Therapie-Station — Ergebnisse einer randomisierten kontrollierten Studie. Klin Wochenschr 64: 245–256PubMedCrossRefGoogle Scholar
  32. 30.
    Kääb S, Appel R, Pilz G, Samtleben W, Gurland HJ, Werdan K (1991) Fallbeobachtung bei drei additiven Sepsistherapie-Maßnahmen: I.V.-Immunglobuline (IVIG); Plasmapherese (PP) und Hämofiltration (HF). Intensivmedizin 28: 312–313Google Scholar
  33. 31.
    Kobosko J, Nicol P (1992) Renal toxicity of intravenous immunoglobulin (letter to the editor). Clin Nephrol 37: 216–217PubMedGoogle Scholar
  34. 32.
    Kress HG, Scheidewig C, Engelhardt W, Wallasch H, Elert O (1989) Prediction and prevention, by immunological means, of septic complications after elective cardiac surgery. In: Schlag G, Redl H (eds) Progress in clinical and biological research, vol 308: Second Vienna Shock Forum. Liss, New York, pp 1031–1035Google Scholar
  35. 33.
    Lehmkuhl P, Pichlmayr I (1991) Sepsis-Therapie mit 5-S-Immunglobulinen. In: Deutsch E, Gadner H, Graninger W et al. (Hrsg) Intensivmedizinisches Seminar, Bd 3: Infektionen auf Intensivstationen. Springer, Berlin Heidelberg New York Tokyo, S 127–137CrossRefGoogle Scholar
  36. 34.
    Mao P, Enrichens F, Olivero G, Festa T, Beuedetto G, Sciascia C, Vigetti E, Mauri A, Olivero S (1989) Early administration of intravenous immunoglobulins in the prevention of surgical and post-traumatic sepsis: a double blind randomized clinical trial. Surg Res Comm 5: 93–98Google Scholar
  37. 35.
    Marra MN, Thornton MB, Snable JL, Wilde CG, Scott RW (1994) Endotoxin-binding and neutralizing properties of recombinant bactericidal/permeability-increasing protein and monoclonal antibodies HA-1A and E5. Crit Care Med 22: 559–565PubMedCrossRefGoogle Scholar
  38. 36.
    McCloskey RV, Straube RC, Sanders C, Smith SM, Smith CR, and the CHESS Trial Study Group (1994) Treatment of septic shock with human monoclonal antibody HA-1A. A randomized, double-blind, placebo-controlled trial. Ann Intern Med 121: 1–5PubMedGoogle Scholar
  39. 37.
    Michie HR (1992) The case for immunotherapy against endotoxin in sepsis and septicemia. In: Lamy M, Thijs LG (eds) Update in intensive care and emergency medicine, vol 16: Mediators of sepsis. Springer, Berlin Heidelberg New York Tokyo, pp 329–338Google Scholar
  40. 38.
    Müller U, Melnitzki SM, Reithmann C, Werdan K (1989) Herzmuskelzellkulturen der Ratte: Ein Modell zur Beurteilung kardiotoxischer Effekte von Pseudomonas-aerugi-nosa-Endotoxin und Exotoxin A. Intensivmedizin 26 [Suppl 1]: 26–31Google Scholar
  41. 39.
    Padova FE di, Brade H, Barclay GR, et al. (1993) A broadly cross-protective monoclonal antibody binding to Escherichia coli and Salmonella lipopolysaccharides. Infect Immun 61: 3863–3872PubMedGoogle Scholar
  42. 40.
    Phillips AO (1992) Renal failure and intravenous immunoglobulins (letter to the editor). Clin Nephrol 37: 217PubMedGoogle Scholar
  43. 41.
    Pilz G, Werdan K (1990) Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock. Infection 18: 253–262PubMedCrossRefGoogle Scholar
  44. 42.
    Pilz G, Kääb S, Neeser G, Class I, Schweigart U, Brähler A, Bujdoso O, Neumann R, Werdan K (1991) Supplemental immunoglobulin (ivIgG) treatment in 163 patients with sepsis and septic shock — an observational study as a prerequisite for placebo-controlled clinical trials. Infection 19: 216–227PubMedCrossRefGoogle Scholar
  45. 43.
    Pilz G, Appel R, Gurniak T, Bujdoso O, Werdan K (1992) APACHE II und Elebute Score-Berechnung und Sepsisbeurteilung auf der Intensivstation anhand eines BASIC Computerprogramms. Intensivmedizin 29: 81–89Google Scholar
  46. 44.
    Pilz G, Fateh-Moghadam S, Vieil B, Bujdoso O, Döring G, Marget W, Neumann R, Werdan K (1993) Supplemental immunoglobulin therapy in sepsis and septic shock comparison of mortality under treatment with polyvalent i. v. immunoglobulin versus placebo: Protocol of a multicenter, randomized, prospective, double-blind trial. Theor Surg 8: 61–83Google Scholar
  47. 45.
    Pilz G, Kreuzer E, Kääb S, Appel R, Werdan K (1994) Early sepsis treatment with immunoglobulins after cardiac surgery in score-identified high-risk patients. Chest 105: 76–82PubMedCrossRefGoogle Scholar
  48. 46.
    Pilz G, Appel R, Kreuzer E, Werdan K (1994) Comparison of early IgG vs. IgGMA administration in score-identified post-cardiac surgical patients at high risk for sepsis. Shock 2 [Suppl 1]: 17CrossRefGoogle Scholar
  49. 47.
    Pilz G., Kääb S, Kreuzer E, Werdan K (1994) Evaluation of definitions and parameters for sepsis assessment in patients after cardiac surgery. Infection 22: 8–17PubMedCrossRefGoogle Scholar
  50. 48.
    Poutsiaka DD, Clark BD, Vannier E, Dinarello CA (1991) Production of interleukin-1 receptor antagonist and interleukin-lß by peripheral blood mononuclear cells is differentially regulated. Blood 78: 1275–1281PubMedGoogle Scholar
  51. 49.
    Quezado MN, Natanson C, Ailing DW, Banks SM, Koev CA, Elin RJ, Hosseini JM, Bacher JD, Danner RL, Hoffman WD (1993) A controlled trial of HA-1A in a canine model of gramnegative septic shock. JAMA 269: 2221–2227PubMedCrossRefGoogle Scholar
  52. 50.
    Rietschel ET, Brade H (1992) Bacterial endotoxins. Sei Am 267: 26–33Google Scholar
  53. 51.
    Schedel I, Dreikhausen U, Nentwig B, Höchenschneider M, Rauthmann D, Balikcioglu S, Coldewey R, Deicher H (1991) Treatment of Gram-negative septic shock with an immunoglobulin preparation. A prospective, randomized clinical trial. Crit Care Med 19:1104–1113PubMedCrossRefGoogle Scholar
  54. 52.
    Schumann RR, Lamping N, Kirschning C, Knopf HP, Hoess A, Herrmann F (1994) Lipopolysaccharide binding protein: its role and therapeutical potential in inflammation and sepsis. Biochem Soc Transact 22: 80–82Google Scholar
  55. 53.
    Skansén-Saphir U, Andersson J, Björk L, Andersson U (1994) Lymphokine production induced by streptococcal pyrogenic exotoxin-A is selectively down-regulated by pooled human IgG. Eur J Immunol 24: 916–922PubMedCrossRefGoogle Scholar
  56. 54.
    Spannbrucker N, Münch HG, Kunze R, Vogel F (1987) Auswirkungen von Immunglo-bulin-Substitution bei Sepsis. Intensivmedizin 24: 314Google Scholar
  57. 55.
    Stuttmann R, Hartert M, Coleman JE, Kill H, Germann G, Doehn M (1989) Prophylaxe mit einem Pseudomonas-Immunglobulin bei Brandverletzten. Intensivmedizin 26 [Suppl 1]: 130–137Google Scholar
  58. 56.
    Trautmann M, Held T (1990) Intravenöse Immunglobuline bei Septikämie und septischem Schock: Eine aktuelle Übersicht. Intensivmedizin 27: 225–232Google Scholar
  59. 57.
    Vogel F (1988) Bewertung der intravenösen IgM-Therapie bei schweren nosokomialen Infektionen (Ergebnis einer kontrollierten randomisierten Studie). In: Deicher H, Schoppe W (Hrsg) Klinisch angewandte Immunologie — Sepsistherapie mit IgM-angereichertem Immunglobulin. Springer, Berlin Heidelberg New York Tokyo, S 30–41CrossRefGoogle Scholar
  60. 58.
    Wenzel R., Bone R, Fein A et al. (1991) Results of a second double-blind, randomized controlled trial of anti-endotoxin antibody E 5 in gram-negative sepsis. 31st Inter-science Conference of Antimicrobial Agents and Chemotherapy. Am Soc Microbiol (Abstract 1170): 294Google Scholar
  61. 59.
    Werdan K, Pilz G (1992) Treatment of Gram-negative septic shock with an immunoglobulin (letter to the editor). Crit Care Med 20: 1364–1365PubMedGoogle Scholar
  62. 60.
    Wortel CH, Dellinger P (1993) Treatment of Gram-negative septic shock with an immunoglobulin preparation: a prospective, randomized clinical trial (letter to the editor) Crit Care Med 21: 163–165PubMedCrossRefGoogle Scholar
  63. 61.
    Yentis SM, Soni N, Riches PG (1994) In vitro effects of HA-IA (Centoxin) on cytokine production in whole blood from intensive care unit patients. Br J Anaesth 73: 805–811PubMedCrossRefGoogle Scholar
  64. 62.
    Ziegler EJ, McCutchan JA, Fierer J, Glauser MP, Sadoff JC, Douglas H, Braude AI (1982) Treatment of gram-negative bacteremia and shock with human antiserum to a mutant Escherichia coli. N Engl J Med 307: 1225–1230PubMedCrossRefGoogle Scholar
  65. 63.
    Ziegler EJ, Fisher CF, Sprung CL, Straube RC, Sadoff JC, Foulke GE, Wortel CH, Fink MP, Dellinger RP, Teng NNH, Allen IE, Berger HJ, Knatterud GL, LoBuglio AF, Smith CR, and the HA-1A Sepsis Study Group (1991) Treatment of Gram-negative bacteremia and septic shock with HA-IA human monoclonal antibody against endotoxin — A randomized, double-blind, placebo-controlled trial. N Engl J Med 324: 429–436PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1996

Authors and Affiliations

  • K. Werdan
  • G. Pilz

There are no affiliations available

Personalised recommendations