Carrillo ER

Language: Spanish
References: 20
Page: 92-95
PDF size: 64.65 Kb.

ABSTRACT

Spite of therapeutic advances mortality associated to sepsis remain high. Systemic inflammatory response syndrome (SIRS) accompany frequently sepsis and is a common problem in the intensive care units. The failure of mechanisms involved in the autoregulation of SIRS lead to multiple organ dysfunction. NF-kB, a transcription factor, play an important role in the features of SIRS and its activation is related with the developing, severity and outcome of ARDS. Transcription factors, included NF-kB, amplify the inflammatory response in sepsis, SIRS and septic shock, but the regulation of these can contribute to block the inflammatory response using steroids. A salutary effect of steroids has been described in late ARDS and early sepsis in patients with occult adrenal insufficiency. In this issue is reviewed the mechanisms related with the developing and modulation of sepsis and the perspective for its future treatment.

REFERENCES

1. Bone RC, Grodzin CJ, Balk RA. Sepsis: a new hypothesis for pathogenesis of the disease process. Chest 1997; 112: 235-243.

2. Marshall J. Both the disposition and means of cure: “Severe SIRS, sterile shock”, and the ongoing challenge of description. Crit Care Med 1997; 25: 1765-1766.

3. Papavassiliou AG. Transcription factors. N Engl J Med 1995; 332: 45-7.

4. Wedel A, Ziegler-Heitbrock HW. The C/EBP family of transcription factors. Immunobiology 1995; 193: 171-185.

5. Siebenlist U, Franzoso G, Brown K. Structure regulation and function of NF-kB. Annu Rev Cell Biol 1994; 10: 405-55.

6. Baeuerle PA, Baltimore D. NF-kB: ten years after. Cell 1996; 87: 13-20.

7. Balwin AS Jr. The NF-kB and IkB proteins: new discoveries and insights. Annu Rev Immunol 1996; 14: 649-83.

8. Baeuerle Patrick and Baltimore David: IkB: A specific inhibitor of the NF-kB transcriptor factor. Science 1998: 540-545.

9. Kopp EB, Ghosh S. NF-kB and Rel proteins in innate immunity. Adv Immunol 1995; 58: 1-27.

10. Schwartz MD, Moore EE, Moore FA. Nuclear factor kB is activated in alveolar macrophages from patients with acute respiratory distress syndrome. Crit Care 1996; 24: 1285-1291.

11. Bohrer H, Qiu F, Zimmermann T. Role of NF-kB in the mortality of sepsis. J Clin Invest 1997; 100: 972-985.

12. Williams DL, Tuanzhu Ha, Chuanfu L. Early activation of hepatic NF-kB and IL-6 in polymicrobial sepsis correlates with bacteremia, citokine expression, and mortality. Ann Surg 1999; 230: 95-104.

13. Stefanec T. Endotelial apoptosis: Could it have a role in the pathogenesis and treatment of disease? Chest 2000; 117: 1-27.

14. Read MA, Whitley MZ, Williams. NF-kB and IkB-alfa: An inducible regulatory system in endothelial activation. J Exp Med 1994; 179: 503-512.

15. Ayala A. Lymphoid apoptosis during sepsis: Now that we’ve found it, what do we do with it? Crit Care Med 1997; 25: 1261-1262.

16. Iimuro Y, Hellerbrand C. NF kappa B prevents apoptosis and liver dysfunction during liver regeneration. J Clin Invest 1998; 101: 802-811.

17. Adcock IM, Gelder CM, Shirasaky. Effects of steroids on transcription factor activation in human lung (abstract). Am Rev Respir Dis 1992; 143: A834.

18. Barnes PJ, Adcock IM. Antiinflammatory actions of steroids: molecular mechanisms. Trends Pharmacol Sci 1993; 14: 9179-9189.

19. Beato M. Gene regulation by steroid hormones. Cell 1989; 56: 335-44.

20. Auphan N, DiDonato JA, Rosette C. Immunossuppression by glucocorticoids: Inhibition of NF-kB activity through induction of IkB synthesis. Science 1995; 270: 286-290.