Glucan-based macrophage stimulators - A review of their anti-infective potential

Sepsis and sepsis syndrome are significant causes of morbidity and mortality in critically ill surgical patients. Despite technological and therapeutic advances in critical care, sepsis continues to be a pivotal factor in 20 to 50% of deaths in surgical intensive care units. It is clear that alternative approaches to the prevention and/or treatment of sepsis must be found. Preclinical data indicate that macrophage activation with (1-->3)-beta-D-glucans will ameliorate sequelae associated with Gram-negative septicaemia. We and others have translated these preclinical observations to the clinical setting and have shown that macrophage activation with (1-->3)-beta-D-glucans will significantly reduce septic morbidity and mortality in trauma and/or high-risk surgical patients. The precise mechanism(s) by which (1-->3)-beta-D-glucans prevent or ameliorate infections have not been fully elucidated. However, recent data suggest the anti-infective efficacy of (1-->3)-beta-D-glucans is attributable, in part, to macrophage activation induced by binding of (1-->3)-beta-D-glucan to a specific receptor followed by modulation of macrophage pro-inflammatory cytokine expression. This article reviews the anti-infective potential of (1-->3)-beta-D-glucans in the prevention of sepsis and septic sequelae.