The beginning of personalized medicine in sepsis: small steps to a bright future

被引:58
作者
Christaki, E. [1 ,2 ]
Giamarellos-Bourboulis, E. J. [3 ,4 ]
机构
[1] AHEPA Univ Hosp, Dept Internal Med 1, Thessaloniki, Greece
[2] Brown Univ, Alpert Sch Med, Infect Dis Div, Providence, RI 02912 USA
[3] Univ Athens, Sch Med, Dept Internal Med 4, GR-11527 Athens, Greece
[4] Jena Univ Hosp, Ctr Sepsis Control & Care, Jena, Germany
关键词
genomics; individualized medicine; metabolomics; personalized medicine; sepsis; septic shock; single nucleotide polymorphism; transcriptomics; FACTOR GENE POLYMORPHISMS; SEPTIC SHOCK; EXPRESSION; BIOMARKERS; OUTCOMES; TNF; CLARITHROMYCIN; ASSOCIATION; VALIDATION; PNEUMONIA;
D O I
10.1111/cge.12368
中图分类号
Q3 [遗传学];
学科分类号
071007 ; 090102 ;
摘要
There is a growing recognition that there is a need for a more personalized approach towards sepsis care. In most clinical trials investigating novel therapeutic interventions against sepsis, patients have been considered a rather homogeneous population. However, there is probably more individual variability between septic patients than previously considered. The pathophysiology of sepsis is a complex and dynamic process that originates from the host immune response to infection and varies according to the genetic predisposition, immune status and co-morbid conditions of the host, the type of pathogen and the site and extent of infection. Until now, efforts to stratify septic patients according to their immune profile were hampered by the lack of specific biomarkers. Recent advances in molecular medicine have made it possible to develop tools that will facilitate a faster and more precise diagnosis of infection. Individual variability between each patient's responses to infection can assist in tailoring therapeutic interventions to the individual's disease profile and monitoring treatment response. In this review, we describe those recent advances in genomics and theragnostics, which are slowly entering clinical practice and which will make possible a more personalized approach to each septic patient in the next decade.
引用
收藏
页码:56 / 61
页数:6
相关论文
共 47 条
[1]   Tumor necrosis factor (TNF) and lymphotoxin-alpha (LTA) single nucleotide polymorphisms: Importance in ARDS in septic pediatric critically ill patients [J].
Azevedo, Z. M. ;
Moore, D. B. ;
Lima, F. C. ;
Cardoso, C. C. ;
Bougleux, R. ;
Matos, G. I. ;
Luz, R. A. ;
Xavier-Elsas, P. ;
Sampaio, E. P. ;
Gaspar-Elsas, M. I. ;
Moraes, M. O. .
HUMAN IMMUNOLOGY, 2012, 73 (06) :661-667
[2]   TLR4 and TNF-α polymorphisms are associated with an increased risk for severe sepsis following burn injury [J].
Barber, RC ;
Aragaki, CC ;
Rivera-Chavez, FA ;
Purdue, GF ;
Hunt, JL ;
Horton, JW .
JOURNAL OF MEDICAL GENETICS, 2004, 41 (11) :808-U1
[3]   Use of procalcitonin to reduce patients' exposure to antibiotics in intensive care units (PRORATA trial): a multicentre randomised controlled trial [J].
Bouadma, Lila ;
Luyt, Charles-Edouard ;
Tubach, Florence ;
Cracco, Christophe ;
Alvarez, Antonio ;
Schwebel, Carole ;
Schortgen, Frederique ;
Lasocki, Sigismond ;
Veber, Benoit ;
Dehoux, Monique ;
Bernard, Maguy ;
Pasquet, Blandine ;
Regnier, Bernard ;
Brun-Buisson, Christian ;
Chastre, Jean ;
Wolff, Michel .
LANCET, 2010, 375 (9713) :463-474
[4]  
Christaki E, 2011, EXPERT REV ANTI-INFE, V9, P1013, DOI [10.1586/ERI.11.122, 10.1586/eri.11.122]
[5]  
DELLINGER RP, 2013, INTENS CARE MED, V39, P165, DOI DOI 10.1007/s00134-012-2769-8
[6]   Monocyte deactivation in septic patients: Restoration by IFN-gamma treatment [J].
Docke, WD ;
Randow, F ;
Syrbe, U ;
Krausch, D ;
Asadullah, K ;
Reinke, P ;
VolK, HD ;
Kox, W .
NATURE MEDICINE, 1997, 3 (06) :678-681
[7]   TLR4 polymorphisms, infectious diseases, and evolutionary pressure during migration of modern humans [J].
Ferwerda, Bart ;
McCall, Matthew B. B. ;
Alonso, Santos ;
Mouktaroudi, Maria ;
Giamarellos-Bourboulis, Evangelos J. ;
Izagirre, Neskuts ;
Syafruddin, Din ;
Kibiki, Gibson ;
Cristea, Tudor ;
Hijmans, Anneke ;
Hamann, Lutz ;
Israel, Shoshana ;
Eighazali, Gehad ;
Troye-Blomberg, Marital ;
Kumpf, Oliver ;
Maiga, Boubacar ;
Dolo, Amagana ;
Doumbo, Ogobara ;
Hermsen, Cornelus C. ;
Stalenhoef, Anton F. H. ;
van Crevel, Reinout ;
Brunner, Han G. ;
Oh, Djin-Ye ;
Schumann, Ralf R. ;
de la Rúa, Concepcion ;
Sauerwein, Robert ;
Kullberg, Bart-Jan ;
van der Ven, Andre J. A. M. ;
van der Meer, Jos W. M. ;
Netea, Mihai G. .
PROCEEDINGS OF THE NATIONAL ACADEMY OF SCIENCES OF THE UNITED STATES OF AMERICA, 2007, 104 (42) :16645-16650
[8]   Translational research in infectious disease: current paradigms and challenges ahead [J].
Fontana, Judith M. ;
Alexander, Elizabeth ;
Salvatore, Mirella .
TRANSLATIONAL RESEARCH, 2012, 159 (06) :430-453
[9]   Association of IL-10 polymorphism with severity of illness in community acquired pneumonia [J].
Gallagher, PM ;
Lowe, G ;
Fitzgerald, T ;
Bella, A ;
Greene, CM ;
McElvaney, NG ;
O'Neill, SJ .
THORAX, 2003, 58 (02) :154-156
[10]   Effect of clarithromycin in patients with sepsis and ventilator-associated pneumonia [J].
Giamarellos-Bourboulis, Evangelos J. ;
Pechere, Jean-Claude ;
Routsi, Christina ;
Plachouras, Diamantis ;
Kollias, Spyridon ;
Raftogiannis, Maria ;
Zervakis, Dimitrios ;
Baziaka, Fotini ;
Koronaios, Apostolos ;
Antonopoulou, Anastasia ;
Markaki, Vassiliki ;
Koutoukas, Pantelis ;
Papadomichelakis, Evangelos ;
Tsaganos, Thomas ;
Armaganidis, Apostolos ;
Koussoulas, Vassilios ;
Kotanidou, Anastasia ;
Roussos, Charis ;
Giamarellou, Helen .
CLINICAL INFECTIOUS DISEASES, 2008, 46 (08) :1157-1164