Adjunctive Immunotherapy With Polyclonal Ig-M Enriched Immunoglobulins for Septic Shock: From Bench to Bedside. The Rationale for a Personalized Treatment Protocol

Abstract

Septic shock still has a high mortality rate which has not hinted at decreasing in recent years. Unfortunately, randomized trials failed mainly because the septic patient was considered as a homogeneous entity. All this creates a sort of therapeutic impotence in everyday clinical practice in treating patients with septic shock. The need to customize therapy on each patient with sepsis has now become an established necessity. In this scenario, adjuvant therapies can help if interpreted as modulators of the immune system. Indeed, the host's immune response differs from patient to patient based on the virulence of the pathogen, comorbidity, infection site, and prolonged hospitalization. In this review, we summarize the rationale for using immunoglobulins as an adjunctive treatment. Furthermore, we would like to suggest a possible protocol to personalize treatment in the different clinical scenarios of the host's response to serious infectious events.

Keywords: adjunctive treatment; immunoglobulins; protocol; sepsis; septic shock.

Figure 1

The proposed role of immunoglobulins correlated to the phases of the host response after an infectious insult. (A) Hyperinflammatory response and role of immunoglobulins in modulating the proinflammatory storm. (B) Immunosuppressive response and role of immunoglobulins as immune system adjuvants.

Figure 2

Flow chart of the immunoglobulins' treatment protocol in patients with different septic shock phenotypes. More details in the text. IgGAM, Immunoglobulins G, A, and M; ASAP, as soon as possible; Noradr, Noradrenaline.