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Báo cáo khoa học: " Recombinant activated protein C in sepsis: endothelium protection or endothelium therapy"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Recombinant activated protein C in sepsis: endothelium protection or endothelium therapy? | Available online http ccforum.eom content 11 1 103 Commentary Recombinant activated protein C in sepsis endothelium protection or endothelium therapy Veronique Regnault1 and Bruno Levy2 1Inserm U734 Coordination Circulation Henri Poincare University Nancy France 2Coordination Circulation UHP-INSERM Contrat Avenir INSERM Groupe CHOC Faculte de Médecine. Université de Nancy-1 Nancy France Corresponding author Bruno Levy b.levy@chu-nancy.fr Published 11 January 2007 This article is online at http ccforum.com content 11 1 103 2007 BioMed Central Ltd Critical Care 2007 11 103 doi 10.1186 cc5135 See related review by Looney and Matthay http ccforum.com content 10 6 239 Abstract Endothelium dysfunction is one of the hallmarks of sepsis. Looney and Mattay in the previous issue of Critical Care highlight the role of activated protein C APC as a protective endothelial drug in septic situations. Nevertheless the results of in vivo studies are less explicit and it remains uncertain whether these properties are relevant in human septic shock. Before considering recombinant APC rAPC as a therapeutic drug for the endothelium we have to demonstrate its efficiency to protect or to reduce endothelium injury when infused a long time after the septic challenge. Nevertheless if rAPC is efficient when infused in the early phase of septic challenge we thus need to treat our patients earlier. At the least genetically engineered variants have been designed with greater anti-apoptotic activity and reduced anticoagulant activity relative to wild-type APC. Further studies are needed to demonstrate the usefulness of these variants in septic shock therapy. The use of recombinant activated protein C rAPC is one of the hottest topics in septic shock therapy. The pivotal phase 3 placebo-controlled Protein C Worldwide Evaluation in Severe Sepsis PROWESS clinical trial demonstrated a 19.4 relative risk reduction in 28-day mortality 6.1 absolute risk reduction with an increased risk 3.5 versus 2.0 of