A systematic review of randomized controlled trials exploring the effect of immunomodulative interventions on infection, organ failure, and mortality in trauma patients

Abstract

IntroductionFollowing trauma, patients may suffer an overwhelming pro-inflammatory response and immune paralysis resulting in infection and multiple organ failure (MOF). Various potentially immunomodulative interventions have been tested. The objective of this study is to systematically review the randomized controlled trials (RCTs) that investigate the effect of potentially immunomodulative interventions in comparison to a placebo or standard therapy on infection, MOF, and mortality in trauma patients.MethodsA computerized search of MEDLINE, the Cochrane CENTRAL Register of Controlled Trials, and EMBASE yielded 502 studies, of which 18 unique RCTs were deemed relevant for this study. The methodological quality of these RCTs was assessed using a critical appraisal checklist for therapy articles from the Centre for Evidence Based Medicine. The effects of the test interventions on infection, MOF, and mortality rates and inflammatory parameters relative to the controls were recorded.ResultsIn most studies, the inflammatory parameters differed significantly between the test and control groups. However, significant changes in infection, MOF, and mortality rates were only measured in studies testing immunoglobulin, IFN-γ, and glucan.ConclusionsBased on level 1b and 2b studies, administration of immunoglobulin, IFN-γ, or glucan have shown the most promising results to improve the outcome of trauma patients.

From Hyperthermia to Immunomodulating Polysaccharides

“…First, the attention was focused on immunostimulation, from stimulation of hematopoiesis (Patchen et al, 1988) to potentiation of anti-infectious immunity (Hadden, 1987;Spruijt et al, 2010) and finally suppression of cancer development (Nakao et al, 1983;Hong et al, 2003). Besides these well-established effects, β-glucan was also found to improve HDLC and diminish LDLC and non-HDL cholesterol levels in overweight individuals with mild hypercholesterolemia (Reyna-Villasmil et al, 2007) to potentiate the methotrexate treatment of adjuvant arthritis (Rovensky et al, 2011) and to improve wound healing.…”

Yeast (Saccharomyces cerevisiae) Glucan Polysaccharides – Occurrence, Separation and Application in Food, Feed and Health Industries

“…In Eastern culinary tradition, eating mushrooms (which contain large quantities of soluble -glucan in their fruiting bodies) has long been recognized as healthy, and four pharmaceutical preparations, based on mushroom extracts, have been registered as drugs in Japan (Hyodo et al, 2005). In the Western world several clinical trials (Babineu et al, 1994;Weitberg, 2008;Spruijt et al, 2010) proved the beneficial properties of WGP and PGG glucans, which are still waiting to be registered as drugs (Vetvicka, 2011;Lehtovaara & Gu, 2011). The following therapeutic activities of yeast -glucan are well-established in treating the following conditions: post-surgical infections, hospital pneumonia, acute renal failure (Koc et al, 2011), pressure ulcers (bed sores), wound healing (surgical and as result of injury, Spruijt et al, 2010) and burns caused by heat, UV or X-ray radiation.…”

“…In the Western world several clinical trials (Babineu et al, 1994;Weitberg, 2008;Spruijt et al, 2010) proved the beneficial properties of WGP and PGG glucans, which are still waiting to be registered as drugs (Vetvicka, 2011;Lehtovaara & Gu, 2011). The following therapeutic activities of yeast -glucan are well-established in treating the following conditions: post-surgical infections, hospital pneumonia, acute renal failure (Koc et al, 2011), pressure ulcers (bed sores), wound healing (surgical and as result of injury, Spruijt et al, 2010) and burns caused by heat, UV or X-ray radiation. As an adjuvant yeast -glucans alleviate stress and improves the mAb's plus PGG anticancer treatment for breast, colorectal, colon, leukemia, lung, ovarian and skin cancers, chemotherapy and radiotherapy; antireumatic drug therapy (Sener et al, 2006), and antifungal therapies.…”

Organ Dysfunction Following Trauma, Shock and Sepsis: An Update

“…However, numerous trials which targeted at inhibiting various essential inflammatory mediators and receptors involved in the trauma, shock and sepsis-mediated multiple organ dysfunction, have failed to show a reduction in mortality (4)(5)(6)(7)(8), thus raising the question whether mortality in trauma, shock and sepsis derives from an uncontrolled proinflammatory response. In this review, we emphasize on current information on the multi-organ dysfunction and the use of therapeutic procedures as adjunctive therapy in such clinical situations as well as the exciting future prospects.…”