Publication: Immunomodulation by macrolides: therapeutic potential for critical care
Issued Date
2020-06-01
Resource Type
ISSN
22132619
22132600
22132600
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2-s2.0-85085950258
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Mahidol University
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SCOPUS
Bibliographic Citation
The Lancet Respiratory Medicine. Vol.8, No.6 (2020), 619-630
Suggested Citation
Tom D.Y. Reijnders, Anno Saris, Marcus J. Schultz, Tom van der Poll Immunomodulation by macrolides: therapeutic potential for critical care. The Lancet Respiratory Medicine. Vol.8, No.6 (2020), 619-630. doi:10.1016/S2213-2600(20)30080-1 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/58142
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Title
Immunomodulation by macrolides: therapeutic potential for critical care
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Abstract
© 2020 Elsevier Ltd Critical illness is associated with immune dysregulation, characterised by concurrent hyperinflammation and immune suppression. Hyperinflammation can result in collateral tissue damage and organ failure, whereas immune suppression has been implicated in susceptibility to secondary infections and reactivation of latent viruses. Macrolides are a class of bacteriostatic antibiotics that are used in the intensive care unit to control infections or to alleviate gastrointestinal dysmotility. Yet macrolides also have potent and wide-ranging immunomodulatory properties, which might have the potential to correct immune dysregulation in patients who are critically ill without affecting crucial antimicrobial defences. In this Review, we provide an overview of preclinical and clinical studies that point to the beneficial effects of macrolides in acute diseases relevant to critical care, and we discuss the possible underlying mechanisms of their immunomodulatory effects. Further studies are needed to explore the therapeutic potential of macrolides in critical illness, to identify subgroups of patients who might benefit from treatment, and to develop novel non-antibiotic macrolide derivatives with improved immunomodulatory properties.