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Titolo:
New therapies and vaccines for meningococcal disease
Autore:
Carrol, ED; Thomson, APJ; Hart, CA;
Indirizzi:
Royal Liverpool Childrens Hosp, Inst Child Hlth, NHS Trust Alder Hey, Liverpool L12 2AP, Merseyside, England Royal Liverpool Childrens Hosp Liverpool Merseyside England L12 2AP gland Univ Liverpool, Dept Med Microbiol, Liverpool L69 3BX, Merseyside, EnglandUniv Liverpool Liverpool Merseyside England L69 3BX , Merseyside, England
Titolo Testata:
EXPERT OPINION ON INVESTIGATIONAL DRUGS
fascicolo: 8, volume: 10, anno: 2001,
pagine: 1487 - 1500
SICI:
1354-3784(200108)10:8<1487:NTAVFM>2.0.ZU;2-T
Fonte:
ISI
Lingua:
ENG
Soggetto:
TUMOR-NECROSIS-FACTOR; PLACEBO-CONTROLLED TRIAL; BACTERICIDAL/PERMEABILITY-INCREASING PROTEIN; DISSEMINATED INTRAVASCULAR COAGULATION; EXTRACORPOREAL MEMBRANE-OXYGENATION; ACTIVATOR RESTORES PERFUSION; RANDOMIZED CONTROLLED TRIAL; HUMAN MONOCLONAL-ANTIBODY; GRAM-NEGATIVE BACTEREMIA; AMINO-TERMINAL FRAGMENT;
Keywords:
anti-inflammatory; cytokine; endotoxin; meningococcal disease; therapy; TNF-alpha; vaccine;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Life Sciences
Citazioni:
118
Recensione:
Indirizzi per estratti:
Indirizzo: Carrol, ED Royal Liverpool Childrens Hosp, Inst Child Hlth, NHS Trust Alder Hey, Eaton Rd, Liverpool L12 2AP, Merseyside, England Royal Liverpool Childrens Hosp Eaton Rd Liverpool Merseyside England L12 2AP
Citazione:
E.D. Carrol et al., "New therapies and vaccines for meningococcal disease", EXPERT OP I, 10(8), 2001, pp. 1487-1500

Abstract

Meningococcal disease (MCD) is an important cause of morbidity and mortality. The pathophysiology consists of a complex interaction of bacterial and host factors, triggered by the release of endotoxin which initiates the inflammatory cascade, resulting in multi-organ failure, coagulopathy, capillary leak, metabolic derangement and eventually death. Prompt recognition and aggressive management are essential in reducing mortality. over the past decade, there has been intense research into novel therapies and vaccines, with largely disappointing results. Therapies have been broadly divided into anti-endotoxin and anti-TNF-alpha therapies, treatment aimed at correcting coagulopathy and at blood purification and anti-inflammatory cytokine therapy. The reasons for the disappointing results in the search for new therapeutic strategies are difficult to identify. The disordered physiology in MCDresults from a complex interaction of several mediators; therefore attempts to correct this by altering just one step represents a gross oversimplification of the process. In addition, the experimental model of endotoxaemia,which is often used, is a poor representation of an acutely ill patient with rapidly progressive shock. There have been several small or poorly designed trials, which have failed to reach definite conclusions. In order to yield conclusive results any future trials must be multicentre, randomised, controlled trials, but these are expensive and, in practice, difficult to conduct. The BPI trial (vide infra) was a significant step forward in this regard and demonstrated the ability to organise a large multicentred trial which can act as a template for future trials. Although the results were not significant there was an overall trend towards improved outcome in the treatment arm. Whilst the development of effective therapies and vaccines are awaited, the priorities at present must be the prompt recognition and aggressive management of disease.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 18/01/20 alle ore 01:42:51