Table 1

Immunomodulation of sepsis: summary of experimental and clinical studies

Experimental treatmentTheoretical basisExperimental studiesCase reportsRandomised controlled trial
✓ = positive reports; × = negative reports.
a. Anti-endotoxin
HA-1AAnti-endotoxin antibody×
rBPI21Endotoxin binding and inactivation
Possible benefit
LBPEndotoxin binding protein
b. Leucocyte antagonists
Corticosteroids×
Most studies show no significant benefit
c. Anti-cytokine
Anti-TNFα antibodyTNFα blockade×
No benefit
IL-1β receptor antagonistIL-1β blockade×
No benefit
d. Treatment of coagulopathy
Activated protein CReplacement of protein C in an active form
Adult sepsis trial showed benefit
Serum derived protein C (unactivated)Replacement of depleted protein C?
May not be appropriate in unactivated form
AntithrombinReplacement of depleted antithrombin×
Risk of bleedingNo benefit
HeparinAnticoagulation, prevention of limb necrosis
Risk of bleeding
Tissue plasminogen activatorFibrinolysis, prevention of limb necrosis
Risk of bleeding
e. Other
Haemodialysis/plasmapharesisCytokine removal✓/×
Some positive reports but not conclusive
Nitric oxide synthase inhibitorsReduction of nitric oxide synthesis×
Extracorporeal membrane oxygenationTreatment of ARDS