New Frontiers in Immunological Therapeutics in the Critically Ill Patient: From Immunosuppression to Immunomodulation

Abstract

TSince the onset of the SARS-CoV-2 pandemic, there has been a significant advancement in our ability to intervene in specific immunological pathways, supported by compelling evidence. Autoinflammatory and autoimmune responses represent deregulations of innate and adaptive immunity, respectively, and are common in critically ill patients, occurring primarily or secondarily. Immunosuppression entails the global inhibition of immune responses, while immunomodulation involves the regulation or activation of specific pathways through selective activation or inhibition of molecules and their receptors. A structured search was conducted using the MeSH terms "immunomodulation," "immunosuppression," and "critical patient" in the MEDLINE, SCOPUS, and WoS databases. The objective of this review is to explore how immunomodulation offers a rational approach to counter immunoparalysis processes and modulate excessive proinflammatory responses, ultimately leading to improved clinical outcomes.