Management dilemma in choosing evolving treatments in neutropenic septic shock.

IF 2.6 3区 医学 Q1 PEDIATRICS
Pediatric Nephrology Pub Date : 2025-11-01 Epub Date: 2025-06-21 DOI:10.1007/s00467-025-06798-y
H David Humes, Kera Luckritz, Stephen Gorga, Katie Plomaritas, Sara Hoatlin, Michael Humes, Lenar Yessayan
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Abstract

How does a physician decide to use a recently FDA-approved life-saving device in a desperately ill child in which little prior clinical experience is available? This report presents a pediatric patient with neutropenic septic shock and multiorgan failure (MOF) with a 95% chance of death and the availability of a therapeutic device with a completely new approach to treat sepsis. This device, called the selective cytopheretic device (SCD), is a first-in-class autologous immune cell directed therapy. The SCD, when integrated into an extracorporeal blood circuit, has been shown to bind activated neutrophils and monocytes. With a simple pharmacologic maneuver within the device, the bound cells in real time are immunomodulated from a highly pro-inflammatory state to a less inflammatory phenotype. These transformed cells are then released back into the systemic circulation thereby tempering the systemic hyperinflammatory disorder. Since this cell directed therapy focuses on neutrophils, the processing of these cells in a neutropenic state may be a substantive risk resulting in further immunosuppression. On the other hand, the immunomodulation of the circulating neutrophils and monocytes, although sparse, may be beneficial to disrupt the dysregulated inflammatory state responsible for ongoing tissue damage and organ dysfunction. Prior clinical SCD trials excluded patients with neutropenia so that no prior clinical experience was available to make a difficult decision. This report presents the way the medical team approached these issues and made a therapeutic plan that resulted in a positive clinical outcome for the patient.

中性粒细胞减少性脓毒性休克治疗选择的管理困境。
一个医生如何决定在一个几乎没有临床经验的病入膏肓的孩子身上使用最近fda批准的救生设备?本报告报告了一例小儿中性粒细胞减少性感染性休克和多器官功能衰竭(MOF),死亡率为95%,并介绍了一种全新的治疗败血症的治疗装置。这种装置被称为选择性细胞增生装置(SCD),是一种一流的自体免疫细胞定向疗法。当SCD被整合到体外血液循环中时,已被证明可以结合活化的中性粒细胞和单核细胞。通过在设备内进行简单的药理学操作,结合的细胞可以实时从高度促炎状态免疫调节到炎症程度较低的表型。这些转化的细胞随后被释放回体循环,从而缓和了全身性高炎症性疾病。由于这种细胞导向治疗侧重于中性粒细胞,因此在中性粒细胞减少状态下处理这些细胞可能会导致进一步的免疫抑制。另一方面,循环中性粒细胞和单核细胞的免疫调节虽然稀疏,但可能有利于破坏导致持续组织损伤和器官功能障碍的失调炎症状态。先前的临床SCD试验排除了中性粒细胞减少的患者,因此没有先前的临床经验可以做出困难的决定。本报告介绍了医疗团队处理这些问题的方法,并制定了治疗计划,为患者带来了积极的临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Pediatric Nephrology
Pediatric Nephrology 医学-泌尿学与肾脏学
CiteScore
4.70
自引率
20.00%
发文量
465
审稿时长
1 months
期刊介绍: International Pediatric Nephrology Association Pediatric Nephrology publishes original clinical research related to acute and chronic diseases that affect renal function, blood pressure, and fluid and electrolyte disorders in children. Studies may involve medical, surgical, nutritional, physiologic, biochemical, genetic, pathologic or immunologic aspects of disease, imaging techniques or consequences of acute or chronic kidney disease. There are 12 issues per year that contain Editorial Commentaries, Reviews, Educational Reviews, Original Articles, Brief Reports, Rapid Communications, Clinical Quizzes, and Letters to the Editors.
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