转Survivin基因树突状细胞抗消化道肿瘤的免疫效应研究

目的　研究转染Survivin的树突状细胞 (DC)在体外诱导高效而特异的抗消化道肿瘤免疫效应。方法　用脂质体作为介质 ,将Survivin基因转染入DC ,用Westernblot法检测培养上清Survivin的表达 ,检测这种DC分泌细胞因子白介素 (IL 12 )、肿瘤坏死因子 (TNF) α的功能 ,以及表面分子CD1a、CD83、MHcⅡ、CD80、CD86表达的高低 ,用MTT法诱导人特异的细胞毒性T淋巴细胞 (CTLs)的能力。结果　培养上清中均可以检测到Survivin表达 ;转基因DC的上清IL 12、TNF α两种细胞因子含量为 (2 65 .2± 3 2 .7)ng/L和(4 3 7.1± 83 .5 )ng/L明显比单纯DC组高(P <0 .0 5 ) ;转基因DC表面高表达CD1a、CD83、MHCⅡ、CD80、CD86;转基因的DC提呈的T细胞对胃癌细胞、结肠癌细胞、胆管癌细胞杀伤率分别为 :65 %、77%、85 % ,而未修饰的单纯DC杀伤作用较低。结论　Survivin基因转染修饰的DC能诱导细胞毒性T淋巴细胞的特异性 ,显著地提高DC的抗原提呈功能 ,体外能诱导高效而特异的抗癌免疫效应。     

转存活素基因树突状细胞抗消化道肿瘤的免疫效应

目的研究转染存活素基因对树突状细胞(DC)免疫功能的影响,观察修饰后的DC在体外诱导的抗消化道肿瘤免疫效应。方法脂质体介导存活素基因转染入DC,用蛋白印迹法检测培养上清存活素的表达,检测转存活素基因DC分泌细胞因子白细胞介素12(IL12)、肿瘤坏死因子α(TNFα)的功能,以及经流式细胞仪检测DC表面CD1a、CD83、MHCⅡ、CD80、CD86表达的高低,用噻唑蓝(MTT)法诱导人特异的细胞毒性T淋巴细胞(CTL)的能力。结果培养上清中均可以检测到存活素表达;转存活素基因DC的上清IL12、TNFα含量分别为(2652±327)pg/ml和(4371±835)pg/ml,比单纯DC组高(P<005);CD1a、CD83、MHCⅡ、CD80、CD86等在单纯DC表面低表达,在转基因DC表面高表达;MTT法检测,经转染存活素基因的DC提呈的细胞对胃癌细胞、结肠癌细胞、胆管癌细胞杀伤率分别为65%、77%、85%,而单纯DC杀伤作用较低。结论存活素基因转染修饰的DC能诱导细胞毒性T淋巴细胞的特异性,显著地提高DC的抗原提呈功能,体外能诱导高效而特异的抗癌免疫效应。     

胃癌抗原肽Hsp70复合物对转染全长野生型p53的树突状细胞免疫功能的影响

目的 应用联合修饰的树突状细胞(DC)在体外诱导高效而特异的抗胃癌免疫效应。方法 先将全长野生型p53导入脂质体内并转染小鼠骨髓来源的DC,然后用胃癌抗原肽-HSP70复合物等因素修饰已转染全长野生型 p53的 DC(wt-p53 DC),检测这种DC诱导小鼠脾脏淋巴细胞特异的细胞毒性T淋巴细胞(CTLs)的能力,分泌细胞因子功能,以及表面分子表达的高低。结果Western blot检测转染小鼠 p53cDNA的 BMDC及其培养上清中均可以检测到 p53表达;细胞因子含量明显增加(P<0.05),而的其他组的细胞因子含量与对照相比,无显著变化;经流式细胞仪(FACS)检测 wt-p53DC表面高表达 B7-1、B7-2、MCH-Ⅰ、MCH-Ⅱ;脾淋巴细胞经刺激后,能够特异性地杀伤胃癌细胞,杀伤率为91.6％。结论 全长野生型p53基因转染+抗原肽联合修饰DC能诱导小鼠细胞毒性T淋巴细胞的特异性,显著提高DC的抗原提呈功能。     

胆管癌抗原肽对转染全长野生型p53的树突状细胞免疫功能的影响

目的研究胆管癌抗原肽对转染全长野生型p53的树突状细胞(wtp53DC)免疫功能的影响。方法先将全长野生型p53导入脂质体内并转染小鼠骨髓来源的DC,然后用胆管癌抗原肽修饰wtp53DC,检测这种树突状细胞的抗原提呈功能。结果抗原肽修饰的wtp53DC和单纯DC的上清3种细胞因子含量明显增加,分别为(545.2±12.1)ng/L,(511.1±13.3)ng/L,(537.1±11.1)ng/L(P<0.05);wtp53DC刺激小鼠脾脏T细胞增殖水平明显高于对照组(P<0.01);该细胞高表达B7-1、B7-2、MHC-Ⅰ、MHC-Ⅱ(P<0.05);能够特异性地杀伤胆管癌细胞,杀伤率81.6%。结论全长野生型p53基因转染+胆管癌抗原肽联合修饰树突状细胞能诱导小鼠细胞毒性T淋巴细胞的特异性。     

胆管癌肿瘤裂解物修饰和p53基因导入对树突状细胞免疫效应的影响

目的　研究胆管癌裂解物对转染全长野生型p5 3的树突状细胞 (DC)免疫功能的影响。方法　用腺病毒作为介质 ,将全长野生型 p5 3转染入DC ,然后用胆管癌裂解物修饰已转染全长野生型 p5 3的DC(Lywtp5 3DC) ,检测这种DC表面分子B7-1、B7-2、MHC -Ⅰ、MHC -Ⅱ表达的高低 ,诱导特异的细胞毒性T淋巴细胞 (CTLs)的能力 ,对小鼠的免疫保护和对动物模型治疗作用。结果　经流式细胞仪检测胆管癌裂解物刺激的wtp5 3DC表面高表达B7-1( 86.70± 0 .0 7)、B7-2 ( 18.77± 0 .0 8)、MHC -Ⅰ ( 87.2 0± 0 .0 5 )、MHC -Ⅱ ( 5 6.70± 0 .0 7) ,而单纯DC这些分子是低表达的 ;Lywtp5 3DC能够特异性地杀伤胆管癌细胞 ,杀伤率为 81%。Lywtp5 3DC治疗组和其它组在肿瘤生长的直径大小之间有显著差异 (P <0 .0 5 ) ,在Lywtp5 3DC治疗组中 ,肿瘤生长明显减慢。结论　全长野生型 p5 3基因转染 胆管癌裂解物联合修饰的DC能诱导CTLs的特异性 ,显著地提高DC的抗原提呈功能 ,体外能诱导高效而特异的抗胆管癌免疫效应。     

负载肿瘤抗原的DC疫苗体外诱导的特异性抗膀胱癌效应研究

目的 探讨负载膀胱癌抗原成分树突状细胞(dendritic cells,DC)疫苗的制备和体外诱导T淋巴细胞特异性杀伤膀胱癌细胞的作用.方法 冻融法制备EJ细胞裂解物抗原成分,体外培养的人外周血单个核细胞(hu-PBMC)在rhGM-CSF、rhIL-4、TNF-α诱导下分化出DC,负载EJ细胞裂解物抗原后制备膀胱癌DC疫苗;免疫磁珠分离法从人免疫重建Balb/c裸小鼠脾脏组织中分离CD3+ T淋巴细胞,3H-TdR掺入试验测定DC疫苗刺激自体T淋巴细胞增殖的能力,51Cr释放试验检测DC疫苗诱导的T细胞对EJ细胞的杀伤作用.结果 Hu-PBMC在细胞因子rhGM-CSF、rhIL-4和TNF-α的刺激下分化为成熟DC,负载EJ抗原的DC疫苗体外可使同源T淋巴细胞活化,增殖指数增加,活化的T淋巴细胞对EJ细胞的杀伤率为(62.58±6.13)%,和对照组比较差异有统计学意义(P＜0.05).结论 负载膀胱癌冻融抗原的DC疫苗体外可诱导人T淋巴细胞活化增殖,对EJ细胞有明显的杀伤作用.     

腺病毒介导G250基因转染树突状细胞激活免疫效应细胞治疗肾癌的实验研究

目的 探讨以腺病毒(Ad)载体介导肾癌相关抗原G250基因转染制备树突状细胞(DC)瘤苗.体外诱导自体T淋巴细胞特异性抗肾癌免疫效应. 方法 自健康人外周血中提取单核细胞,将贴壁细胞分为3组(Ad-G250基因转染组、G250蛋白致敏组、未致敏组),用粒细胞-巨噬细胞集落刺激因子和诱导活化;3组DC细胞中分别加入自体T淋巴细胞,获得细胞毒性T淋巴细胞(CTL).RT-PCR检测G250在DC细胞内的转录情况;流式细胞仪检测DC表面标志分子和G250抗原蛋白的表达情况;四甲基偶氮唑盐法检测3组CTL对肾癌细胞株786-0和肺癌细胞株A549的杀伤活性. 结果 Ad-G250高效转染DC,G250阳性细胞率为(52.2±1.5)%,G250蛋白在DC:内成功表达:基因转染组DC中成功扩增出G250产物;Ad-G250转染的DC表面标志CD_(80)、CD_(83)、CD_(86)、CD_(1a)、HLA-DR表达高于其他2组.差异均有统计学意义(P<0.05).Ad-G250基因转染组、G250蛋白致敏组、未致敏组诱导的3组CTL对786-0靶细胞杀伤活性分别为(83.4±2.8)%、(79.6±2.4)%、(77.3±2.1)%,组间比较差异有统计学意义(F=69.172,P=0.000);3组CTL对A549靶细胞杀伤活性差异无统计学意义(F=0.373,P=0.693). 结论 以Ad为载体介导抗原基因转染DC,并诱导特异的CTL,技术上可行,所诱导的CTL杀伤活性强,有望成为一种肿瘤免疫治疗方法.     

重组腺病毒介导白细胞介素-18和甲胎蛋白基因修饰的树突状细胞体外诱导抗肝癌免疫活性的研究

目的 探讨甲胎蛋白(AFP)、白细胞介素(IL)-18基冈修饰树突状细胞(DC)较以往AFP基因修饰DC作为肝癌免疫治疗瘤苗是否更具优势.方法 分离外周血单个核细胞定向诱导为DC,以Ad-IL-18和Ad-AFP共感染DC,感染后细胞通过噻唑蓝(MTT)比色法检测其激活的T细胞对HepG2的杀伤活性.结果 检测结果显示目的 基因能够表达于DC细胞中.流氏细胞仪(FCM)结果显示共感染的DC细胞均高表达CD1a(73.4%)、CD11c(84.3%)、CD80(89.5%)、CD86(87.9%)和HLA-DR(91.7%).CTL结果显示IL-18/AFP-DC-T对HepG2的杀伤率(67.49±3.24)%明显高于对SMMC7721细胞(27.32±1.75)%和K562细胞(17.31±1.56)%的杀伤率,另外共感染IL-18/AFP-DC-T组对HepG2的杀伤率与AFP-DC-T、IL-18-DC-T组比较,其差异有统计学意义.结论 AFP和IL-18基因修饰DC,能够在体外诱导特异性细胞毒性T淋巴细胞(CTL)效应,而_且对HepG2细胞杀伤率大于AFP转染DC组.     

IκBα突变体基因修饰树突状细胞降低同种T细胞的反应性

目的观察IκBα突变体基因修饰的树突状细胞(IκBαM-DC)对同种T细胞的反应性。方法利用腺病毒载体将IκBαM基因转染WF大鼠骨髓树突状细胞(DC),Western-blot法检测DC中IκBα、IκBαM基因的表达;用流式细胞仪检测DC中共刺激分子MHCⅡ、CD80、CD86、CD40的表达;酶联免疫法(ELISA)分析DC分泌IL-12的含量。通过混合淋巴细胞反应(MLR)分析Lewis大鼠T细胞对IκBαM-DC刺激的增殖能力,二次MLR检测IκBαM-DC诱导的T细胞抗原特异性的低反应性。结果IκBαM抑制DC共刺激分子MHCⅡ、CD80、CD86、CD40的表达及IL-12分泌。同种T细胞对IκBαM-DC刺激的增殖能力较未转染的DC反应明显降低;T细胞低反应具有抗原特异性。结论表达IκBα突变体基因的DC能降低同种T细胞的反应性。     

MUC1-VNTR基因修饰树突细胞对胰腺癌细胞株体外杀伤效应的研究

目的:通过体外杀伤试验,研究转染黏液蛋白核心肽-连续重复序列(MUC1-VNTR)基因的树突细胞(DC)诱导的细胞毒T淋巴细胞(CTL)对人胰腺癌细胞株的特异杀伤效应.方法:选取入淋巴细胞A抗原(HLA-A2)阳性健康人外周血单个核细胞,体外诱导成熟DC,脂质体介导MUC1-VNTR基因转染入DC(DC-VNTR),以转染空质粒pcDNA3.1(DC-pcDNA3.1)及Lipofectamine处理之DC(DC-Lipo)作为对照,用Western印迹法检测MUC1-VNTR的表达,体外刺激同源T细胞,Elispot检测DC-VNTR诱导分泌IFN-γ和Gramzyme B之CTL能力,细胞毒试验检测DCVNTR诱导的CTL对Capan2和AsPC-1胰腺癌细胞株的杀伤作用.结果:Western印迹法检测到MUC1-VNTR的表达;DC-VNTR诱导的分泌IFN-γ、Gramzyme B的CTL数高于用DC-pcDNA3.1及DC-Lipo作对照者(P＜0.05);DCVNTR诱导的CTL对HIJA-A2、MUC1均阳性的Capan2细胞有显著杀伤效应.且显著高于DC-pcDNA3.1组及DC-Lipo组(P＜0.05).该CTL对HLA-A2阴性、MUC1阳性的AsPC-1细胞无明显杀伤效应.结论:以MUC1-VNTR基因转染的DC可以诱导具特性的CTL,并能特异地杀伤Capan2胰腺癌细胞株.     

Is the recovery profile of mivacurium independent of the rate of decay of its plasma concentration in patients with normal plasma cholinesterase activity?

Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg^?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg^?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg^?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.     

Membranes in Artificial Organs

Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.     

Reduction of Plasma Fibrinogen, Immunoglobulin G, and Immunoglobulin M Concentrations by Immunoadsorption Therapy with Tryptophan and Phenylalanine Adsorbents

Abstract Immunoadsorption (1A) therapy with tryptophan (TR-350) or phenylalanine (PH-350) adsorbents has been used to reduce the concentration of serum antibodies in human lymphocyte antigen (HLA)-immunized patients. Other forms of plasma purification have been reported to reduce the level of fibrinogen, which affects the blood properties. In this study we investigated the effects of IA therapy using both adsorbents on plasma fibrinogen and immunoglobulins G and M in 13 patients (8 patients were treated with TR-350, and 5 patients were treated with PH-350). During each session 1 plasma volume (2.8 ± 0.4 L of plasma) was processed through the immunocolumn and then returned to the patient together with the blood cells. Compared with the pretreatment values, the plasma fibrinogen, IgG, and IgM concentrations were significantly reduced after IA therapy (p < 0.01 for TR-350; p < 0.04 for PH-350). There was a positive correlation between the degree of reduction of plasma proteins and the number of IA treatments given. A nonpara-metric test (Wilcoxon's signed-rank test or the Mann-Whitney test) was used for statistical analysis. We conclude from our study that IA therapy effectively lowers the plasma levels of fibrinogen, IgG, and IgM and thus can be considered a valuable alternative to other blood purification methods.     

Dilemma of Membrane Biocompatibility and Reuse

Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.     

The analgesic effect of racemic ketamine in patients with chronic ischemic pain due to lower extremity arteriosclerosis obliterans

Background : Ketamine in sub-dissociative doses has been shown to have analgesic and phantom-Limb pain, where conventional treatment has often failed. Chronic ischemic pain due to lower extremity arteriosclerosis obliterans often responds poorly to analgesics, and the pain-generating mechanisms are not well understood.
Methods : Eight patients with rest pain in the lower extremity due to arteriosclerosis obliterans were given sub-dissociative doses of 0.15, 0.30, or 0.45 mg/kg racemic ketamine and morphine 10 mg as a 5-min infusion on four separate days in a cross-over, double-blind, randomised protocol. Plasma levels of (S)- and (R)-ketamine and their nor-metabolites were analysed with an enantioselective high-performance liquid chromatography (HPLC) method. Pain levels were evaluated with a visual analogue scale (VAS).
Results : Individual pain levels were highly variable during and after all the infusions but the pooled pain levels showed a dose-dependent analgesic effect of ketamine with a transient but complete pain relief in all patients at the highest dose (0.45 mg/ kg). Side-effects, mainly disturbed cognition and perception, were pronounced and dose-dependent. Morphine 10 mg had an analgesic peak at 20 min and 5/8 patients had complete pain relief. The remaining 3 patients also had high baseline pain scores, indicating a higher analgesic potency for the 0.30 and 0.45 mg/ kg ketamine doses than for morphine 10 mg.
Conclusion : We have demonstrated a potent dose-dependent analgesic effect of racemic ketamine in clinical ischemic pain. Due to a narrow therapeutic window, this analgesic effect is probably best utilised in combination with other analgesics.     

Intravenous endotoxin does not increase tissue extravasation of albumin in rats

Background : It is unclear whether activation of the inducible nitric oxide synthase (iNOS) increases or decreases the extravasation of plasma.
Methods : Chloralose anaesthetised male Wistar rats received E. coli lipopolysacharide (LPS), 3 mg kg^-1 i.v., or the corresponding volume of saline, 3 or 5 h before the end of the experiment. Mean arterial pressure (MAP) and heart rate (HR) were recorded. Tissue clearance of radio-labelled albumin, during the last 2 h of each experiment, was determined by a double-isotope method. In separate animals, the serum concentration of nitrite and nitrate was determined, 5 h after LPS or the solvent.
Main Results : LPS initially decreased MAP and lastingly increased HR. In the 3-h LPS animals (n=8), tissue plasma clearance was lower in the heart and calf muscle and increased only in diaphragm, compared to corresponding control animals (n=8). In the 5-h LPS rats, clearance was lowered (n=8) in the entire gastrointestinal tract and in testes, compared to controls (n=8). The serum nitrite/nitrate concentration was higher in animals given LPS (n=6) than in controls (n=6).
Conclusion : After LPS, tissue clearance of albumin was not increased in any major tissue, in spite of increased serum levels of NO end products. Apparently, after activation of iNOS, the augmented release of NO is not necessarily associated with increased albumin extravasation.     

The multiply injured child

Blunt trauma is the principal cause of childhood death in many developed countries. This review outlines the differences between adults and children with respect to resuscitation and treatment of orthopaedic injuries in a child with polytrauma. Recent advances in techniques of fracture stabilization are reported.     

Adrenaline markedly improves thoracic epidural analgesia produced by a low-dose infusion of bupivacaine, fentanyl and adrenaline after major surgery: A randomised, double-blind, cross-over study with and without adrenaline

Background: Basic pharmacological research indicates that there are synergistic antinociceptive effects at the spinal cord level between adrenaline, fentanyl and bupivacaine. Our clinical experience with such a mixture in a thoracic epidural infusion after major surgery confirms this. The objectives of the present study were to evaluate the effects on postoperative pain intensity, pain relief and side effects when removing adrenaline from this triple epidural mixture. Methods: A prospective, randomised, double-blind, cross-over study was carried out in 24 patients after major thoracic or abdominal surgery. Patients with only mild pain when coughing during a titrated thoracic epidural infusion of about 10 ml · h^?1 of bupivacaine 1 mg · ml^?1, fentanyl 2 μg · ml^?1, and adrenaline 2 μg · ml^?1 were included. On the 1^st and 2^nd postoperative days each patient was given a double-blind epidural infusion, at the same rate, with or without adrenaline. The effect was observed for 4 h or until pain when coughing became unacceptable in spite of a rescue analgesic procedure. Rescue analgesia consisted of up to two epidural bolus injections per hour and i.v. morphine if necessary. All patients received rectal paracetamol 1 g, every 8 h. Fentanyl serum concentrations were measured with a radioimmunoassay technique at the start and end of each study period. Main outcome measures were extent of sensory blockade and pain intensity at rest and when coughing, evaluated by a visual analogue scale, a verbal categorical rating scale, the Prince Henry Hospital pain score, and an overall quality of pain relief score. Results: The number of hypaesthetic dermatomal segments decreased (P <0.001) and pain intensity at rest and when coughing increased (P <0.001) when adrenaline was omitted from the triple epidural mixture. This change started within the first hour after removing adrenaline. After 3 h pain intensity when coughing had increased to unacceptable levels in spite of rescue analgesia (epidural bolus injections and i.v. morphine). Within 15–20 min after restarting the triple epidural mixture with adrenaline, pain intensity was again reduced to mild pain when coughing. Serum concentration of fentanyl doubled from 0.22 to 0.45 ng · ml^?1 (P <0.01), and there was more sedation during the period without adrenaline. Conclusions: Adrenaline increases sensory block and improves the pain-relieving effect of a mixture of bupivacaine and fentanyl infused epidurally at a thoracic level after major thoracic or abdominal surgery. Serum fentanyl concentrations doubled and sedation increased when adrenaline was removed from the epidural infusion, indicating more rapid vascular absorption and systemic effects of fentanyl.     

Utilisation des médicaments prokinétiques en réanimation : indications et limites ?

Enteral feeding is often limited by gastric and intestinal motility disturbances in critically ill patients, particularly in patients with shock. So, promotility agents are frequently used to improve tolerance to enteral nutrition. This review summaries the pathophysiology, presents the available pharmacological strategies, the clinical data, the counter-indications and the principal limits. The clinical data are poor. No study demonstrates a positive effect on clinical outcomes. Metoclopramide and erythromycin seems to be the more effective. Considering the risk of antibiotic resistance, the first line use of erythromycin should be avoided in favor of metoclopramide.