The inflammatory balance in human sepsis

Sepsis and its potential degradation into multiple organ failure, reflects a complex immunological process occurring system wide, fueled by local and systemic proinflammatory stimuli, the activity of which is only minimally reflected in the levels of pro- and anti-inflammatory mediators found in the blood. On a cellular level, sepsis encompasses the up-regulation of both pro- and anti-inflammatory pathways. Inflammation is augmented through activation of the intracellular promoter protein nuclear factor κB (NF-κB), which induces synthesis of mRNA coding for many of the pro-inflammatory mediators, including TNF-α, IL-8, and inducible nitric oxide synthase. Similarly, the same stimuli also produce parallel activation of the heat shock protein (hsp) pathways that inhibit NF-κB activation and minimize the inflammatory response. It is the balance between these two pathways that appears to determine the immune responsiveness of the cells both locally and system wide. By characterizing this immune responsiveness, one may understand better the determinants of the ultimate inflammatory response and potential immunotherapy.