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INMUNOMODULACION DE LAS INFECCIONES MICOTICAS INVASIVAS: ¿AVANZARA DEL LABORATORIO A LA CAMA DEL PACIENTE

(especial para SIIC © Derechos reservados)
La administración exógena de citoquinas y la transfusión de citoquinas obtenidas de fagocitos alogénicos parecen ser adyuvantes prometedores en la quimioterapia antifúngica de las infecciones micóticas invasivas.
roilides9.jpg Autor:
Emmanuel Roilides
Columnista Experto de SIIC

Institución:
Department of Pediatrics Hippokration Hospital

Artículos publicados por Emmanuel Roilides
Coautor
John Dotis* 
M.D., Research Fellow, 3rd Department of Paediatrics, Aristotle University*
Recepción del artículo
14 de Febrero, 2005 		Aprobación
14 de Febrero, 2005
Primera edición
23 de Enero, 2006 		Segunda edición, ampliada y corregida
7 de Junio, 2021

INMUNOMODULACION DE LAS INFECCIONES MICOTICAS INVASIVAS: ¿AVANZARA DEL LABORATORIO A LA CAMA DEL PACIENTE

Resumen
Las infecciones micóticas invasivas (IMI) adquieren constantemente mayor importancia en el manejo de los pacientes inmunocomprometidos debido al aumento de la presencia de trastornos que provocan inmunosupresión y al surgimiento de hongos oportunistas que, con anterioridad, eran infrecuentes. Junto con la destrucción de los hongos mediante los agentes antimicóticos, la ayuda de la respuesta inmune a través de la reconstitución de las células efectoras, ya sea de su número o de su función con citoquinas o transfusiones de glóbulos blancos, o por la manipulación del desequilibrio de las citoquinas parece ser un adyuvante promisorio para la quimioterapia antifúngica. La evaluación de los beneficios de la prevención antimicótica y el tratamiento adyuvante con la combinación de factores de crecimiento hematopoyéticos o citoquinas y de agentes antimicóticos es una prioridad urgente para la investigación clínica. Sin embargo, es probable que los múltiples defectos inmunológicos que predisponen a las IMI, las diferencias biológicas entre los hongos patógenos y las respuestas variables a los inmunomoduladores compliquen el diseño de los estudios clínicos, y para que los resultados sean valederos será necesaria la inclusión de un gran número de casos. Un mejor conocimiento de la sinergia entre las citoquinas y los agentes antimicóticos puede aportar herramientas poderosas adicionales para el manejo de estas infecciones graves.

Palabras clave
Infecciones micóticas invasivas, pacientes inmunocomprometidos, tratamiento antifúngico adyuvante, inmunomodulación


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IMMUNOMODULATION OF INVASIVE FUNGAL INFECTIONS: WILL IT PROCEED FROM LAB TO BED

Abstract
Invasive fungal infections (IFIs) continuously acquire more importance in the management of immunocompromised patients especially because of the increased frequency of immunocompromising states and the emergence of previously rare opportunistic fungi. Together with destruction of fungi by antifungal agents, helping immune response by reconstitution of effector cells numerically and/or functionally with cytokines and/or white blood cell transfusions, or by manipulation of cytokine dysbalance appears to be promising adjunct to antifungal chemotherapy. Evaluation of the benefits of the antifungal prevention and adjunctive therapy combining hematopoietic growth factors/cytokines with antifungal agents is urgent priority for clinical research. However, the multiple immune defects that predispose to IFIs, the biological differences among pathogenic fungi, and the variable responses to immune modulators are likely to complicate the design of clinical studies, and large sample sizes will likely be required for valid results. A better understanding of the synergy between cytokines and antifungal agents may provide additional powerful tools for managing these serious infections.

Key words
Invasive fungal infections, immunocompromised patients, immunomodulation, adjunctive antifungal treatment


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Especialidades
Principal: Infectología, Inmunología
Relacionadas: Bioquímica, Diagnóstico por Laboratorio, Medicina Farmacéutica, Medicina Interna, Neumonología



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