Will biomarker-guided specific therapies the best option for treating sepsis in the future?
In a symposium at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID 2019), Tom van der Poll, MD, PhD, professor and chair of medicine at UMC Amsterdam, the Netherlands, gave a presentation on redefining the syndrome of sepsis based on the use of biomarkers.
At the conclusion of the presentation, van der Poll highlighted that the hosts' response to sepsis is made up of concurrent proinflammatory and immune suppressive reactions. Therefore, gene transcription signatures can be used to gain information into pathogenetic mechanisms, while allowing stratification of patients into homogenous groups, and providing biomarker-guided treatment selection and monitoring.
In an exclusive interview at ECCMID 2019, Contagion® sat down with van der Poll to learn more about his presentation and using biomarkers in the field of sepsis.
Interview transcript (modified slightly for readability):
Contagion®: Can you summarize your presentation on sepsis biomarkers?
van der Poll: My presentation on sepsis biomarkers is about a new area of research in which I try to convey the message that biomarker-guided specific therapies are the way to go in the future. Thus far, sepsis trials have been based on enrollment of patients with a certain severity of disease, rather than with a certain pathophysiological profile.
So, in immune therapy trials in sepsis, these were given to patients with more severe disease and they did not examine the target of the immune therapy. So, in the future I think that we need to specify the expression pattern of the targets that is targeted by the immunotherapy and only select those patients that are likely to benefit from a certain immunotherapy rather than selecting patients with more severe disease.
Contagion®: What is the most important message you want to convey about this topic?
van der Poll: The biggest point in this topic is that thus far there has been no attempt whatsoever to look at the immunological profile of patients with sepsis. Although, the therapies that have been tried over the past 30 years, that seek to modify the immune response in patients with sepsis, target specific components of the host response to the infection.
So, we need to put more effort in discovering biomarkers that reflect the activity of certain immunological pathways that we seek to target with our immune interventions, and in doing so we are more likely to provide benefit to patients with sepsis — more benefit than thus far because thus far all clinical trials seeking to modify the immune response in patients with sepsis have been negative.
Contagion®: Why is this an important area to study?
van der Poll: This is an important basis for me personally to study [because] obviously it’s an interesting topic. It's also an unresolved issue in the treatment of patients with sepsis — sepsis prognosis is still pretty grim in terms of that approximately 25% died and we need to improve that and looking at the immune response in patients and seeking to modify there seems to be promising. Although, thus far, extremely unsuccessful: no positive clinical trials and I'm looking forward to see this changed by this new approach.
The presentation "Sepsis: redefining the syndrome based on biomarkers," was given on Monday, April 15, 2019, in a symposium at ECCMID 2019 in Amsterdam, the Netherlands.