グラム陽性菌敗血症に対するアフェレシス治療 : 治療標的としてのスーパー抗原(<特集>新しい体外循環治療を学ぶ)

概要

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The increasing prevalence of sepsis from Gram-positive bacterial pathogens has been reported. Though Gram-positive bacteria do not have endotoxins as cell-wall components, they have lipoteichoic acid and peptidoglycan. These are less potent than endotoxins, but may play a role in some circumstances. Some types of Gram-positive bacteria such as Staphylococcus aureus and Streptococcus pyogenes liberate exotoxin superantigens. These toxins are postulated to induce toxic shock syndrome. Superantigens could be associated with the pathogenesis of Gram-positive septic shock. A therapeutic approach to remove superantigens from the blood stream may become the option to treat Gram-positive sepsis. Hemoadsorption devices to eliminate superantigens are now in development. Another important point to be considered is the synergistic effect between superantigens and endotoxin. In the clinical setting, Gram-negative and Gram-positive bacteria are frequently cultured at the same time and endotoxemia has been observed even with Gram-positive infection. Endotoxin removal may become the option to treat Gram-positive septic shock, from the viewpoint of reducing the burden. To examine the therapeutic effect of apheresis for removing superantigens during sepsis, further studies are needed to measure blood superantigen levels before and after treatment and evaluate the associated clinical symptoms.
2005-10-31