Innate immune response in acute critical illness: a narrative
review
Annals of
Intensive Care volume 14,
Article number: 137 (2024) Published: 04 September 2024
Background
Activation of innate immunity is a first line of host
defense during acute critical illness (ACI) that aims to contain injury and
avoid tissue damages. Aberrant activation of innate immunity may also
participate in the occurrence of organ failures during critical illness. This
review aims to provide a narrative overview of recent advances in the field of
innate immunity in critical illness, and to consider future potential
therapeutic strategies.
Main text
Understanding the underlying biological concepts supporting
therapeutic strategies modulating immune response is essential in
decision-making. We will develop the multiple facets of innate immune response,
especially its cellular aspects, and its interaction with other defense
mechanisms. We will first describe the pathophysiological mechanisms of
initiation of innate immune response and its implication during ACI. We will
then develop the amplification of innate immunity mediated by multiple
effectors. Our review will mainly focus on myeloid and lymphoid cellular
effectors, the major actors involved in innate immune-mediated organ failure.
We will third discuss the interaction and integration of innate immune response
in a global view of host defense, thus considering interaction with non-immune
cells through immunothrombosis, immunometabolism and long-term reprogramming
via trained immunity. The last part of this review will focus on the
specificities of the immune response in children and the older population.
Conclusions
Recent understanding of the innate immune response
integrates immunity in a highly dynamic global vision of host response. A
better knowledge of the implicated mechanisms and their
tissue-compartmentalization allows to characterize the individual immune profile,
and one day eventually, to develop individualized bench-to-bedside
immunomodulation approaches as an adjuvant resuscitation strategy.
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