Sepsis, signals, and surgical sequelae (a hypothesis)
H. R. Michie and D. W. Wilmore
Department of Surgery, Harvard Medical School, Boston, Mass.
Cytokines, products of the bodies on cells, are the major signals that
orchestrate the host's response to bacterial infection. Those signals
generated following infection include interleukins 1, 2, and 6, interferon
gamma, and tumor necrosis factor (or cachectin). Tumor necrosis factor is
the only cytokine, to date, that has been shown to fulfill Koch's
postulates and, thus, be casually related to host responses. Host responses
to cytokines vary because of alterations in the genetic mechanism that
controls cytokine production, because of an alteration in the
responsiveness of the reticuloendothelial system at the time of signal
induction and because of alterations in cell surface receptors. Only now
are techniques evolving that can detect cytokine concentrations or
production rates to relate these molecules to varying aspects of human
disease. A major therapeutic goal in the future will be directed toward
blocking the deleterious effects of cytokines while maintaining their
protective or beneficial effects.
