Immune blockade impedes
blood poisoning
By N. Seppa
Each year, roughly a half million people in the United States come
down with sepsisblood poisoning that is usually caused by bacteria.
The consequences can be dire: One-third to one-half of these patients
die from the disease, despite massive doses of antibiotics.
The body doesn't handle sepsis well in part because key white blood
cells called neutrophils, whose job it is to destroy bacteria in the
blood, tend to shut down when it strikes. Researchers have now engineered
an antibody that blocks this neutrophil deactivation in rats with sepsis,
extending their survival. The research, reported in the July Nature
Medicine, suggests that a similar antibody might work in human disease.
Sepsis, also called septicemia, is a blood infection that can arise
from trauma or disease. In past centuries, plagues, battle wounds, and
unsanitary surgery caused many cases.
Neutrophil deactivation in sepsis stems from a tragic misfire in the
complement system, a complex cascade of protein interactions that guides
many immune responses. In a normal immune response, some complement
proteins activate neutrophils to combat bacteria.
Scientists became curious, however, when they found large amounts of
a complement-protein fragment called C5a attached to neutrophils in
blood from people with sepsis. While C5a normally incites neutrophils
to do battle, too much of it shuts them down, says study coauthor Peter
A. Ward, a pathologist at the University of Michigan in Ann Arbor.
Despite the complement system's apparent role in sepsis, many scientists
have hesitated to tamper with these proteins because their immune functions
are critical, if poorly understood, he says. Changing or blocking one
protein risks upsetting the balance of the system.
Nonetheless, by devising an antibody that blocks the action of C5a,
Ward and his colleagues have ventured into the complement realm. C5a
breaks off from a complement protein called C5. The antibody that the
researchers engineered recognizes C5a and binds to itpreventing the
overload of C5a that would deactivate neutrophils. However, the antibody
doesn't recognize C5a until it splits from C5 and so doesn't interfere
with that protein's normal function.
"We developed an antibody that turned out [to be] very fortuitous,"
Ward says.
Preserved neutrophil function greatly aided rats in the study. The
researchers perforated the large intestine in 43 rats, causing sepsis
to develop. Of 10 rats getting the new antibody that blocks C5a, half
survived beyond 10 days, Ward says. Nineteen of 21 rats receiving another
antibody died within 8 days, and 12 rats getting no antibody all died
within 5 days.
"The data in this paper are very impressive," says Kevin J. Tracey,
a neurosurgeon at North Shore University Hospital in Manhasset, N.Y.
"It's an important study that could lead to ... development of new therapeutics
for sepsis." Indeed, Ward and his colleagues are now trying to devise
an antibody to use against human sepsis.