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Die Anaesthesiologie
Erschienen in: Der Anaesthesist 1/2004

01.01.2004 | Leitthema

Bedeutung der angeborenen Immunantwort in der Sepsis

verfasst von: C. Hörner, A. Bouchon, A. Bierhaus, P. P. Nawroth, E. Martin, H. J. Bardenheuer, Dr. M. A. Weigand, DEAA

Erschienen in: Die Anaesthesiologie | Ausgabe 1/2004

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Zusammenfassung

Das angeborene („innate“) Immunsystem bekämpft erfolgreich den größten Teil unserer Infektionen, noch bevor das erworbene Immunsystem aktiviert wird. Genauere Kenntnisse über Wirkmechanismen des angeborenen Immunsystems lassen uns die Pathophysiologie systemischer Infektionen, wie der Sepsis, besser verstehen und dienen der Entwicklung neuer Therapiestrategien. Das angeborene Immunsystem ist für die erste Abwehrreaktion auf eine Infektion verantwortlich. Darüber hinaus aktiviert und interagiert es mit dem erworbenen Immunsystem. Wechselwirkungen werden über Immunzellen, wie Makrophagen und dendritische Zellen, sowie lösliche Faktoren, wie Zytokine, vermittelt. Aufgrund neuer Erkenntnisse aus Tiermodellen, die neben der Inflammation auch ein Fortschreiten der Bakterienabwehr berücksichtigen, mussten bisherige Erkenntnisse überprüft und korrigiert werden. Die Vorstellung von Sepsis als überwiegende „Überreaktion auf eine Entzündung“ wich neuen Theorien. Die Zellen des angeborenen Immunsystems erkennen Eindringlinge mit Hilfe spezieller Rezeptoren. Nach Rezeptorinteraktion führen intrazelluläre Signalkaskaden zur Zellaktivierung, durch die zahlreiche Zytokine und antimikrobielle Substanzen freigesetzt werden. Im Verlauf einer Sepsis kommt es durch verschiedene Regelkreise zu zunehmender Immunsuppression. Mit dem angeborenen Immunsystem verknüpft ist die Migration von Leukozyten in entzündetes Gewebe. Chemokine und Adhäsionsmoleküle übernehmen dabei Schlüsselrollen. Auch die Blutgerinnung ist mit dem angeborenen Immunsystem eng verzahnt. Immunzellen sezernieren „tissue factor“; dies führt über eine Kaskade u. a. zur Bildung von Thrombin. Dieses kann unter den besonderen Bedingungen der Sepsis eine disseminierte intravasale Gerinnung verursachen. Umgekehrt werden durch Thrombin auch Endothelzellen zur Freisetzung von Chemokinen und Adhäsionsmolekülen angeregt; dies stellt einen positiven „Feedback-Mechanismus“ für die angeborene Immunantwort dar. Neue Therapieansätze zur Sepsis versuchen diese Regelkreise zu durchbrechen und durch Blockade von Zytokinen, Rezeptoren oder durch Aktivierung immunstimulierender Systeme eine ausgewogene Reaktion des angeborenen Immunsystems ohne Suppression der antibakteriellen Funktion zu erzielen.
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Metadaten
Titel
Bedeutung der angeborenen Immunantwort in der Sepsis
verfasst von
C. Hörner
A. Bouchon
A. Bierhaus
P. P. Nawroth
E. Martin
H. J. Bardenheuer
Dr. M. A. Weigand, DEAA
Publikationsdatum
01.01.2004
Verlag
Springer-Verlag
Erschienen in
Die Anaesthesiologie / Ausgabe 1/2004
Print ISSN: 2731-6858
Elektronische ISSN: 2731-6866
DOI
https://doi.org/10.1007/s00101-003-0626-4

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