Antibodies targeting the shared cytokine receptor IL-1 receptor accessory protein invoke distinct mechanisms to block all cytokine signaling

Interleukin-1 (IL-1)-family cytokines are potent modulators of inflammation, coordinating a vast array of immunological responses across innate and adaptive immune systems. Dysregulated IL-1-family cytokine signaling, however, is involved in a multitude of adverse health effects, such as chronic inflammatory conditions, autoimmune diseases, and cancer. Within the IL-1 family of cytokines, six-IL-1α, IL-1β, IL-33, IL-36α, IL-36β, and IL-36γ-require the IL-1 receptor accessory protein (IL-1RAcP) as their shared co-receptor. Common features of cytokine signaling include redundancy of signaling pathways, sharing of cytokines and receptors, pleiotropy of the cytokines themselves, and multifaceted immune responses. Accordingly, targeting multiple cytokines simultaneously is an emerging therapeutic strategy and can provide advantages over targeting a single cytokine pathway. Here, we show that two monoclonal antibodies, CAN10 and 3G5, which target IL-1RAcP for broad blockade of all associated cytokines, do so through distinct mechanisms and provide therapeutic opportunities for the treatment of inflammatory diseases.

Treating sepsis with vitamin C, thiamine, and hydrocortisone: Exploring the quest for the magic elixir

The administration of ascorbic acid (vitamin C) alone or in combination with thiamine (vitamin B1) and corticosteroids (VCTS) has recently been hypothesized to improve hemodynamics, end-organ function, and may even increase survival in critically ill patients. There are several clinical studies that have investigated the use of vitamin C alone or VCTS in patients with sepsis and septic shock or are ongoing. Some of these studies have demonstrated its safety and potential benefit in septic patients. However, many questions remain regarding the optimal dosing regimens and plasma concentrations, timing of administration, and adverse effects of vitamin C and thiamine. These questions exist because the bulk of research regarding the efficacy of vitamin C alone or in combination with thiamine and corticosteroids in sepsis is limited to a few randomized controlled trials, retrospective before-and-after studies, and case reports. Thus, although the underlying rationale and mechanistic pathways of vitamin C and thiamine in sepsis have been well described, the clinical impact of the VCTS regimen is complex and remains to be determined. This review aims to explore the current evidence and potential benefits and adverse effects of the VCTS regimen for the treatment of sepsis.

Cerebro-spinal lactate status in childhood pyogenic meningitis in Nigeria

This study was undertaken to ascertain the status of cerebrospinal (CSF) lactate level in Nigerian children with pyogenic meningitis. Forty patients aged from 1 month to 12 years with proven meningitis were the subjects in the study which lasted 8 months. All the patients who had pyogenic meningitis had mean cerebrospinal lactate level over 25 mg/dl. The patients who recovered with neurological deficit had higher level of cerebrospinal lactate than those who recovered without any neurological deficit, on admission and on-discharge, although the differences were not statistically significant. The patients who died had persistently high mean CSF lactate on admission and at death. The study suggests that persistently elevated CSF lactate in cases of pyogenic meningitis receiving adequate antibiotic therapy might indicate poor prognosis with increased mortality. It is not being suggested that CSF lactate determination should replace the conventional tests for meningitis. However, it can provide pertinent, rapid, and reliable diagnostic information, and can also provide useful evaluation information at different stages of treatment of proven meningitis with appropriate antibiotics.