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Why have clinical trials in sepsis failed?
Abstract
The systemic inflammatory response is biologically complex, redundant, and activated by both infectious and noninfectious triggers. Its manipulation can cause both benefit and harm. More than 100 randomized clinical trials have tested the hypothesis that modulating the septic response to infection can improve survival. With one short-lived exception, none of these has resulted in new treatments. The current challenge for sepsis research lies in a failure of concept and reluctance to abandon a demonstrably ineffectual research model. Future success will necessitate large studies of clinical and biochemical epidemiology to understand the course of illness, better integration of basic and clinical science, and the creation of stratification systems to target treatment towards those who are most likely to benefit.
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“The underlying molecular mechanisms behind pathological capillary leakage remain incompletely understood, hindering the development of targeted therapies aimed at vascular stabilization (3).”
From Targeting β1-integrin inhibits vascular leakage in endotoxemia (2018) · cites this paper as [3]
In the citing paper
“Increased capillary leakage leading to hypovolemic shock and multiorgan failure is a key event in the pathobiology of several difficult-to-treat conditions, such as sepsis (2, 3, 6).”
From Targeting β1-integrin inhibits vascular leakage in endotoxemia (2018) · cites this paper as [3]
In the citing paper
“Over the last 40 years, more than 100 clinical trials of would‐be sepsis drugs aimed at modulating host immune responses to infection have failed.”
From On race, human variation, and who gets and dies of sepsis (2022) · cites this paper as Marshall, 2014
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Metadata
- Authors
- Marshall, J. C.
- Affiliations
- St. Michael's Hospital (CA)
- Corresponding author
- Marshall, John C.
- ORCID
- Marshall, John C.
- Venue
- Trends in Molecular Medicine
- Publisher
- Elsevier BV
- Published
- 2014-04
- Volume
- 20
- Issue
- 4
- Pages
- 195-203
- ISSN
- 1471-4914 (ISSN-L)
- OpenAlex
- W1991209345
- Cited by
- 805
- References
- 56
- Citations by year
- 2026: 77 · 2025: 75 · 2024: 69 · 2023: 75 · 2022: 96 · 2021: 66 · 2020: 72 · 2019: 69 · 2018: 59 · 2017: 62 · 2016: 45 · 2015: 28 · 2014: 12
- FWCI
- 6.58
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Trends in Molecular Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
- Health Sciences › Nursing › Nutrition and Dietetics › Vitamin C and Antioxidants Research
- Keywords
- sepsis, clinical trial failure, systemic inflammatory response, sepsis treatment, translational research, patient stratification, sepsis epidemiology, inflammatory markers
- MeSH terms
- Animals, Clinical Trials as Topic, Drug Evaluation, Preclinical, Humans, Immunity, Innate, Immunologic Factors, Treatment Outcome, Sepsis
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