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A medical "smart-bomb" to save septicemia victims.

However much we deplore war, one cannot help but be amazed at the incredible precision with which airborne weapons had attacked Persian Gulf military targets because of recent technological advances. A report in the February 14 New England Journal of Medicine suggests that a very different type of "smart bomb" may be instrumental in saving the lives of the many thousands (including wounded soldiers) who die each year from septic shock-a massive type of "blood poisoning" secondary to a wide variety of medical conditions.

Bloodstream infections have increased markedly in recent years because of more vigorous medical and surgical treatment previously unavailable for many conditions. Many who would have died from trauma, burns, cancer, and other overwhelming conditions are now being saved. Having survived surgery or chemotherapy, however, many patients develop bloodstream infections which progess so rapidly that massive failure of critical organs occurs before conventional antibiotic and other therapy can intervene. A case in point is that of the late, beloved puppeteer Jim Henson, whose septicemic infection had become so severe by the time he got to the hospital that he died within hours of admission, despite lengthy heroic treatment efforts.

The NEJM reports of a genetically engineered "monoclonal antibody" that goes precisely to its target, the poisonous toxins created by these overwhelming infections. These toxins attack such critical organs as the heart, liver, and kidneys. The drug, manufactured by a Pennsylvania-based biotechnology company named Centocor, has been tested at 24 centers in the United States. The centers report a 40 percent reduction in fatalities from septic shock. The Food and Drug Administration had already given the go-ahead for its use in casualties of the Gulf war, and it is likely that the NEJM report will bring FDA approval for more general use.

Monoclonal therapy with genetically engineered drugs has been largely a dream in recent years, seen as a possible cure for such fatal disorders as cancer and AIDS. Dr. Charles Fisher of Case Western Reserve University in Cleveland, notes that, when approved, the septic shock drug will be the first human monoclonal antibody put into therapy. The U.S. Centers for Disease Control in Atlanta reports 400,000 to 500,000 cases of severe bloodstream infections each year in this country, many of which occur among patients admitted to hospital for other conditions. When the infection becomes so severe that organ systems abruptly fail and blood pressure rapidly falls, death is usually the result. However, many patients in the study who had reached that stage survived when treated with the septic shock drug.
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Title Annotation:monoclonal therapy
Publication:Medical Update
Date:Mar 1, 1991
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