More than a decade ago, clinicians noted striking similarities between patients with Ebola and those with bacterial sepsis. Both diseases involve severe dysfunction of the endothelial cells that line blood vessels throughout the body. This dysfunction in turn precipitates major abnormalities in blood coagulation. Both can eventually lead to the failure of internal organs, primarily the liver and kidneys, and organ failure often leads to death. Something similar is seen in many patients with other forms of acute critical illness, including pneumonia and influenza.
Researchers have since discovered that abnormalities of endothelial function and coagulation can be modified or reversed by treatment with drugs such as statins, angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs), which were developed to treat patients with cardiovascular diseases and diabetes. Known as immunomodulatory drugs, they also have the ability to modify the body’s response to infection. While they don’t prevent infection itself, they can prevent complications like organ failure. A clinical trial published in the journal Critical Care in 2012 demonstrated, for example, that early treatment of sepsis patients with a statin reduced the occurrence of organ failure (a complication that often kills Ebola patients) by 83 percent.
Perhaps one day these immunomodulatory drugs might be used in the treatment of patients with many forms of acute critical illness, including pneumonia and influenza, much as oral rehydration solution is used to treat patients with severe diarrhea, regardless of the cause.
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