Removal of circulating tumor necrosis factor. Its role in septic shock treatment.

The tumor necrosis factor (TNF) is a polypeptide secreted by macrophages in response to endotoxins, especially from Gram-negative bacteria. Previous investigations suggest that TNF plays a prominent role in septic shock and meningococcal disease toxicity. A positive correlation was found between the initial serum TNF level and the patient's outcome. Despite the progress made in intensive care management and antibiotic therapy, the prognosis of septic shock remains very poor. Because of the implication of TNF in the pathogenesis of septic shock, we suggest that neutralization or elimination of this cytokine by plasma or blood exchanges could contribute to the treatment of severe forms of this syndrome. Five plasma exchanges and two blood exchanges were performed in 6 patients admitted for septic shock or purpura fulminans. Serum TNF levels were measured by immunoradiometric assay (Medgenix, ERIA Pasteur) before and after exchange. Serum TNF levels were found to be decreased by an average of 62% after the exchange. We conclude that exchange therapies are efficient in removing plasma TNF. Nevertheless, because of the limited number of patients treated, it is not possible to evaluate the clinical efficacy of such techniques.