Immune therapy in sepsis; are we ready to try again?

Immune-therapy to ease the burden of sepsis has thus far failed to consistently improve patient outcomes. Advances in cancer immune-therapy and awareness that prolonged immune suppression in sepsis can leave patients vulnerable to secondary infection and death, have driven resurgence in the field of sepsis immune-therapy investigation. As we develop and evaluate these novel therapies, we must learn from past experiences where single-mediator targeted immune-therapies were blindly delivered to heterogeneous patient cohorts with complex and evolving immune responses. Advances in genomics, proteomics, metabolomics, and point-of-care technology, coupled with a better understanding of sepsis pathogenesis have meant that personalised immune-therapy is on the horizon. Here we review the complex immune pathogenesis in sepsis and the contemporary immune therapies that are being investigated to manipulate this response. An outline of the immune biomarkers that may be used to support this approach is also provided