S. Buzinschi *
* Conf. Dr. Sorin Buzinschi, șef catedră Specialitati Medicale, Facultatea de Medicina, Universitatea Transilvania Brasov; Spitalul de copii Brasov, Str. Nicopole nr. 45, Tel 0268415130, e-mail: sbuzinschi@unitbv.ro
Abstract
The genetic polymorphisms has an influence over the outcome of the patients with shock through the presence of a configuration of alleles that determine the protein specific synthesis as a response towards aggression in different quantities and reports. The genetic profile of the mediators establish the systemic inflamatory response and the compensatory antiinflamatory reaction. It has been proved that the presence of TNF2, a stable mutation of TNF-alpha gene, produces during the shock severe proinflamatory effects along with a high rate of death. In the antiinflamatory mediators system, investigation of genetic polymorphisms of antiinflamatory citokine IL-1ra, showed that the A2 allele is frecvently met at patients with severe shock rather than at healthy subjects. At some patients with acute infections there can appear sudden systemic reaction, shock and death, explained maybe by a hyperproduction of TNF-alpha and type A2 IL-1ra. It is possible at these changes are representative for an extended haplotype that includes other shock proteins: stress proteins, transmembrane signaling receptor system, defensins, plasmatic inhibitory clotting factors. Until now the antimediators therapy has been inefffective.For the future the immunomodulatory therapy appliable after identifing the predominant mediators, may be the solution especially for the genetic risk groups.