248 Chapter 8 be suppressed and M2 differentiation should be enhanced [69,74]. Lymphocyte activity could be regulated by suppressing Th1/Th17 T cell activity or enhancing Th2/Treg activity. Distortion in the immune response after trauma not only leads to long-lasting, excessive inflammation, but can also lead to CARS induced immune paralysis. CARS causes defects in the adaptive immunity and will increase the patient’s overall susceptibility to infection [6,138–140]. It is therefore of utmost importance to accurately monitor the immune status of patients before applying immunosuppressive therapies. Treatments aimed at reversing the immunosuppression such as inhibition of the programmed cell death protein 1/programmed death ligand (PD-1/PD-L) pathway on T cells are used and tested in diseases like cancer and sepsis [141]. Such interventions might also be of use for burn patients to restore immune paralysis. As there is much variation between patients, burn injuries and clinical progression, therapy should be tailored to individual needs. Moreover, we showed in Chapter 2 and Chapter 3 that factors such as age, sex, burn severity and burn agent can influence the immune response. Overall, therapy should be personalized and aimed at a timely restoration of the immune balance by modulating the intensity and duration of inflammatory responses.
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