To counteract or to clear high-mobility group box-1 protein in influenza A (H1N1) infection? That may become the question

Up to one third of patients with influenza A (H1N1) virus require intensive care unit (ICU) admission because of severe pneumonia, sepsis, or acute respiratory distress syndrome or a combination of these. Still, inICU mortality rate remains excessively high despite the deployment of maximal therapeutic support, often including extracorporeal membrane oxygenation [1]. In this perspective, the recently published experimental findings of Nosaka and colleagues in Critical Care may represent an important therapeutic breakthrough [2]. These investigators show that an anti-high-mobility group box-1 (anti-HMGB-1) monoclonal antibody suppresses the H1N1-induced immuno-inflammatory response, resulting in significant attenuation of lung injury and improved survival [2]. This study underscores that pharmacological inhibition of key inflammatory cytokines, despite offering