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Endotoxin elimination in sepsis: physiology and therapeutic application

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Abstract

Purpose

The present review summarizes key papers on the elimination of endotoxin in human.

Results

Lipopolysaccharides (LPS) are extremely strong stimulators of inflammatory reactions, act at very low concentrations, and are involved in the pathogenesis of sepsis and septic shock. Elimination of LPS is vital; therefore, therapeutic detoxification of LPS may offer new perspectives. Multiple mechanisms eliminate LPS in human comprising molecules that bind LPS and prevent it from signaling, enzymes that degrade and detoxify LPS, processes that inactivate LPS following uptake into the reticulo-endothelial system, and mechanisms of adaptation that modify target cells responding to LPS. These mechanisms are powerful and detoxification capacity adapts as required. Results of therapeutic interventions aiming at the removal of LPS by medication (immunoglobulins) or extracorporeal means are controversial. At least in part, animal experiments revealed increased survival. Human trials confirmed the positive effects on parameters of secondary importance, but not on morbidity or survival which was attributed to the heterogeneity of patients suffering from consequences of severe infectious diseases and sepsis.

Conclusion

The hypothesis of LPS-driven inflammatory processes remains very attractive. However, few therapeutic yet immature options have been developed to date.

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Acknowledgments

No funding was received for doing this overview. Klaus Buttenschoen, Peter Radermacher, and Hendrik Bracht are authors of the publication Eur Surg Res (2009) 43:53–60, “Efficacy of an Extracorporeal Endotoxin Adsorber System during Hyperdynamic Porcine Endotoxemia”. This study was supported by a research grant of Fresenius Company, Germany.

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Authors and Affiliations

  1. Department of Surgery, Division of General Surgery, University of Alberta, 8440–112 St, Edmonton, AB, Canada, T6G 2B7

    Klaus Buttenschoen

  2. Sektion Anästhesiologische Pathophysiologie und Verfahrensentwicklung, Universitätsklinik für Anästhesiologie, Universitätsklinikum, Ulm, Germany

    Peter Radermacher & Hendrik Bracht

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  1. Klaus Buttenschoen
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  2. Peter Radermacher
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  3. Hendrik Bracht
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Correspondence to Klaus Buttenschoen.

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Buttenschoen, K., Radermacher, P. & Bracht, H. Endotoxin elimination in sepsis: physiology and therapeutic application. Langenbecks Arch Surg 395, 597–605 (2010). https://doi.org/10.1007/s00423-010-0658-6

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  • DOI: https://doi.org/10.1007/s00423-010-0658-6

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