Skip to main content
Log in

Antiendotoxin Monoclonal Antibodies in Sepsis

Lessons from Recent Clinical Trials

  • Leading Article
  • Published:
Clinical Immunotherapeutics Aims and scope Submit manuscript

Summary

Gram-negative bacteria release lipopolysaccharide (endotoxin) that causes sepsis and septic shock. Monoclonal antibodies against endotoxins have been proposed as a treatment of sepsis. One such antibody, nebacumab (HA-1A), was released onto the market in some European countries and its approval in the USA was recommended.

However, doubts raised by the lack of reproducible preclinical data, and by an independent reanalysis of the results of the first clinical trial, led to a further clinical trial. This second trial revealed an increase in mortality in nebacumabtreated patients. The trial was stopped and the drug withdrawn from the market.

To avoid such disappointments, the marketing of new biotechnology products should be based on critical scientific analysis, free from commercial pressures, of thorough, reproducible and consistent preclinical and clinical studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Increase in National Hospital Discharge Survey rates for septicemia — United States, 1979–1987 [editorial]. Morb Mortal Wkly Rep 1990; 39: 31–4

  2. Glauser MP, Zanetti G, Baumgartner JD, et al. Septic shock: pathogenesis. Lancet 1991; 338: 732–6

    Article  PubMed  CAS  Google Scholar 

  3. Baumgartner JD. Immunotherapy with antibodies to core LPS: a critical appraisal. Infect Dis Clin North Am 1991; 5: 915–27

    PubMed  CAS  Google Scholar 

  4. Heumann D, Baumgartner JD, Jacot-Guillarmod H, et al. Antibodies to core lipopolysaccharide determinants: absence of cross-reactivity with heterologous lipopolysaccharides. J Infect Dis 1991; 163: 762–8

    Article  PubMed  CAS  Google Scholar 

  5. Baumgartner JD, Eggimann P, Glauser MP. Management of septic shock: new approaches. In: Remington JS, Swartz MN, editors. Current clinical topics in infectious diseases, vol. 12. Cambridge: Blackwell Scientific, 1992: 165–87

    Google Scholar 

  6. Ziegler EJ, McCutchan JA, Fierer J, et al. Treatment of Gram-negative bacteremia and shock with human antiserum to a mutant Escherichia coli. N Engl J Med 1982; 307: 1225–30

    Article  PubMed  CAS  Google Scholar 

  7. Baumgartner JD, Glauser MP, McCutchan JA, et al. Prevention of Gram-negative shock and death in surgical patients by prophylactic antibody to endotoxin core glycolipid. Lancet 1985; 2: 59–63

    Article  PubMed  CAS  Google Scholar 

  8. McCutchan JA, Wolf JL, Ziegler EJ, et al. Ineffectiveness of single-dose human antiserum to core glycolipid (E. coli J5) for prophylaxis of bacteremic, gram-negative infection in patients with prolonged neutropenia. Schweiz Med Wochenschr 1983; 113Suppl. 14: 40–5

    Google Scholar 

  9. J5 Study Group. Treatment of severe infectious purpura in children with human plasma from donors immunized with Escherichia coli J5: a prospective double-blind study. J Infect Dis 1992; 165: 695–701

    Article  Google Scholar 

  10. Calandra T, Glauser MP, Schellekens J, et al. Treatment of Gram-negative septic shock with human IgG antibody to Escherichia coli J5: a prospective, double-blind, randomized study. J Infect Dis 1988; 158: 312–9

    Article  PubMed  CAS  Google Scholar 

  11. Intravenous Immunoglobulin Collaborative Study Group. Prophylactic intravenous administration of standard immune globulin as compared with core-lipopolysaccharide immune globulin in patients at high risk of postsurgical infection. N Engl J Med 1992; 327: 234–40

    Article  Google Scholar 

  12. Baumgartner JD, Heumann D, Calandra T, et al. Antibodies to lipopolysaccharides after immunization of humans with the rough mutant Escherichia coli J5. J Infect Dis 1991; 163: 769–72

    Article  PubMed  CAS  Google Scholar 

  13. Teng NNH, Kaplan HS, Hebert JM. Protection against Gram-negative bacteremia and endotoxemia with human monoclonal IgM antibodies. Proc Natl Acad Sci USA 1985; 82: 1790–4

    Article  PubMed  CAS  Google Scholar 

  14. Young LS, Gascon R, Alam S, et al. Monoclonal antibodies for treatment of gram-negative infections. Rev Infect Dis 1989; 11Suppl. 7: S1564–S1571

    Article  PubMed  Google Scholar 

  15. Baumgartner JD, Heumann D, Glauser MP. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 281–2

    Google Scholar 

  16. Baumgartner JD, Heumann D, Gerain J, et al. Association between protective efficacy of anti-lipopolysaccharide (LPS) antibodies and suppression of LPS-induced tumor necrosis factor α and interleukin 6: comparison of O side chain-specific antibodies with core LPS antibodies. J Exp Med 1990; 171: 889–96

    Article  PubMed  CAS  Google Scholar 

  17. Ziegler EJ, Fisher CJ, Sprung CL, et al. Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin: a randomized, double-blind, placebo-controlled trial. N Engl J Med 1991; 324: 429–36

    Article  PubMed  CAS  Google Scholar 

  18. Warren HS, Danner RL, Munford RS. Anti-endotoxin monoclonal antibodies. N Engl J Med 1992; 326: 1153–7

    Article  PubMed  CAS  Google Scholar 

  19. Greenman RL, Schein RMH, Martin MA, et al. A controlled clinical trial of E5 murine monoclonal IgM antibody to endotoxin in the treatment of Gram-negative sepsis. JAMA 1991; 266: 1097–102

    Article  PubMed  CAS  Google Scholar 

  20. Wenzel R, Bone R, Fein A, et al. Results of a second double-blind, randomized, controlled trial of antiendotoxin antibody E5 in gram-negative sepsis [extended abstract]. In: Program and abstracts of the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy; 1991 Sep 29–Oct 2; Chicago. Washington DC: American Society for Microbiology, 1991: 294

    Google Scholar 

  21. Wenzel RP. Antiendotoxin monoclonal antibodies — a second look. N Engl J Med 1992; 326: 1151–3

    Article  PubMed  CAS  Google Scholar 

  22. Winslow R. Effectiveness of new drug against septic infections is questioned by agency. Wall Street Journal 1992 Apr 16; B5

    Google Scholar 

  23. Fisher LM. Investors punish Centocor for more bad news. New York Times 1993 Jan 19; D1

    Google Scholar 

  24. Gazmuri RJ, Mecher C, Weil MH. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 279–80

    Article  Google Scholar 

  25. Tanio CP, Feldman HI. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 280

    Google Scholar 

  26. Carlet J, Offenstadt G, Chastang C. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 280

    Google Scholar 

  27. Schmidt GA. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 280–1

    Google Scholar 

  28. Peled HB. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 281

    Google Scholar 

  29. Ziegler EJ, Fisher CJ, Sprung CL. The HA-1A monoclonal antibody for gram-negative sepsis [letter]. N Engl J Med 1991; 325: 282–3

    Google Scholar 

  30. Kweder SL, Schnur RA, Cooper EC. Inosine pranobex — is a single positive trial enough? N Engl J Med 1990; 322: 1807–9

    Article  PubMed  CAS  Google Scholar 

  31. Di Padova FE, Barclay R, Liehl E, et al. Widely cross-reactive anti-LPS core monoclonal antibodies have LPS neutralizing properties. Abstract CB404. J Cell Biochem 1992; Suppl. 16C–170

    Google Scholar 

  32. Saxen H, Vuopio-Varkila J, Luk J, et al. Detection of enterobacterial lipopolysaccharides and experimental endotoxemia by means of an immunolimulus assay using both serotype-specific and cross-reactive antibodies. J Infect Dis 1993; 168: 393–9

    Article  PubMed  CAS  Google Scholar 

  33. Piercey L. Star-crossed lovers — is biotech bad for science? Biopeople 1993; 4: 20–7

    Google Scholar 

  34. Tobias PS, Mathison JC, Ulevitch RJ. A family of lipopolysaccharide binding proteins involved in responses to gram-negative sepsis. J Biol Chem 1998; 263: 13479–81

    Google Scholar 

  35. Ooi CE, Weiss J, Doefler ME, et al. Endotoxin-neutralizing properties of the 25 kD N-terminal fragment and a newly isolated 30kD C-terminal fragment of the 55–60 kD bactericidal/permeability-increasing protein of human neutrophils. J Exp Med 1991; 174: 649–55

    Article  PubMed  CAS  Google Scholar 

  36. Marra MN, Snable JL, Scott RW, et al. Bactericidal/permeability-increasing protein: a naturally occurring lipopolysaccharide antagonist. Circ Shock 1991; 34–7

    Google Scholar 

  37. Heumann D, Gallay P, Betz-Corradin S, et al. Competition between bactericidal/permeability-increasing protein and lipopolysaccharide-binding protein for lipopolysaccharide binding to monocytes. J Infect Dis 1993; 167: 1351–7

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Baumgartner, JD. Antiendotoxin Monoclonal Antibodies in Sepsis. Clin. Immunother. 1, 8–14 (1994). https://doi.org/10.1007/BF03258487

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03258487

Keywords

Navigation