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Journal of Antimicrobial Chemotherapy, Vol 41, 71-80, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy

ORIGINAL ARTICLES

Anti-endotoxin therapeutic options for the treatment of sepsis

WA Lynn
Cameron Centre, Ealing Hospital, Southall, Middlesex, UK.

The identification of lipopolysaccharide binding protein (LBP) and CD14 as key molecules in the cellular response to endotoxin has been a major advance in unravelling the pathophysiological basis of Gram-negative sepsis. Much interest has focused on developing effective anti- endotoxin treatments to abrogate the inflammatory consequences of Gram- negative infection. The therapeutic options can be divided into those aimed at neutralizing or clearing circulating endotoxin, including anti- endotoxin antibodies and endotoxin neutralizing proteins, and those that antagonize the effects of endotoxin on human cells--for example, lipid A analogues. Initial experiences with anti-lipopolysaccharide antibodies have been disappointing but a new generation of anti- endotoxin agents is about to enter clinical trials. Whether these will prove sufficiently effective to reduce the morbidity and mortality of Gram-negative sepsis remains to be seen.
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