Adsorption of endotoxin on glass in the presence of rhIL-11

Recent developments in the treatment of sepsis

Despite advances in supportive care, septic shock remains a major cause of morbidity and mortality. With the identification of the systemic inflammatory response as a major component in the pathogenesis of the septic shock syndrome, much of the recent work has focused on modulating this response. This includes antiendotoxin therapies in patients with Gram-negative sepsis, and therapies to modulate the pro-inflammatory mediators produced in response to infection, such as TNF-alpha, platelet-activating factor and complement. High-flow haemofiltration has the potential advantage of clearing both endotoxin and pro-inflammatory mediators. Antithrombotic strategies have been investigated and have yielded the first major success in the treatment of sepsis with activated protein C. Nitric oxide produces the cardiovascular features of sepsis and investigators have looked at both reducing its production and mopping up the excess. Attempts to reduce apoptosis have been a new focus in the treatment of sepsis. There have also been recent developments in supportive care suggesting a role for vasopressin and replacement corticosteroid therapy.

Adsorption of endotoxins on glass in the presence of cationic proteins

Endotoxin activity was detected in empty glass tubes where endotoxins were incubated with lysozyme, histone or RNaseA, indicating adsorption of endotoxins on glass in the presence of cationic proteins. In the case of lysozyme, the recovery of spiked endotoxins (90.0%) using polystyrene tubes for incubation was much greater than the recovery (28.5%) using glass tubes, suggesting that lysozyme-mediated adsorption of endotoxins on glass is a major cause of poor recovery of spiked endotoxins in the LAL assay using glass tubes. In contrast, the recovery of spiked endotoxins (64.7%) using polystyrene tubes in the presence of the non-cationic protein BSA was less than the recovery (103.9%) using glass tubes. The difference in endotoxin recovery using glass or polystyrene tubes in the presence of cationic proteins or BSA can be explained by differences in protein adsorption on the tubes. Consequently, care must be exercised in selecting containers used for the LAL assay of proteins which bind to endotoxins.