ANTIENDOTOXIN THERAPEUTIC OPTIONS FOR THE TREATMENT OF SEPSIS

The identification of lipopolysaccharide binding protein (LBP) and CD1 4 as key molecules in the cellular response to endotoxin has been a ma jor advance in unravelling the pathophysiological basis of Gram-negati ve sepsis. Much interest has focused on developing effective anti-endo toxin treatments to abrogate the inflammatory consequences of Gram-neg ative infection. The therapeutic options can be divided into those aim ed at neutralizing or clearing circulating endotoxin, including anti-e ndotoxin antibodies and endotoxin neutralizing proteins, and those tha t antagonize the effects of endotoxin on human cells-for example, lipi d A analogues. Initial experiences with anti-lipopolysaccharide antibo dies have been disappointing but a new generation of anti-endotoxin ag ents is about to enter clinical trials. Whether these will prove suffi ciently effective to reduce the morbidity and mortality of Gram-negati ve sepsis remains to be seen.