Endotoxin and antiendotoxin antibodies in patients with acute pancreatitis

Objective: To elucidate the time course of endotoxaemia and antiendotoxin a ntibodies in patients with acute pancreatitis. Design: Prospective clinical study. Setting: University hospital, Germany. Subjects: 25 patients with oedematous (n = 9) or necrotising (n = 16) pancr eatitis, and 20 healthy controls. Main outcome measures: Concentrations of endotoxin and immunoglobulins (cla sses G, M, and A) directed at two lipid A molecules, four lipopolysaceharid es, and a-haemolysin of Staphylococcus aureus measurements in plasma during a 12 day period. Results: There were no differences in the degree of endotoxaemia between pa tients with oedematous and necrotising pancreatitis on admission. However, from the day after admission and throughout the observation period patients with necrotising pancreatitis had significantly higher concentrations of e ndotoxin than those with oedematous pancreatitis. Concentratons of IgM spec ific fur endotoxin peaked at day 4, and then decreased in patients with oed ematous pancreatitis while remaining high for those with necrotising pancre atitis. There was only a slight increase in IgA specific for endotoxin, and Ige and immunoglobulins to alpha-haemolysin remained steady throughout the observation period. There was strong cross-reactivity (r > 0.7) between Ig M specific for endotoxin (70%), but this was less with IgA (52%), and IgG ( 20%). Conclusions: Necrotising pancreatitis is accompanied by persistent endotoxa emia with an extended rise in antiendotoxin antibodies. Patients with oedem atous pancreatitis have a transient endotoxaemia with a temporary increase of Ig specific for endotoxin. Endotoxin stimulates the synthesis of specifi c antibodies (IgM) despite general immunosuppression.