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Lipopolysaccharide Binding Protein Associated With Immune And Haemodynamic Derangement In Cirrhosis
A DGReview of :"Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement."
Hepatology
01/09/2003
By James Adams
Levels of lipopolysaccharide binding protein are elevated in ascitic cirrhotic patients with marked immune and haemodynamic derangement.
These abnormalities are relieved by treatment with norfloxacin, suggesting the involvement of enteric bacteria or their products, according to investigators from the Hospital Ramon Y Cajal in Madrid, Spain.
Overgrowth and translocation of intestinal bacteria are common in cirrhosis with ascites, the investigators explain, and may result in activation of monocytes and lymphocytes and also in increased levels of pro-inflammatory cytokines and in enhanced synthesis of nitric oxide.
The synthesis of lipopolysaccharide binding protein is enhanced by bacterial endotoxin. The complex of binding protein and lipopolysaccharide that forms then binds to CD14.
The investigators evaluated lipopolysaccharide binding protein levels in 102 cirrhotic patients and 30 controls. Plasma levels of lipopolysaccharide binding protein, endotoxin, soluble CD14, cytokines, renin, nitrites and systemic vascular resistance were assessed before and four weeks after treatment with either norfloxacin or placebo.
Forty-two percent of the ascitic cirrhotic patients had elevated levels of lipopolysaccharide binding protein. In 60% of these patients, endotoxin was within the normal range.
Ascitic cirrhotic patients with high lipopolysaccharide binding protein also had higher levels of soluble CD14, tumor necrosis factor alpha, interleukin 6, nitrites plus nitrates/creatinine and renin. Vascular resistance was lower in these patients.
Norfloxacin treatment normalized soluble CD14, reduced cytokines, nitrites plus nitrates/creatinine and renin and increased vascular resistance in patients with high lipopolysaccharide binding protein. It had no effect in patients with normal lipopolysaccharide binding protein levels.
Hepatology 2003;37(1):208-217.
"Increased lipopolysaccharide binding protein in cirrhotic patients with marked immune and hemodynamic derangement."
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