Maxime Nguyen, Marvin Alvarez, Vivien Berthoud, Gaetan Pallot, Sohel Abagri, Damien Leleu, Jean-Paul Pais-De-Barros, Pablo Ortega-Deballon, Pierre-Grégoire Guinot, David Masson, Thomas Gautier, Belaid Bouhemad
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Abstract
Background: The high-density lipoprotein (HDL) and the phospholipid transfer protein (PLTP) have been demonstrated to enhance endotoxin elimination and inactivation in animal models of sepsis. This study aimed to confirm such a role in patients presenting with abdominal sepsis undergoing emergent surgery and explore the relationships between HDL, PLTP and the lipopolysaccharide (LPS) burden (mass and activity).
Methods: Patients operated for abdominal sepsis were prospectively included in the study. Blood samples were obtained before surgery, at the end of the operation (H0), 4 h (H4) and 24 h (H24) later. Peritoneal fluid was also sampled. HDL cholesterol, LDL cholesterol, PLTP activity, LPS mass and activity were measured.
Results: Twenty-seven patients were included. At H0, LPS mass was mostly measured in the lipoprotein fractions (46% [23; 58] in HDL and 36% [29; 54] in LDL). Overall, LPS mass and LPS activity did not decrease in the 24 h following admission to the ICU. Both HDLc concentrations and PLTP activity were associated with increased H4-LPS elimination (drop in LPS concentration, -3% [-26;10] vs. 29% [13;52], p < 0.01 and -2% [-15;10] vs. 20% [8:52], p = 0.03, respectively). Increased H4-LPS elimination was associated with reduced inflammation (plasma cytokine concentration) and mortality. High HDL cholesterol was associated with reduced mortality but not with inflammation.
Conclusion: Our data support the role of HDL and PLTP in the elimination of LPS during human peritonitis with sepsis. Increased H4-LPS elimination was associated with reduced inflammation and lower mortality.
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EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.
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