Molecular mechanisms in endotoxin fever.

Two important concepts are presented in this review. First, endotoxin fever, like all fevers, is mediated by a host product, leukocytic pyrogen (LP). The mechanism by which LP production is initiated by endotoxin is discussed and evidence is provided which clearly distinguishes the biological and physical differences between LP and endotoxins. The second concept is that many of the molecular and neurochemical mechanisms by which LP causes fever by its action on the hypothalamic thermoregulatory center are also observed when endotoxins are introduced into the central nervous system. Thus, there may be experimental and clinical situations in which endotoxins can directly affect the hypothalamus and initiate fever. Although this bi-modal effect of endotoxin on the production of fever can occur, the importance of LP in mediating endotoxin and other fevers cannot be overstated.