Zanetti G, Glauser M P, Baumgartner J D
Department of Internal Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
New Horiz. 1993 Feb;1(1):110-9.
Neutralization of endotoxin (lipopolysaccharide) would be of considerable benefit in the treatment of Gram-negative sepsis. Administration of anti-lipopolysaccharide antibodies is an old approach that has been renewed by improvements in monoclonal antibody technology. Experimental and clinical studies of antibodies directed at the conserved core region of lipopolysaccharide or at the lipid A are discussed. Some of these antibodies appear to be protective in animal models or in clinical trials, but discrepant results have been reported and the mechanism of the postulated protection was not clarified. Despite the availability of a monoclonal anti-lipid A antibody on the market in some European countries, this type of treatment should still be considered of unclear value until further experimental and clinical studies have reinvestigated the protection afforded by these antibodies. The use of detoxified lipid A analogs with lipopolysaccharide antagonist properties is another promising strategy that is discussed briefly in this review. Recently, substantial progress has been made in understanding how lipopolysaccharide triggers the immune system. A family of proteins possessing lipopolysaccharide-binding sites has been discovered. These proteins have a striking homology in DNA sequence, but they have different functions. The biological role of these proteins is now being actively investigated. New strategies to improve the outcome of Gram-negative sepsis may result from this research.
中和内毒素（脂多糖）在革兰氏阴性菌败血症的治疗中会有相当大的益处。给予抗脂多糖抗体是一种古老的方法，随着单克隆抗体技术的改进又重新受到关注。本文讨论了针对脂多糖保守核心区域或脂质A的抗体的实验和临床研究。其中一些抗体在动物模型或临床试验中似乎具有保护作用，但也有不一致的结果报道，且假定的保护机制尚未阐明。尽管在一些欧洲国家市场上有单克隆抗脂质A抗体，但在进一步的实验和临床研究重新探讨这些抗体所提供的保护作用之前，这种治疗方法的价值仍不明确。使用具有脂多糖拮抗特性的解毒脂质A类似物是另一种有前景的策略，本文将对此进行简要讨论。最近，在理解脂多糖如何触发免疫系统方面取得了重大进展。已发现一类具有脂多糖结合位点的蛋白质。这些蛋白质在DNA序列上有显著的同源性，但功能不同。目前正在积极研究这些蛋白质的生物学作用。这项研究可能会带来改善革兰氏阴性菌败血症治疗结果的新策略。
