A new limulus assay for the detection of endotoxin.

The limulus amebocyte lysate (LAL) assay has proven to be a highly sensitive and reliable indicator of endotoxin in most biological fluids; however, it has not been a reliable indicator when used with blood because of different inhibitors present in the blood. To avoid these problems, investigators have used difficult extraction procedures, but but even with these, results were oftentimes not uniform. It was found that a recently developed inert polymer (PSI-HAP 100) has a specific affinity for endotoxin, so that is was possible to develop a simple, reliable, reproducible method for the detection of endotoxin in blood. In the assay procedure, the polymer, compressed into a 3-mm diameter bead, is incubated with 0.2 cc of heparinized whole blood. The bead is then removed from the blood, washed in pyrogen-free saline to remove any inhibitors of the LAL, and placed in a tube containing LAL. The LAL and bead are incubated together; after incubation the LAL is examined for gellation. Using this new method, it was possible to predict Gram-negative septic episodes in burn patients several days before sepsis evolved clinically.