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Critical Care

Open Access

Regional variation in anti-endotoxin core antibody levels in healthy and preoperative surgical populations

  • M Rashid1,
  • R Stephens1,
  • M Siva1,
  • M Grocott1,
  • E Burdett1,
  • D Turner2 and
  • M Mythen1
Critical Care20037(Suppl 2):P199

Published: 3 March 2003


Healthy DonorCardiac PatientMedian SerumHealthy Blood DonorMedian Unit


Endotoxin has a central role in sepsis and organ dysfunction after surgery. Levels of one of our natural defences against endotoxin, antibodies to endotoxin core (EndoCAb), are independent predictors of postoperative outcome [1]. There is a heterogeneity in EndoCAb levels between European and North American healthy donor populations that remains unexplained [2].


Blood samples from healthy blood donors were collected in London, UK and compared with levels of baseline EndoCAb in previous studies. An ELISA assay of serum EndoCAb IgG (n = 165) and IgM (n = 65*) levels was performed and expressed as median units per ml (MU/ml) [3].


The median serum EndoCAb IgG and IgM levels in this population were 189.7 (41.8–1023) MU/ml and 222.5 (42.3–913.9) MU/ml, respectively (Fig. 1).

Figure 1


EndoCAb levels are higher in London healthy donors than in the Scottish population. US cardiac patients show higher IgG levels than UK cardiac patients and Scottish healthy donors, but are similar to London healthy donors. US surgery patients show higher IgM levels than all groups but are similar to London healthy donors. Differences may be due to prior exposure to endotoxin, different disease process, differences in sampling and patient management, or genetic variation between countries. We are collecting further healthy donor samples to assess a larger cohort of EndoCAb levels in London.

Authors’ Affiliations

UCL Centre for Anaesthesia, Middlesex Hospital, London, UK
National Blood Transfusion Service, Colindale, London, UK


  1. Bennett-Guerrero E, Panah MH, Barclay GR, Bodian CA, Winfree WJ, Andres LA, Reich DL, Mythen MG: Decreased endotoxin immunity is associated with greater mortality and/or prolonged hospitalization after surgery. Anesthesiology 2001, 94: 992-998. 10.1097/00000542-200106000-00012View ArticlePubMedGoogle Scholar
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  3. Barclay GR, Scott BB: Serological relationship between Escherichia coli and Salmonella smooth- and rough-mutant lipopolysaccharides as revealed by enzyme-linked immunosorbent assay for human immunoglobulin G antien-dotoxin antibodies. Infect Immun 1987, 55: 2706-2714.PubMed CentralPubMedGoogle Scholar


© BioMed Central Ltd 2003