Clinical experience with lipopolysaccharide adsorber in cancer patients with severe sepsis and septic shock

Introduction

Sepsis is one of the most often met complications for cancer patients. It is caused by immunosuppression after radiotherapies and chemotherapies as extensive operations. For sepsis treatment, many experts now recommend even more often using extracorporeal detoxification methods. Since sepsis is more often caused by Gram-negative microorganisms in clinical hospitals, lipopolysaccharide (LPS) adsorption was offered for treatment of the patients.

Methods

For extracorporeal detoxification of cancer patients with severe Gram-negative sepsis and septic shock (APACHE II score 28 ± 7 on starting hemoperfusion) we used LPS adsorber (Alteco^® LPS Adsorber; Alteco Medical AB, Lund, Sweden). The patient's blood was taken before and after adsorption, then the serum was separated and stored at -70°C. We determined the LPS concentration by LAL test, lipopolysaccharide-binding protein (LBP), sIL-1 RII and sCD14 by ELISA kits (Hycult Biotechnology, the Netherlands), and proinflammatory and anti-inflammatory cytokines IL-6, TNFβ, IL-8, IL-2, INFγ, IL-12, TNFα, IL-4, IL-5, IL-1β and IL-10 by ELISA kit (Bender MedSystems).

Results

In all cases we saw reliable reduction of the LPS level in serum (1.8 to 2 times). After the investigation of some cytokine levels we obtained similar results: IL-6, TNFβ and IL-8 levels had been reduced 30 to 40%, 87% and 62 to 76% accordingly. At the same time, IL-2, INFγ, IL-12, TNFα, IL-4 and IL-5 levels in serum had not changed practically. However, in approximately 1/3 cases an IL-1β and IL-10 concentration increase in serum was observed (33 and 40% accordingly). Also our research has shown that, in the most of the cases after application of this sorbent, LBP decreased insignificantly (10 to 32%), but the sIL-1 RII level slightly increased (10 to 18%) in the majority of patients and considerably decreased (two times) in 1/3 investigated patients. The CD14 concentration in patient serum reliably did not change before and after adsorption. The somatic status of patients was stabilized after LPS adsorption.

Conclusions

After LPS adsorption with Alteco^® the LPS level in patient serum significantly reduced. Simultaneously, concentrations of some cytokines (IL-6, TNFβ, IL-8) were reliably decreased. But the LPS adsorber probably does not eliminate soluble receptors like sCD14 and RIL-1 from blood. So the LPS adsorption may represent a significant improvement in the treatment of cancer patients with severe Gram-negative sepsis and septic shock.