Endotoxin, or lipopolysaccharides LPS, is one of the major components of the cell membrane in gram-negative bacteria. When the bacteria are lysed, e.g. following administration of certain antibiotics, the endotoxin is exposed. A secondary endogenous source of endotoxin is epithelial barrier dysfunction in the gut.

Endotoxins are macromolecules, consisting of a lipid part, called Lipid A and a polysaccharide chain. The polysaccharide chain varies between different bacteria strains while the Lipid A component is constant. Lipid A, which is responsible for the toxic effects, is exposed when bacteria are lysed. When bound to Toll-like receptors (TLR4) they activate a cellular signalling mechanism, causing release of pro- and anti-inflammatory cytokines. Simultaneous disturbances in the coagulation cascade and microcirculation contribute to impaired tissue perfusion and organ failure. The final outcome is multiple organ dysfunction and in severe cases, death.

Endotoxin is always present in the body and is partly metabolized in the liver. However, during endotoxemia the overload triggers the inflammatory response and leads to sepsis.

The Alteco® LPS Adsorber has the capacity to significantly reduce endotoxemia when used in hemoperfusion of patients with gram-negative sepsis. The subsequent decrease of the endotoxin level is beneficial to the patients as it reduces the effects of gram-negative sepsis, such as cardiorespiratory dysfunction and the release of pro-inflammatory mediators, and thus turns the course of sepsis for the patient.

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