Nephrology Dialysis Transplantation, Vol 13, Issue 4 969-974, Copyright © 1998 by Oxford University Press
K Schafer, R Schumann, S Stoteknuel, P Schollmeyer and G Dobos
Background: Bacterial peritonitis is a frequent
complication during treatment of end-stage renal failure by continuous
ambulatory peritoneal dialysis. Local host defence mechanisms including the
secretion of proinflammatory cytokines by peritoneal macrophage are of
particular importance in the pathogenesis of infectious complications.
LPS-binding protein (LBP) and soluble CD14 (sCD14) are serum factors known
to regulate the endotoxin-induced cellular immune response. However, it is
still unknown whether LBP and sCD14 are also present in the peritoneal
effluent of CAPD patients. Methods: Using specific
immunoassays, we examined the concentration of LBP, sCD14 and the
proinflammatory cytokines TNF=&agr;, IL-1{beta} and IL-6 in the
dialysis effluents of 31 patients with CAPD-associated peritonitis. Twenty
patients without peritonitis served as controls. Intraperitoneal LPS
concentrations were determined using the limulus amebocyte lysate assay.
Results: Bacterial lipopolysaccharide could be
detected in 42% of the infected dialysis effluents. In comparison to
controls (0.2±0.05 &mgr;g/ml), LBP was significantly
elevated in both Gram-negative/LPS-positive (1.03±0.3
&mgr;g/ml) and Gram-positive infections (0.5±0.14
&mgr;g/ml) (P<0.05). No significant differences were detected
concerning the intraperitoneal sCD14 levels in the three patient groups.
Levels of TNF-&agr;, IL-1{beta} and IL-6 were significantly
increased in the effluents of patients with bacterial peritonitis compared
to non-infected controls. Moreover the respective cytokine concentrations
were significantly higher in the Gram-negative/LPS-positive compared to the
gram-positive bacterial infections (P<0.01).
Conclusion: Our data demonstrate that LBP is
significantly elevated in the dialysis effluents of patients with
CAPD-associated peritonitis caused by both Gram-negative and Gram-positive
bacteria and might be used as a marker of intraperitoneal infection.
Moreover, our findings support the concept that LBP enhances the effects of
LPS on cytokine production by peritoneal macrophages. The function of LBP
in Gram-positive infection remains to be further elucidated. Key
words: CAPD-associated peritonitis; cytokines;
lipopolysaccharide-binding protein; macrophages; peritoneal dialysis;
soluble CD14
ORIGINAL ARTICLES
Lipopolysaccharide-binding protein is present in effluents of patients with Gram-negative and Gram-positive CAPD peritonitis
Department of Nephrology, University of Freiburg, Hugstetter Strasse 55, D-79106, Freiburg, Germany; Molecular Sepsis Research Laboratory, Max-Delbruck-Zentrum, and Department of Microbiology and Hygiene, University Hospital Charite, Humboldt-University Berlin, Germany; Corresponding author
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