Endogenous endotoxemia in patients with liver cirrhosis--a quantitative analysis of endotoxin in portal and peripheral blood.

In order to investigate the mechanism of endogenous endotoxemia (that is, endotoxemia observed in the absence of infection) in patients with liver cirrhosis, the concentration of endotoxin in the portal (PO-Et) and peripheral blood (PE-Et) from fifty three patients undergoing abdominal surgery was simultaneously measured by a quantitative endotoxin assay. The PE-Et of the patients with liver cirrhosis (19.8 +/- 20.2 pg/ml, n = 23) was significantly elevated, when compared with that of the patients without liver cirrhosis (9.2 +/- 5.1 pg/ml, n = 30), and was close to the normal range of PE-Et obtained from thirty healthy volunteers (7.2 +/- 4.1 pg/ml, n = 30). The PO-Et was also higher in the patients with liver cirrhosis than in the patients without liver cirrhosis. Moreover, PO-Et was significantly higher than PE-Et in all the patients (p less than 0.05). The per cent difference in the endotoxin concentration between the portal and peripheral blood (percentage of delta Et) was significantly decreased in the cirrhotic patients, especially in those with esophageal varices, which was well correlated with the phagocytic activity of the reticuloendothelial system (RES) determined by the clearance of iron colloid. The endogenous endotoxemia is thus likely to be due to the impaired clearance of endogenous endotoxin in portal blood, resulting from both the decreased phagocytic activity of RES in the liver and the coexisting porta-systemic bypass.

[A case of remarkable regression of a colonic cancer involving metastasis to the liver as a result of FT-207 treatment].

In mid-August, 1986, a 50-year-old man underwent a detailed examination following the finding of a tumor in the upper abdominal region. The tumor was revealed to be a sigmoid colon cancer with multiple metastasis to both halves of the liver. Subsequent administration of FT-207 suppositories (750 mg X 2/day) resulted in a recognizable shrinkage of the metastatic lesions in the liver after one month, and a barium enema a month later indicated a decrease in the size of the original tumor. The pre-operative CEA value was 2,317 ng/ml, but this has reduced to 46.7 ng/ml to date March, 1987. In this report of single chemotherapy treatment with FT-207 of a sigmoid colon cancer involving metastasis to the liver, the prognosis obtained for the original and hepatic lesions has been good, and the patient's course to date healthy.

Chromogenic assay of endotoxin in platelet poor or rich plasma.

In order to determine which sample preparation, platelet rich plasma (PRP) or platelet poor plasma (PPP), is more suitable for clinical endotoxin assay, we investigated the binding of endotoxins to platelets by comparing the amount of endotoxin in PRP with that in PPP, using a newly developed colorimetric assay with chromogenic substrate (Boc-Leu-Gly-Arg-pNA). When purified endotoxins were added to human whole blood, the amount of endotoxin recovered in PPP was significantly lower than that in PRP for all endotoxins tested except that from E. coli 0111:B4 and their ability to bind to platelets was varied depending on the species of bacteria from which they were purified. However, the amount of endotoxin in PRP obtained from surgical patients (n = 50) was almost same as that in PPP with a correlation coefficient r = 0.95, indicating that natural endotoxins circulating in human blood may not bind to platelets and that PPP can be used for endotoxin assay as well as PRP.