Section Review: Endotoxaemia and novel therapies for the treatment of sepsis:Pulmonary-Allergy,Dermatological, Gastrointestinal & Arthritis

Numerous agents have been developed with specific binding and inhibitory activity against endotoxin which have all shown promise in preclinical evaluations through the protection of animals against endotoxin challenge. The results of the clinical trials of agents published to date have not met the expectations generated by the results of the pre-clinical studies. A concept not reflected in animal models is that Gram-negative sepsis is a heterogeneous entity: not all patients are either bacteraemic or endotoxaemic. Sub-groups of patients that could be recognised prospectively using newer methods may not respond equally to anti-endotoxin agents. The future success of these therapeutic modalities will probably depend on our ability to identify and target the therapies to those patients who will benefit most, possibly through the application of an assay for endotoxaemia.