Abstract
Background. Biliary obstruction changes the spectrum of lipoproteins, which are now known to
bind and neutralize endotoxin. Postoperative septic complications related to an increased
susceptibility to endotoxin occur frequently in patients with obstructive jaundice.
The effect of preoperative biliary drainage on changes in the lipoprotein spectrum
and its relation to endotoxin sensitivity was studied. Methods. Abnormalities in the lipoprotein spectrum were assessed in 15 patients with malignant
obstructive jaundice before and 3 weeks after endoscopic biliary drainage. Changes
in endotoxin responsiveness were assessed by using endotoxin-neutralizing reagents
(anti-CD14 monoclonal antibody, polymyxin B, and recombinant bactericidal permeability
increasing protein) to block cytokine production in whole blood cell cultures that
were stimulated by cholestatic plasma taken before and after drainage. Results. Drainage normalized very-low-density, low-density, and high-density lipoprotein cholesterol
fractions from, respectively, 43% to 19%, 50% to 65%, and 6% to 16% (P <.01). Ex vivo
stimulation of whole blood with predrainage cholestatic plasma was 20-fold higher
(P <.001) than with postdrainage plasma. Blocking the endotoxin response during the
stimulation with predrainage cholestatic plasma with anti-CD14 monoclonal antibody,
polymyxin B or recombinant bactericidal permeability increasing protein resulted in
attenuation of the inflammatory response, reducing tumor necrosis factor-α levels
at least 5-fold. Conclusions. Preoperative biliary drainage normalizes the changed lipid profile and the endotoxin-stimulating
capacity of cholestatic plasma, and this signifies a change in sensitivity to endotoxin.
(Surgery 2001;129:282-91.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Lipoprotein abnormalities in primary biliary cirrhosis. Association with hepatic lipase inhibition as well as altered cholesterol esterification.Gastroenterology. 1985; 89: 1266-1278
- Lipoproteins in liver disease.J Clin Chem Clin Biochem. 1987; 25: 541-551
- High density lipoprotein particle size distribution in subjects with obstructive jaundice.J Lipid Res. 1988; 29: 121-135
- Plasma lipoproteins and apoproteins in primary biliary cirrhosis.Hepatology. 1985; 5: 286-292
- Dyslipoproteinaemia of liver disease.Baillieres Clin Endocrinol Metab. 1990; 4: 807-832
- Lipoprotein-X.Arch Pathol Lab Med. 1986; 110: 1123-1127
- Chylomicrons can inhibit endotoxin activity in vitro.J Surg Res. 1991; 51: 413-416
- Prevention of endotoxin-induced monokine release by human low- and high-density lipoproteins and by apolipoprotein A-I.Infect Immun. 1993; 61: 5140-5146
- Detection of endotoxin in triglyceride-rich lipoproteins in vitro.J Lab Clin Med. 1991; 118: 186-193
- Reconstituted high-density lipoprotein neutralizes gram-negative bacterial lipopolysaccharides in human whole blood.Infect Immun. 1995; 63: 253-258
- In vitro inactivation of bacterial endotoxin by human lipoproteins and apolipoproteins.Infect Immun. 1992; 60: 596-601
- Cytokine response by monocytes and macrophages to free and lipoprotein-bound lipopolysaccharide.Infect Immun. 1990; 58: 2375-2382
- Role for circulating lipoproteins in protection from endotoxin toxicity.Infect Immun. 1995; 63: 2041-2046
- Human very low density lipoproteins and chylomicrons can protect against endotoxin-induced death in mice.J Clin Invest. 1990; 86: 696-702
- In vivo protection against endotoxin by plasma high density lipoprotein.Proc Natl Acad Sci U S A. 1993; 90: 12040-12044
- Triglyceride-rich lipoproteins prevent septic death in rats.J Exp Med. 1995; 182: 267-272
- Triglyceride-rich lipoproteins improve survival when given after endotoxin in rats.Surgery. 1995; 117: 62-67
- The complications of pancreatectomy.Ann Surg. 1988; 207: 39-47
- Endotoxaemia in obstructive jaundice.HPB Surg. 1991; 4: 81-94
- Prevention of postoperative complications in jaundiced rats. Internal biliary drainage versus oral lactulose.Ann Surg. 1990; 212: 221-227
- Biliary drainage in obstructive jaundice: experimental and clinical aspects.Br J Surg. 1993; 80: 834-842
- Preoperative biliary drainage, colonisation of bile and postoperative complications in patients with tumours of the pancreatic head: a retrospective analysis of 241 consecutive patients.Eur J Surg. 1996; 162: 881-888
- Preoperative endoscopic drainage for malignant obstructive jaundice.Br J Surg. 1994; 81: 1195-1198
- Enzymatic determination of total serum cholesterol.Clin Chem. 1974; 20: 470-475
- Serum triglycerides determined colorimetrically with an enzyme that produces hydrogen peroxide.Clin Chem. 1982; 28: 2077-2080
- Fast lipoprotein chromatography: new method of analysis for plasma lipoproteins.Clin Chem. 1993; 39: 2276-2281
- High performance gel permeation chromatography: comparison with current methods for the determination of HDL and LDL cholesterol [abstract].in: Proceedings of the XVI International Congress of Clinical Chemistry1996
- Determination of apolipoprotein B by kinetic (rate) nephelometry.J Lipid Res. 1982; 23: 893-902
- Plasma endotoxin concentrations in patients with alcoholic and non-alcoholic liver disease: reevaluation with an improved chromogenic assay.J Hepatol. 1991; 12: 162-169
- Liver failure induces a systemic inflammatory response. Prevention by recombinant N-terminal bactericidal/permeability-increasing protein.Am J Pathol. 1995; 147: 1428-1440
- Down-regulation of surface receptors for TNF and IL-1 on circulating monocytes and granulocytes during human endotoxemia: effect of neutralization of endotoxin-induced TNF activity by infusion of a recombinant dimeric TNF receptor.J Immunol. 1997; 158: 1490-1497
- Interleukin-1 beta (IL-1 beta), IL-1 receptor antagonist, and TNF alpha production in whole blood.J Leukoc Biol. 1992; 52: 687-692
- Increased LDL receptor mRNA expression in colon cancer is correlated with a rise in plasma cholesterol levels after curative surgery.Int J Cancer. 1995; 61: 461-464
- The plasma lecithins: cholesterol acyltransferase reaction.J Lipid Res. 1968; 9: 155-167
- Lipoprotein-X fails to inhibit hydroxymethylglutaryl coenzyme A reductase in HepG2 cells.Metabolism. 1993; 42: 807-813
- Chylomicrons alter the fate of endotoxin, decreasing tumor necrosis factor release and preventing death.J Clin Invest. 1993; 91: 1028-1034
- Chylomicrons enhance endotoxin excretion in bile.Infect Immun. 1993; 61: 3496-3502
- Antiinflammatory effects of reconstituted high-density lipoprotein during human endotoxemia.J Exp Med. 1996; 184: 1601-1608
- Binding of endotoxin to macrophages: distinct effects of serum constituents.Immunol Invest. 1991; 20: 377-386
- Endotoxin inactivating action of plasma in patients with liver cirrhosis.Liver. 1995; 15: 104-109
- Endotoxin-induced mortality in bile duct-ligated rats after administration of reconstituted high-density lipoprotein.Hepatology. 2000; 32: 1289-1299
- Endotoxaemia: an early predictor of septicaemia in febrile patients.Lancet. 1988; 1: 605-609
- Effectiveness of a human monoclonal anti-endotoxin antibody (HA-1A) in gram-negative sepsis: relationship to endotoxin and cytokine levels.J Infect Dis. 1992; 166: 1367-1374
- Inhibition of endotoxin-induced cytokine release and neutrophil activation in humans by use of recombinant bactericidal/permeability-increasing protein.J Infect Dis. 1995; 172: 144-151
- Relationship of antibodies to endotoxin core to mortality in medical patients with sepsis syndrome.Intensive Care Med. 1999; 25: 435-444
- Conclusive evidence of endotoxaemia in biliary obstruction.Gut. 1998; 42: 293-299
- Tumor necrosis factor unresponsiveness after surgery in bile duct-ligated rats.Am J Physiol. 1996; 271: G980-G986
- Endotoxin, cytokines, and endotoxin binding proteins in obstructive jaundice and after preoperative biliary drainage.Gut. 2000; 46: 725-731
- High performance gel chromotography (HPGC) for the analysis of lipoprotein associated endotoxin.Clin Chem. 1998; 44: 356
- Association of preoperative biliary drainage with postoperative outcome following pancreaticoduodenectomy.Ann Surg. 1999; 230: 131-142
- Effects of biliary endoprostheses on the extrahepatic bile ducts in relation to subsequent operation of the biliary tract.J Am Coll Surg. 1994; 178: 343-352
- Do preoperative biliary stents increase post-pancreaticoduodenectomy complications?.Gastroenterology. 1999; 116 ([Abstract]): A1371
Article info
Publication history
Accepted:
August 12,
2000
Footnotes
☆Reprint requests: D. J. Gouma, Department of Surgery/G4-144, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
☆☆Surgery 2001;129:282-91
Identification
Copyright
© 2001 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
