Gut-Derived Infectious-Toxic Shock Syndrome: Therapeutic Chances with Polyspecific Immunoglobulins

  • H. Cottier
  • A. Hässig
  • R. Kraft


Septic shock is probably the most feared complication of major surgery, especially of interventions in the abdominal cavity [1]. Frequently, but by no means always, bacteremia accompanies this condition, and gram-negative microbes predominate as causative agents. This points to the intestine as the main source of infection, i.e. it involves—at least in many cases—a gut-derived infectious-toxic shock (GITS). Despite considerable progress in antibiotic therapy and supportive care, the fatality rate has remained high [2]. There is thus a need for novel strategies.


Septic Shock Adult Respiratory Distress Syndrome Passive Immunization Treated Poly Rough Mutant 
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  1. 1.
    Shires GT (1986) Historical perspective. In: Gallin JL, Fauci AS (eds) Advances in host defense mechanisms. Raven, New York, pp 1–3Google Scholar
  2. 2.
    The Veterans Administration Systemic Sepsis Cooperative Study Group (1987) Effect of high-dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N Engl J Med 317:659–665CrossRefGoogle Scholar
  3. 3.
    Siegel JH (1990) Multiple organ failure as a systemic disease of host-defense failure. In: Schlag G, Redl H, Siegel JH (eds) Shock, sepsis, and organ failure. Springer, Berlin Heidelberg New York, pp 627–638Google Scholar
  4. 4.
    Christou NV (1989) Relationship between immune function and post-trauma morbidity and mortality. In: Faist E, Ninnemann J, Green D (eds) Immune consequences of trauma, shock and sepsis. Mechanisms and therapeutic approaches. Springer, Berlin Heidelberg New York, pp 357–362CrossRefGoogle Scholar
  5. 5.
    Faist E, Ertel W, Mewes A (1988) Möglichkeiten der Immunmodulation bei chirurgischen Patienten. In: Schmutzler W, Darlath W, Knopp J (eds) Immunstimulation, Dustri, Munich, pp 103–116Google Scholar
  6. 6.
    Baumgartner JD, Calandra T, Glauser MP (1988) Intervention on gram-negative bacterial disease by immunoglobulin therapy: reality or myth? In: Krijnen HW, Strengers PFW, van Aken WG (eds) Immunoglobulins. Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, pp 191–205Google Scholar
  7. 7.
    Baumgartner JD (1990) Monoclonal anti-endotoxin antibodies for the treatment of gram-negative bacteremia and septic shock. Eur J Clin Microbiol Infect Dis 9:711–716PubMedCrossRefGoogle Scholar
  8. 8.
    Tracey KJ, Fong Y, Hesse DG, Manogue KR, Lee AT, Kuo GC, Lowry SF, Cerami A (1987) Anti-cachectin/TNF monoclonal antibodies prevent septic shock during lethal bacteraemia. Nature 330:662–664PubMedCrossRefGoogle Scholar
  9. 9.
    Billiau A (1988) Not just cachectin involved in toxic shock. Nature 331:665PubMedCrossRefGoogle Scholar
  10. 10.
    Kirkland TN, Ziegler EJ (1984) An immunoprotective monoclonal antibody to lipopolysaccharide. J Immunol 132:2590–2592PubMedGoogle Scholar
  11. 11.
    Kistler D, Kauhl W, Piert M, Hettich R (1989) Unterstützende Therapie mit einem Pseudomonas-Immunglobulin beim septischen Schock von Brandverletzten. Intensivmedizin 26 [Suppl 1]: 138–143Google Scholar
  12. 12.
    Hässig A, Cottier H (1988) The role of immunoglobulins in the control of inflammatory reactions. In: Krijnen HW, Strengers PFW, van Aken WG (eds) Immunoglobulins. Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, Amsterdam, pp 77–86Google Scholar
  13. 13.
    Schwander R, Hess MW, Keller HU, Cottier H (1980) The postnatal development of lymph nodes in mice. Immunobiology 157:425–436PubMedCrossRefGoogle Scholar
  14. 14.
    Luscieti P, Hubschmid T, Cottier H, Hess MW, Sobin LH (1986) Human lmyph node morphology a function of age and site. J Clin Pathol 33:454–461CrossRefGoogle Scholar
  15. 15.
    Barandun S, Imbach P, Kindt H, Morell A, Nydegger UE, Römer J, Schneider T, Sidiropoulos D, Skvaril F (1981) Der Klinische Einsatz von Immunglobulin (Gammaglobulin). Sandoz, BaselGoogle Scholar
  16. 16.
    DeMaria A jr, Johns MA, Berberich H, McCabe WR (1988) Immunization with rough mutants of salmonella minnesota; initial studies in human subjects. J Infect Dis 158:301–311PubMedCrossRefGoogle Scholar
  17. 17.
    Fiddian-Green RG (1988) Splanchnic ischaemia and multiple organ failure in the cirtically ill. Ann R Coll Surg 70:128–134Google Scholar
  18. 18.
    Deitch EA, Bridges W, Ma L, Berg R, Specian RD, Granger DN (1990) Hemorrhagic shock-induced bacterial translocation: the role of neutrophils and hydroxyl radicals. J Trauma 30:942–951PubMedCrossRefGoogle Scholar
  19. 19.
    Meakins JL (1981) clinical importance of host resistance to infection in surgical patients. Adv Surg 15:225–255PubMedGoogle Scholar
  20. 20.
    Malbran A, Frank MM, Fries LF (1987) Interactions of monomeric IgG bearing covalently bound C3b with polymorphonuclear leukocytes. Immunology 61:15–20PubMedGoogle Scholar
  21. 21.
    Cafiero F, Gipponi M (1989) Profilassi delle infezioni in chirurgia per neoplasia dell’apparato digerente. IN: Rossi Ferrini P (ed) Impiego clinico delle Immunoglobuline endo-vena: presente e futuro. Grafiche Mazzuchelli, Milano, pp 63–68Google Scholar
  22. 22.
    Emerson TE jr, Lurton JM, Collins MS (1985) Efficaciousness of immunoglobulin G prophylaxis on mortality and physiological variables in gram-negative peritonitis in rodents. Circ Shock 17:213–222PubMedGoogle Scholar
  23. 23.
    Duswald KH, Müller K, Seifert J, Ring J (1980) Wirksamkeit von i.v. Gammaglobulin gegen bakterielle Infektionen chirurgischer Patienten. Münch Med Wochenschr 122:832–836Google Scholar
  24. 24.
    Burkhardt A, Cottier H (1989) cellular events in alveolitis and the evolution of pulmonary fibrosis. Virchows Arch [B] 58:1–13Google Scholar
  25. 25.
    Bacigalupo A, Frassoni F, van Lint MT, Chierichetti S, Corbetta PD, Studer C, Marmont AM (1983) Prevention of ARDS, occurring after allogeneic marrow transplantation, with high-dose intravenous immunoglobulins. Exp Hematol 11 [Suppl 14]:135 (abstract)Google Scholar
  26. 26.
    Cometta A, Baumgartner JD, Lee M, Glauser MP, the Anti-Core LPS IVIG Collaborative Study Group (1990) Prophylaxis of infection in high risk surgical patients (pat) with standard intravenous immunoglobulin G (St-IVIG) or with antibody to core glycolipid (Co-IVIG). ICAAC abstr nr 476Google Scholar
  27. 27.
    Glinz W, Grob PJ, Nydegger UE, Ricklin T, Stamm F, Stoffel D, Lasance A (1985) Polyvalent immunoglobulins for prophylaxis of bacterial infections in patients following multiple trauma. Intensive Care Med 11:288–294PubMedCrossRefGoogle Scholar
  28. 28.
    Just HM, Metzger M, Vogel W, Pelka RB (1986) Einfluss einer adjuvanten Immunglobulintherapie auf Infektionen bei Patienten einer operativen Intensiv-Therapie-Station. Klin Wochenschr 64:245–256PubMedCrossRefGoogle Scholar
  29. 29.
    DeSimone C, Delogu G, Corbetta G (1988) Intravenous immunoglobulins in association with antibiotics: a therapeutic trial in septic intensive care unit patients. Crit Care Med 16:23–26CrossRefGoogle Scholar
  30. 30.
    Garner RJ, Sacher RA (1988) Intravenous gammaglobulin therapy. Am Assoc Blood Banks, ArlingtonGoogle Scholar
  31. 31.
    Schedel I (1988) New aspects in the treatment of gram-negative bacteraemia and septic shock. Infection 16:8–11CrossRefGoogle Scholar
  32. 32.
    Schedel I (1990) Invited comment. Vox Sang 58:319–321Google Scholar
  33. 33.
    Dominioni L, Benevento A, Zanello M, Gennari R, Besozzi MC, Hourcade M, Dionigi R (1991) Non specific immunotherapy and intravenous gammaglobulin administration in surgical sepsis. In: Imbach P, de Haes P, Morell A, Nydegger UE, Perret BA (eds) Immunotherapy with intravenous immunoglobulin. Academic, London (in press)Google Scholar
  34. 34.
    McCabe WR, DeMaria A jr, Berberich H, Johns MA (1988) Immunization with rough mutants of Salmonella minnesota: protective activity of IgM and IgG antibody to the R595 (Re chemotype) mutant. J Infect Dis 158:291–300PubMedCrossRefGoogle Scholar
  35. 35.
    Tutschka PJ (1988) Gammaglobulin therapy in bone marrow transplantation. In: Garner RJ, Sacher RA (eds) Intravenous gammaglobulin therapy. Am Assoc Blood Banks. Arlington, pp 79–97Google Scholar

Copyright information

© Springer-Verlag, Berlin Heidelberg 1993

Authors and Affiliations

  • H. Cottier
    • 1
  • A. Hässig
    • 2
  • R. Kraft
    • 2
  1. 1.Zeutrallaboratorium Blutspendedienst SRKBern 2Switzerland
  2. 2.Central Laboratory Swiss Red Cross Blood Transfusion Service, and Institute of PathologyUniversity of BernBernSwitzerland

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