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A number of diseases lead to a so called systemic inflammatory response syndrome (SIRS). This excessive response is self-destructive and leads to major complications of the initial disease: dysfunction of the microcirculation, systemic vasodilation, and increased capillary leakage and oedema. Animal studies have shown that pre-treatment with endotoxin (lipopolysaccharide or LPS) suppress the excessive immune response and when rechallenged, the animal survive a normally lethal dose of endotoxin.
Besides a diminished cytokine response, an increased production of leucocytes in the bone marrow and an increased phagocytosis after pre-treatment with endotoxin is seen. The combination of these factors: diminished systemic inflammatory response and increased cellular immunity makes that endotoxin tolerance is a useful tool for preventing the complications after an excessive inflammatory response.
Further, the presence of cross-tolerance has also been shown: Endotoxin tolerant mice survive more after induction of a normally lethal fungal infection. Endotoxin tolerance is also protective for ischemia/reperfusion injury in kidneys, heart and liver. Little data is known about endotoxin tolerance in human.
The purpose of this study is to induce a state of tolerance through 2 different administration schedules and monitor the effect of tolerance on pro- and anti-inflammatory cytokines, other inflammatory parameters and different proteins involved in the signalling pathway. The effects of tolerance on vascular reactivity will be determined. Finally, the effect of tolerance on ischemia-reperfusion injury will be investigated.
See protocol
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| repeated injections of endotoxin during 5 days | Drug |
| Measure | Description | Time Frame |
|---|---|---|
| inducing endotoxin tolerance | 5 days | |
| Hemodynamics | 5 days | |
| Markers of Inflammation | 5 days | |
| Cytokines | 5 days | |
| Mediators of Vascular reactivity | 5 days | |
| Sensitivity to norepinephrine | 5 days | |
| Endothelial-dependent vasorelaxation | 5 days | |
| Cross tolerance | 6 days | |
| Ischemia-reperfusion injury | 6 days | |
| Effects on tissue saturation (measured by NIRS) | 24 hrs after LPS administration |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Peter Pickkers, MD PhD | Radboud University Nijmegen Medical Center | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Radboud University Nijmegen Medical Center | Nijmegen | Gelderland | 6500HB | Netherlands |
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| ID | Term |
|---|---|
| D019446 | Endotoxemia |
| ID | Term |
|---|---|
| D016470 | Bacteremia |
| D018805 | Sepsis |
| D007239 | Infections |
| D014115 | Toxemia |
| D018746 |
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| Systemic Inflammatory Response Syndrome |
| D007249 | Inflammation |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |