Endotoxin and cytokine profile in plasma of baboons challenged with lethal and sublethal Escherichia coli

This descriptive study compares the inflammatory, coagulant, and hemodynamic responses of the baboon to a 2-hr infusion of lethal and sublethal concentrations of Escherichia coli (40 and 4.0 billion organisms per kilogram, respectively). The response to lethal E. coli challenge occurred in three stages: an inflammatory stage marked by a fall in white blood cell count (0-2 hr), a coagulant stage marked by a fall in fibrinogen concentration (2-6 hr), and a hypoxic cell injury stage marked by a rise in SGPT/BUN and by a gradual cardiovascular collapse, and death (6-24 hr). The inflammatory, or first stage coincided with the appearance in plasma of tumor necrosis factor (TNF) and interleukin-1 beta (IL-1 beta), which peaked at 120 and 240-300 min, respectively; a slow but continuous appearance and rise of interleukin-6 (IL-6); and the appearance of endotoxin reaching a maximum at 120 min. This contrasted markedly with the response to sublethal E. coli, in which only one of the three stages was observed (inflammatory) and only minor amounts of the cytokines or endotoxin appeared in the plasma. This study describes the cytokine and endotoxin profiles and the bacteremia in the primate under experimental conditions. It shows for the first time the extreme qualitative differences in their response to lethal and sublethal concentrations of E. coli. It raises the possibility that lethality is associated with an override of the tissue threshold for processing these mediators, as marked by their appearance in plasma in response to lethal E. coli infusion.