High-density lipoproteins alleviate the endotoxin burden in patients with peritonitis and sepsis: The LIPS study

The high-density lipoprotein (HDL) and the phospholipid transfer protein (PLTP) have been demonstrated to enhance endotoxin elimination and inactivation in animal models of sepsis. This study aimed to confirm such a role in patients presenting with abdominal sepsis undergoing emergent surgery and explore the relationships between HDL, PLTP and the lipopolysaccharide (LPS) burden (mass and activity).

Patients operated for abdominal sepsis were prospectively included in the study. Blood samples were obtained before surgery, at the end of the operation (H0), 4 h (H4) and 24 h (H24) later. Peritoneal fluid was also sampled. HDL cholesterol, LDL cholesterol, PLTP activity, LPS mass and activity were measured.

Twenty-seven patients were included. At H0, LPS mass was mostly measured in the lipoprotein fractions (46% [23; 58] in HDL and 36% [29; 54] in LDL). Overall, LPS mass and LPS activity did not decrease in the 24 h following admission to the ICU. Both HDLc concentrations and PLTP activity were associated with increased H4-LPS elimination (drop in LPS concentration, -3% [-26;10] vs. 29% [13;52], p < 0.01 and -2% [-15;10] vs. 20% [8:52], p = 0.03, respectively). Increased H4-LPS elimination was associated with reduced inflammation (plasma cytokine concentration) and mortality. High HDL cholesterol was associated with reduced mortality but not with inflammation.

Our data support the role of HDL and PLTP in the elimination of LPS during human peritonitis with sepsis. Increased H4-LPS elimination was associated with reduced inflammation and lower mortality.

gov: NCT04126577.