Hemorheological and microcirculatory effects of Pentaglobin therapy in an experimental model of fulminant sepsis

Sepsis is a life-threatening syndrome characterized by dysregulated immune response to infection and multi-organ dysfunction. One of the key components of this condition is microcirculatory dysfunction. The aim of our study was to evaluate the effects of IgM-enriched immunoglobulin (Pentaglobin, PG) on microcirculation and hemorheological parameters in a porcine model of fulminant sepsis induced by intravenous Escherichia coli (E. coli) suspension.

Thirty female juvenile pigs were randomized into four groups: Control, E. coli bacteremia, E. coli + PG parallel, and E. coli + delayed PG. Under anesthesia, the external jugular veins and the right femoral artery were cannulated. The Control group received fluid therapy only. In all sepsis groups, 38 ml of E. coli suspension was administered intravenously over 3 hours. The E. coli + PG parallel group received a 0.75 g/kg Pentaglobin bolus infusion simultaneously with E. coli. The E. coli + delayed PG group received 0.67 g/kg bolus Pentaglobin 1 hour after sepsis induction, followed by a 0.02 g/kg/h maintenance infusion for 4 hours. Microcirculatory assessments were performed before infusion and every 2 hours until hour 6. Hematological parameters, red blood cell (RBC) aggregation, and blood/plasma viscosity were measured.

The microvascular flow index reached its highest values in the E. coli + delayed PG group at hour 6 (neck: 2.65 ± 0.23; sublingual: 2.67 ± 0.38). Perfused vessel density was highest in the Control group (sublingual: 1.58 ± 0.39 mm/mm2). Microcirculatory values were worse in the E. coli bacteremia group, indicating marked edema, RBC aggregates, and vascular heterogeneity. E. coli + PG parallel, and E. coli + delayed PG groups showed reduced hematocrit values (p<0.001 vs. baseline) and less pronounced increases in whole blood viscosity and RBC aggregation compared to the E. coli bacteremia group.

Fulminant sepsis resulted in severe microcirculatory and hemodynamic disturbances. Pentaglobin therapy mitigated the decline in tissue perfusion, attenuated the elevation of blood viscosity and red blood cell aggregation.