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Molecular Aspects of Endotoxic Reactions A BACTERIOLCGICAL REVIEWS, Mar. 1969, p. 72-98 Vol. 33, No. I Copyright © 1969 American Society for Microbiology Printed in U.S.A. Molecular Aspects of Endotoxic Reactions A. NOWOTNY Department of Microbiology, Temple University School of Medicine, Philadelphia, Pennsylvania 19122 INTRODUCTION............................................................ 72 CHEMICAL PROPERTIES AND CONSTITUENTS ............................ 73 BIOLOGICAL PROPERTIES ................................................. 73 Characteristic Endotoxic Reactions ............................................ 73 Sensitization and Desensitization Against Endotoxic Effects ....................... 75 Relationships Among Endotoxic Reactions ...................................... 76 Fate of Injected Endotoxins ................................................... 77 RELATION OF STRUCTURAL PARTS TO BIOLOGICAL FUNCTIONS ........ 78 Role of Polysaccharides ..................................................... 78 Role of Polypeptides ........................................................ 78 Lipid Moiety ........................................................... 78 Polysaccharide-free Endotoxic Glycolipids ....... ............................... 80 SEARCH FOR THE TOXIC PRINCIPLE ..................................... 80 Role of Hypersensitivity ..................................................... 80 Relation of Particle Size to Endotoxicity ....................................... 81 Toxic Constituents or Toxic Conformation? ..................................... 82 DETOXIFICATION AS AN APPROACH ............................... 82 Biological and Biochemical Detoxification ................................ .... 82 Detoxification by Complexing ............................................... 83 Immunochemical Detoxification ............................................... 83 Chemical Detoxification ............................................... 84 Alkaline Detoxification ........................ ....................... 84 Chemical and Biological Changes Induced By Detoxification ...................... 85 THEORETICAL CONSIDERATIONS OF THE POSSIBLE ROLE OF FATTY ACIDS IN ENDOTOXICITY .............................................. 87 SOME OF THE UNANSWERED PROBLEMS ................................ 87 SUMMARY................................................................. 88 LITERATURE CITED ........................................................ 89 "Febrim laudamus medici instrumentum shown to have altered biological effectiveness, felicissimum . ." (H. Boerhaave, Leyden, 1731). indicating that these activities require a certain organization of subunits. INTRODUCTION Blocking some parts of the molecule has been The most common procedure in searching for successfully used in enzymology. The existence of active sites in biological macromolecules is partial functional groups and their specific steric ar- hydrolysis. In a few cases, acidic, alkaline, or rangement in the structure is the molecular ex- enzymatic breakdown of the macromolecule planation of their activity. The same statement results in the removal of the inert sites of the can be applied to a very large number of other complex, reducing the size of the remainder to biologically active substances. Interference with the active core structure. Similar treatments this steric arrangement by alteration of the func- frequently serve as steps of purification by re- tional groups achieved by their blockage or moving noncovalently bound contaminants. removal, or by substitution, leads to changes in Isolation of the active materials in a ho- activity. Similarly, modification between the mogeneous state often decreases biological ac- distances of the important functional groups by tivity by separating either the solubilizing factor distortion of the structure also results in changes or a carrier constituent, or by removing a co- in biological properties. factor the presence of which is essential for full Most of these approaches have been applied biological potency. Several examples are also in the investigation of gram-negative endotoxins. known wherein dissociation of the macromolecu- The present review of the achievements will not lar complex with mild methods, such as the use of include a discussion in detail of the chemical surfactants, depolymerizes the structure without aspects of endotoxin research, because several introducing hydrolytic cleavage of covalent extensive surveys were recently published on this bonds. These depolymerized structures were subject. The most impressive array of different 72 VOL. 33 MOLECULAR ASPECTS OF ENDOTOXIC REACTIONS 73 biological effects elicited by endotoxins will be In addition, pentoses, hexosamines, heptoses, merely outlined, because a full discussion of this octonic acid derivatives, and different deoxy aspect alone would require a separate mono- sugars are frequently present in similar endotoxin graph. The relationship of structure to biological preparations. The carboxylic acids of the lipid effects in endotoxins is the subject of this review. moiety are the usual even-numbered, saturated Although no final answer has been found in this and unsaturated fatty acids. Odd-numbered research, it seems timely to review this field and acids were observed in only a few cases, but to evaluate the achievements critically. hydroxy-acids are probably the most char- acteristic constituents of all endotoxins. CHEMICAL PROPERTIES No unusual amino acids have been found AND CONSTITUENTS thus far. The most commonly occurring amino Endotoxins (frequent synonyms: "lipopoly- acids in the few preparations which have been saccharides," "pyrogens," "Boivin antigens") analyzed are aspartic acid, glutamic acid, cysteine, are constituents of the walls of gram-negative valine, leucines, alanine, serine, arginine, and bacteria, forming the outer layer of the cell body. lysine, and a few other amino acids found in They were detected in cell-free filtrates of auto- much smaller amounts. lyzed gram-negative cultures more than 100 years Detailed reviews of the chemistry of lipo- ago, indicating that some cells release these sub- polysaccharides have been published by Davies stances spontaneously into the medium (33, 245). (74), Luderitz, Staub, and Westphal, (194), and Some cells release endotoxin readily under the by Luderitz, Jann, and Wheat (192). Therefore, effect of mild treatments or due to specific no further discussion of this aspect needs to be nutritional environments (375). In the majority included in this chapter. of gram-negative families, the endotoxin-con- taining outer layers are so closely associated BIOLOGICAL PROPERTIES with the other constituents of the cell wall that their separation requires strong chemical treat- Characteristic Endotoxic Reactions ment. Inflammation is the summation of actions Endotoxic substances are not extracted in the taken by the defense system of the host after form of dissolved monomers. They form aggre- infection. Besides the indications of the activated gates easily and also complex with a number of natural resistance, symptoms of damage initi- other natural products. This indicates difficulties ated by the invading microorganisms are also in obtaining the endotoxin in a purified, homoge- characteristic of inflammation. Enhanced phago- neous state, free from other constituents of the cytosis, fibrin formation, and activation of some cell walls. It also explains the very high molecular metabolic enzymes are units of the mobilized weight of endotoxic materials, measured either defense. Enhanced capillary permeability facili- by sedimentation in analytical ultracentrifuge tates the exit of phagocytic cells and plasma or by light-scattering photometry. The values constituents from the vessels and makes it pos- obtained vary from 1 to 20 million, depending sible for them to reach the site of invasion. mainly upon the method of isolation used and Additional symptoms are numerous; their listing the steps of purification and further treatments would be superfluous. It is of interest that the involved. most characteristic inflammatory reactions can The two major constituents of endotoxins were be elicited by injecting crude or purified endo- discovered by Boivin, Mesrobeanu, and Mesro- toxic lipopolysaccharide preparations obtained beanu (41, 42), who described these materials as from gram-negative bacterial cell walls. There is glycolipids. Mild acidic hydrolysis precipitated a little doubt that some pathological effects of lipid and left a degraded polysaccharide in the gram-negative bacterial infections are caused supernatant fluid. Almost all authors claimed the by the endotoxin content of the bacteria, but it is absence of proteins in their preparations, but equally important to note that stimulation of the more careful analysis usually revealed the pres- host resistance can be initiated by isolated endo- ence of a low percentage of bound peptides which toxins. form the third characteristic component of such In addition to those endotoxic reactions which preparations. Phosphorus was also found in all are identical with some signs of inflammation, endotoxins hitherto described, and several authors there are many others not obviously related to it. also reported other inorganic constituents, such These are the profound effects of endotoxins as calcium, magnesium, or sodium. on the production of antibodies against many The polysaccharide consists in most cases of a different antigens, the "flushing out" of inter- large number of different carbohydrates, the most feron,
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