Role of the Monocyte Differentiation Antigen CD14 and Lipopolysaccharide-Binding Protein (LBP) in the Recognition of Endotoxin and Gram-Negative Bacteria: In vitro Function, Animal Models and Therapeutic Implications

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Abstract
Objective: The present review summarises in vitro data on structure and function of the monocyte surface antigen CD14 and the lipopolysaccharide-binding protein (LBP) and discusses their role in the pathogenesis of sepsis and septic shock. Data Sources:Original papers and reviews on CD14, LBP and related topics from 1986 to 1998. Results:CD14 is the major receptor for Gram-negative bacterial lipopolysaccharide (Endotoxin, LPS). The acute phase protein LBP catalyses the binding of LPS or bacteria to CD14. Therefore, both proteins are important structures of the innate immune system responsible for recognition and combating bacterial infections. The CD14- and LBP-mediated interaction of LPS and/ or bacteria with monocytes/macrophages stimulates a cascade of inflammatory reactions which in clinical terms is called systemic inflammatory response syndrome (SIRS). Under certain circumstances a SIRS may progress to septic shock and multi-organ failure. Conclusions:The potential value of CD14 and LBP as either target or drug for antiendotoxic or antibacterial therapy has been shown in a variety of animal models of sepsis and septic shock. However, it is not yet clear to what extent these approaches may be useful in the clinical situation of intensive care patients.

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