Opsonic α2 Surface Binding Glycoprotein Therapy During Sepsis

TLDR

Critically ill trauma patients exhibit severe depletion of an opsonic alpha‑2 surface‑binding glycoprotein, a protein similar to cold insoluble globulin, impairing hepatic reticuloendothelial phagocytosis. Cryoprecipitate, rich in cold insoluble globulin, was infused into six septic patients with documented hypoopsonemia, and opsonin levels were measured before and after therapy using bioassay and electroimmunoassay. Cryoprecipitate infusion restored opsonin levels in all six patients, rapidly resolving fever, normalizing leukocytes, improving pulmonary function, and in one case enhancing cardiac output and oxygen delivery, indicating that replacement of the deficient opsonic alpha‑2 surface‑binding glycoprotein may prevent multiple organ failure when hypoopsonemia is documented.

Abstract

A pronounced depletion of an opsonic protein for hepatic reticuloendothelial (RE) phagocytosis has been demonstrated in critically ill trauma patients. This opsonic alpha(2) surface binding (SB) glycoprotein has immunologic identity and a similar amino acid composition to cold insoluble globulin (CIg). Since CIg can be concentrated in cryoprecipitate, it was utilized as a readily available source of opsonic alpha(2)SB glycoprotein for replacement therapy after injury with documented hypoopsonemia. Six septic patients (2 multiple trauma, 2 thermal burn, and 2 intra-abdominal abscess) were studied to test whether cryoprecipitate infusion would restore this humoral component. Pre- and posttherapy opsonin levels were determined by bioassay and electroimmunoassay. In all patients, severe opsonin depletion was reversed following cryoprecipitate infusion. All patients had a rapid improvement in febrile state, normalization of leukocyte levels, and improvement in pulmonary function as evidenced by decreasing requirements for end expiratory pressure at lowered levels of inspired oxygen. One patient was studied more extensively and demonstrated an increase in cardiac output, limb blood flow, total body and limb oxygen delivery, total body and limb oxygen consumption and a progressive decrease in pulmonary shunt fraction. Thus, opsonic alpha(2)SB glycoprotein deficiency can be reversed by cryoprecipitate infusion in critically ill septic injured patients. Replacement of this humoral factor may be an important therapeutic modality in prevention of multiple organ failure, but it should be administered only after documentation of hypoopsonemia in traumatized patients.