A novel leukotriene B4-receptor antagonist in endotoxin shock: A prospective, controlled trial in a porcine model

To evaluate the hypothesis that treatment with LY255283, a novel leukotriene B4-roceptor antagonist, is beneficial in an animal model of the adult respiratory distress syndrome induced by endotoxin. DESIGN:Prospective, randomized, controlled trial. SETTING:Laboratory at a large university medical center. SUBJECTS:Twenty-five, immature, random-bred swine. INTERVENTIONS:Four groups of pigs were studiedthe LPS group of animals (n = 6) were infused with Escherichia coli lipopolysaccharide (strain 0111:B4, 250 μg/kg) from 0 to 60 mins; the LPS + 255283 group of animals (n = 6) were infused with lipopolysaccharide as above, but were also treated with LY255283 (30 mg/kg, then 10 mg/kg/hr), beginning at −15 mins; the 255283 group of animals (n = 6) were infused with the same dose of LY255283, but were not challenged with lipopolysaccharide; and the RL control group of subjects (n = 7) received only the lactated Ringerʼs solution vehicle. Beginning at 30 mins, all groups were infused with dextran-70 solution as needed to maintain cardiac output at 90% to 110% of baseline value. MEASUREMENTS AND MAIN RESULTS:Treatment with LY255283 significantly (p < .05) ameliorated lipopolysaccharide-induced systemic arterial hypotension, pulmonary arterial hypertension, and arterial hypoxemia. Treatment with this drug also abrogated lipopolysaccharide-induced increases in pulmonary extravascular water content and bronchoalveolar lavage fluid protein concentration. CONCLUSIONS:These data suggest that leukotriene B4 may be an important mediator of acute lung injury in this porcine model of septic shock and acute lung injury. Further studies to assess the specificity of LY255283 as a leukotriene B4 antagonist are necessary in order to exclude the possibility that the beneficial effects of this compound are due to pharmacologic actions other than the blockade of LTB4 receptors. (Crit Care Med 1993; 21:1825–1837)