Role of Bactericidal/Permeability-Increasing Protein (BPI) in Sepsis and Liver Cirrhosis, and Its Clinical Implications

Background: Bactericidal/permeability-increasing protein (BPI) is a nat-ural cationic protein, which is stored in the polymorphonuclear leucocyte granules. It exerts anti-infective actions through damaging bacterial membranes, neutralizing microbial endotoxins, and promoting phagocytosis of gram-negative bacteria. Con-sequently, its role in sepsis initially raised much hope in infection control. On the other hand, patients with liver cirrhosis present an important risk of sepsis induced by gram-negative microorganism, especially in advanced stages. Methods: MEDLINE was searched for terms including BPI, endotoxins, lipopoly-saccharides, lipopolysaccharide-binding protein, AND sepsis OR liver cirrhosis. Be-sides, trials addressing clinical BPI implication were retrieved and analyzed. Results: Endotoxemia is frequently elevated in sepsis, in alcoholic liver disease, and in liver cirrhosis. BPI expression is higher in liver cirrhosis patients than in healthy individuals, with a significant increase in patients who present a more severe disease. Contrariwise, most clinical studies failed to show any substantial role of BPI in treating sepsis. Conclusion: This review describes the role of BPI and some other proteins involved in sepsis, with a special focus on patients with alcoholic liver diseases. It outlines their mechanisms, indicates alterations associated with their deficiency, and explains obstacles that restrained their therapeutic use.