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.