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Eva Lorenz, PhD; Jean Paul Mira, MD; Kathy L. Frees; David A. Schwartz, MD

Arch Intern Med. 2002;162:1028-1032.

Background  Septic shock remains a significant health concern worldwide, and despite progress in understanding the physiological and molecular basis of septic shock, the high mortality rate of patients with septic shock remains unchanged. We recently identified a common polymorphism in toll-like receptor 4 (TLR4) that is associated with hyporesponsiveness to inhaled endotoxin or lipopolysaccharide in humans.

Methods  Since TLR4 is a major receptor for lipopolysaccharide in mammals and gram-negative bacteria are the prevalent pathogen associated with septic shock, we investigated whether these specific TLR4 alleles are associated with a predisposition to a more severe disease outcome for patients with septic shock. We genotyped 91 patients with septic shock as well as 73 healthy blood donor controls for the presence of the TLR4 Asp299Gly and TLR4 Thr399Ile mutations.

Results  We found the TLR4 Asp299Gly allele exclusively in patients with septic shock (P = .05). Furthermore, patients with septic shock with the TLR4 Asp299Gly/Thr399Ile alleles had a higher prevalence of gram-negative infections.

Conclusion  Mutations in the TLR4 receptor may predispose people to develop septic shock with gram-negative microorganisms.

From the Department of Medicine (Drs Lorenz and Schwartz and Ms Frees) and the Department of Veterans Affairs Medical Center (Drs Lorenz and Schwartz), The University of Iowa, Iowa City; and Medical Intensive Care Unit, Cochin University Hospital, Paris, France (Dr Mira). Dr Schwartz is now with Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, NC.

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