Leukotoxin, 9, 10-epoxy-12-octadecenoate: a possible responsible factor in circulatory shock and disseminated intravascular coagulation.

We previously demonstrated that neutrophils biosynthesize the Iinoleate epoxide, 9,10-epoxy-12-octadecenoate, from linoleate and hydroxyl radical. This epoxide is highly cytotoxic, and has been termed leukotoxin. We detected leukotoxin in plasma from two patients with infectious endocarditis and circulatory shock. Maximal leukotoxin levels were 580 nmol/ml and 880 nmol/ml, respectively. The leukotoxin levels were affected by hemodialysis or hemofiltration. Disseminated intravascular coagulation was confirmed by blood coagulation studies in these two patients. Leukocytosis was also observed in these patients. In contrast, leukotoxin was not detected in plasma of normal volunteers. Accordingly, leukotoxin synthesized by recruited neutrophils might be a contributory factor in circulatory shock.