Endotoxin in Critical Illness

John Kellum · Debra Foster

Jan. 2026 · Academic Press

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"Endotoxin in Critical Illness intricately explores the theme of endotoxin and sepsis through the lenses of basic, clinical, and translational science. This work consolidates and synthesizes novel clinical insights and groundbreaking scientific discoveries into one comprehensive resource on endotoxic septic shock and sheds light on cutting-edge approaches in treatment. Beginning with a historical journey, the book traces the evolution of understanding from ancient concepts to modern molecular insights. It covers the physiological aspects of endotoxin sensitivity, tolerance, and human response variation. The crucial role of the gut microbiome in critical illness serves as a translational link between foundational science and clinical implications, and the complex language of bacterial communication is introduced, merging basic science with potential translational applications. In the clinical arena, chapters cover the critical role of endotoxin in septic shock, trauma, and its relevance in COVID-19, providing a translational bridge between laboratory findings and real-world clinical scenarios. The historical context of anti-endotoxin drug development is revisited, emphasizing the translational challenges faced in bridging basic science discoveries to clinical applications. The discussion on quantifying endotoxin concentration as well as the exploration of therapeutic rationale and clinical experiences with endotoxin removal therapy serve as a culmination of basic understanding translated into practical applications. The book concludes by contemplating the complexity of sepsis and acknowledging the challenges in achieving personalized medicine and underscoring the dynamic nature of the translational journey. In essence, this comprehensive exploration provides clinicians, researchers, and scientists with a holistic understanding of endotoxin and sepsis and potential advancements in patient care.• Offers a comprehensive and in-depth understanding of endotoxin and sepsis, covering historical perspectives, molecular intricacies, physiological impacts, and evolutionary aspects• Bridges the gap between basic science and clinical application by exploring the molecular basis of endotoxin, including its signaling pathways, physiological effects, and evolutionary significance• Emphasizes the clinical relevance of endotoxin in critical illness, septic shock, trauma, and diseases like COVID-19, ensuring application as a practical guide for clinicians and healthcare practitioners• Reflects on the current state of knowledge and potential future directions, including personalized medicine approaches, acknowledging the evolving nature of the field and inspiring continued research and innovation

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Dr. Kellum is a Distinguished Professor of Critical Care Medicine, Medicine, Bioengineering and Clinical and Translational Science and holds an Endowed Chair in Critical Care Research from the University of Pittsburgh. He is currently on leave and serving as the Chief Medical Officer for Spectral Medical, a late-stage medical device company developing diagnostics and therapeutics for sepsis. Dr. Kellum received his medical degree from the Medical College of Ohio in 1984. His postgraduate training includes an internship and residency in Internal Medicine at the University of Rochester, NY, and a Fellowship in Critical Care Medicine at the University of Pittsburgh. His research interests span various aspects of Critical Care Medicine but center in critical care nephrology, sepsis, and multi-organ failure. He has authored more than 750 publications, has won several teaching awards teaching, has given more than 500 seminars and invited lectures worldwide.

Debra Foster began her professional career as a Registered Nurse specializing in adult critical care. Shortly thereafter Debra joined the critical care clinical research team at Toronto General Hospital and became the project lead for a multi-national, multi-center clinical trial, the MEDIC study. The data was used for a successful 510k de novo submission to the FDA for the Endotoxin Activity Assay (EAA), notably the first IVD in the field of sepsis. Debra went on to follow the device to its commercial partner, where she was appointed Vice President of Clinical Development in 2011, and in 2021 became a clinical consultant of Spectral Medical. Debra has led the EUPHRATES and TIGRIS clinical trials, among many others, for a device to treat patients with endotoxemic septic shock. Debra has co-authored over 50 articles and lectured for academic and industry audiences worldwide on the topics of sepsis and clinical trials for sepsis.

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