Gut-liver axis in liver cirrhosis: How to manage leaky gut and endotoxemia

Table 1 Detection methods of endotoxemia

	Name of the test (manufacturer)	Pro	Con
LAL test	ToxinSensorTM Gel clot Endotoxin Assay Kit (GenScript) PYROGENTTM-5000 LAL Reagent (Lonza)	Good marker of BT	Not specific, react βd-Glucan, plasma preparation difficult
Chromogenic substrate assay	Toxicolr test (Seikagaku Corporation)	Good marker of BT available for both end-point assay and kinetic assay	Not specific, react βd-Glucan PCA method: poor endotoxin recovery plasama pretreatment reagent currently unavailable
	QCL1000 (BioWhittaker/Cambrex Lonza end-point assay Kinetic-QCL™ Kinetic Chromogenic LAL Assays (Lonza)	Good marker of BT available for both end-point assay and kinetic assay	Not specific, react βd-Glucan
	LAL Coatest, S-2423 (Kabi Vitrum Diagnostica, Chromogenix)	Good marker of BT available for both end-point assay and kinetic assay	Not specific, react βd-Glucan, not available now
	EndosafePTS (Charles River Lab)	Good marker of BT handy and quick	Not specific, react βd-Glucan (Concomitasnt use of Endosafe PTS glucan assay may be necessary for specificity)
	LAL chromogenic endpoint assay Hycult Biotech Mini-LAL assay (Hycult Biotechnology) ToxinSensorTM Chromogenic LAL Endotoxin Assay (GenScript) end-point method	Good marker of BT available for both end-point assay and kinetic assay	Not specific, react βd-Glucan
	Pyrochrome (Associates of Cape Cod Inc)	Easy plasma pretreatment (dilution and heatig) available for both end-point assay and kinetic assay	Not specific, react βd-Glucan
	Endospecy (Seikagaku Corporation)	Endotoxin-specific available for both end-point assay and kinetic assay	PCA method: poor endotoxin recovery plasama pretreatment reagent currently unavailable New PCA method: plasma pretreatment reagent currently unavailable
Turbidometric assay	Limulus ES II test (Wako) PYROSTAR™ ES-F LAL Reagent (Charles River Lab)	Endotoxin-specific	Unnable to detect spillover endotoxemia in cirrhosaas
Recombinant factor C (rFC) system assay	Recombinant factor C (rFC) system PyroGene (Lonza) fluorescent EndoLISA Hyglos ELISA EndoZyme® recombinant Factor C (rFC) Assaye HyGlos fluorescent	Endotoxin-specific	Very few reports, usefullness for liver disease unclear
Endotoxin activity assay	EAA™ (Spectral Dianostics Inc)	Received FDA clearance rapid diagnostic for endotoxin activity in human whole blood. Higher EAA™ levels are correlated with a higher risk of mortality, as well as an increasing risk for developing sepsis	Addition of methylprednisolone decreased the EAA levels. Indiredt endotoxin assay to reflect the primed state of polymorphonuclear leukocytes

LAL: Limulus amebocyte lysate; FDA: Food and Drug Administration.