Circulating secretory phospholipase A2 in critical illness--the importance of the intestine.

OBJECTIVE To review the role of secretory phospholipase A2 in the pathogenesis of multiple organ failure in the critically ill patient. DATA SOURCES Relevant articles and published reviews on secretory phospholipase A2 in critical illness. SUMMARY OF REVIEW Secretory phospholipase A2 (sPLA2) has an important role in inflammation and in antimicrobial defence. However, excessive activity of sPLA2 has been shown to result in tissue damage and has been implicated as a mediator of organ failure associated with critical illness. Gastrointestinal release of secretory phospholipase A2 from Paneth cells increases during intestinal ischaemia and may be an important factor in the pathogenesis of the multiple organ dysfunction syndrome. In experimental models, specific PLA2 inhibitors reduce organ failure associated with sPLA infusion and may play an important role in reducing organ failure in the management of the critically ill patient. CONCLUSIONS Intestinal ischaemia may play an important role in the pathogenesis of the multiple organ dysfunction syndrome in the critically ill patient. In patients with sepsis, specific PLA2 inhibitors have the potential to reduce organ failure and improve morbidity and mortality.