1 The major pathological responses to Gram-negative bacterial sepsis are triggered by endotoxin or lipopolysaccharide. As endotoxin is shed from the bacterial outer membrane, it induces immunological responses that lead to release of a variety of cytokines and other cellular mediators. As part of a program aimed at developing a therapeutic agent for septic shock, we have developed E5531, a novel synthetic lipopolysaccharide antagonist. 2 As measured by release by tumour necrosis factor-a, human monocytes or whole blood can be activated by lipopolysaccharide, lipid A, and lipoteichoic acid (from Gram-positive bacteria). E5531 potently antagonizes activation by all these agents while itself being devoid of agonistic activity. 3 The inhibitory activity of E5531 was dependent on time of addition. When 10 nM E5531 was added simultaneously with lipopolysaccharide or 1 ± 3 h before addition of lipopolysaccharide, production of tumour necrosis factor-a was inhibited by more than 98%. The addition of E5531 1 h after lipopolysaccharide reduced the ecacy of E5531 by 47%. 4 Antagonistic activity of E5531 was speci®c for lipopolysaccharide as it was ineective at inhibiting interferon-g mediated NO release of RAW 264.7 cells, phorbor 12-myristate 13-acetate stimulated superoxide anion production in human neutrophils, concanavalin A stimulated mitogenic activity in murine thymocytes and tumor necrosis factor-a induced E-selectin expression in human umbilical vein endothelial cells. 5 E5531 as well as MY4, an anti-CD14 antibody, inhibited radiolabelled lipopolysaccharide binding in human monocytes. 6 These results support our contention that E5531 is a potent antagonist of lipopolysaccharideinduced release of tumour necrosis factor-a and other cellular mediators and may be an eective therapeutic agent for human septic shock due to Gram-negative bacteria.