Neutralizaton of pneumolysin by trimodulin and relevance for severe community-acquired pneumonia patients. (A) In vitro pneumolysin neutralization assay measuring free hemoglobin as marker for cell lysis, using erythrocytes and different concentrations of trimodulin as indicated. Shown are results from 3 repeated measurements (mean plus or minus standard deviation.). (B) Platelet counts of patients in the CIGMA study with confirmed S pneumoniae infection were obtained before (pre), during (days 2-5), and after (days 6, 7, and 14) treatment with trimodulin or placebo. Pretreatment values were obtained from n = 15 (trimodulin group) and n = 18 (placebo group) and day 14 values obtained from n = 11 (trimodulin group, 1 missing value) and n = 12 patients (placebo group), respectively. (C) The 28-day mortality rate in patients with severe, confirmed S pneumoniae lung infection (n = 15 in trimodulin group, n = 18 in placebo group) was nominally lower in the trimodulin group compared with the placebo group (2 of 15 [13.3%] vs 7 of 18 [38.9%]). Due to small patient numbers, no statistical analysis has been performed. NC, negative control (PBS); PC, positive control (1% Triton X-100).