Polymyxin hemoperfusion

Hanasawa K, Tani T, Oka T, Kodama M (1984) A new treatment for endotoxemia with direct hemoperfusion by polymyxin-immobilized fiber. Artif Organs 8(3) 397-398... 

Nakamura, T., Ushiyama, C., Suzuki, Y., Shoji, H., Shimada, N., Koide, H. Hemoperfusion with polymyxin B immobilized fibers for urinary albumin excretion in septic patients with trauma. ASAIO J 48 (2002) 244-248. 

Fig. 15.2 Levels of targeting endotoxin (BP binding-protein BPI bactericidal/permeability increasing protein HLF human lactoferrin PMX-HF polymyxin B hemoperfusion)...

Polymyxin B (PMXB) has a very strong antimicrobial effect on gram negative bacteria, but its intravenous use is limited owing to toxicity profile. PMX B also binds to endotoxin inactivating it in the process (Morrison and Jacobs, 1976). It has been used as an embedded filter component of hemoperfusion cartridges for removal of endotoxin in Japan since 1994. 

Cruz, D.N., Antonelli, M., Fumagalli, R., Foltran, F., Brienza, N., Donati, A., Malcangi, V., Petrini, F., Volta, G., Bobbio Pallavicini, F.M., Rottoli, F., Giunta, F., Ronco, C. Early use of polymyxin B hemoperfusion in abdominal septic shock The EUPHAS randomized controlled trial. JAMA 301 (2009) 2445-2452. 

Hussein, M.H., Daoud, G.A., Kakita, H., Kato, S., Goto, T., Kamei, M., Goto, K., Ozaki, Y., Ito, T., Fukuda, S., Kato, I., Suzuki, S., Hashimoto, T., Togari, H. Effect of polymyxin B-immobilized fiber hemoperfusion on respiratory impairment, hepatocellular dysfunction, and leucopenia in a neonatal sepsis model. Pediatr Surg Int 26 (2010) 187-193. 

Kanesaka, S., Sasaki, J., Kuzume, M., Narihara, K., Takahashi, Y. Effect of direct hemoperfusion using polymyxin B immobilized fiber on inflammatory mediators in patients with severe sepsis and septic shock. Int J Artif Organs 31 (2008) 891-897. 

Kushi, H., Miki, T., Nakahara, J., Okamoto, K., Kawahara, Y., Saito, T., Tanjoh, K. Hemoperfusion with an immobilized polymyxin B fiber column improves tissue oxygen metabolism. Ther Apher Dial 10 (2006a) 430-435. 

Mitaka, C., Tsuchida, N., Kawada, K., Nakajima, Y., Imai, T., Sasaki, S. A longer duration of polymyxin B-immobilizcd fiber column hemoperfusion improves pulmonary oxygenation in patients with septic shock. Shock 32 (2009) 478-483. 

Nakamura, T., Fujiwara, N., Sato, E., Kawagoe, Y., Ueda, Y., Yamada, S., Koide, H. Effect of polymyxin B-immobilizcd fiber hemoperfusion on serum high mobility group box-1 protein levels and oxidative stress in patients with acute respiratory distress syndrome. ASAIO J 55... 

Noma, S., Matsuyama, W., Mitsuyama, H., Suetsugu, T., Koreeda, Y., Mizuno, K., Higashimoto, I., Kakihana, Y., Hashiguchi, T., Maruyama, I., Osame, M., Arimura, K. Two cases of acute exacerbation of interstitial pneumonia treated with polymyxin B-immobilized fiber column hemoperfusion treatment. Intern Med 46 (2007) 1447-1454. 

Oshima, K., Akao, T., Kobayashi, K., Muraoka, M., Matsumoto, K., Takeyoshi, I. The effect of direct hemoperfusion with a polymyxin B-immobilized fiber column (DHP-PMX therapy) on pulmonary ischemia-reperfusion injury in a canine model. J Invest Surg 21 (2008) 127-132. 

Shimizu, T., Hanasawa, K., Sato, K., Umeki, M., Koga, N., Naganuma, T., Sato, S., Shimonishi, T., Ikeda, T., Matsuno, N., Ono, S., Saitoh, H., Satoh, K., Otani, Y., Endo, Y., Eguchi, Y., Tani, T. Direct hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation. Langenbecks Arch Surg 394 (2009) 303-311. 

The polymyxins are cationic, basic, and amphipathic poljtpeptides that interact with lipopolysaccharides in the outer membrane of bacilli. They potently neutralize endotoxin, reduce blood endotoxin concentrations in patients with septic shock during direct hemoperfusion over immobilized poljmyxin B fibers, and are bactericidal for many Gram-negative rods, even in resting bacteria. Alteration of the cell wall is also thought to be the mechanism of damage to renal epithelia and to the nervous system. 

Charcoal hemoperfusion can also remove the toxin in hepatic failure. A model of galactosamine-induced fulminant hepatic failure in a rat with grade 3 hepatic encephalopathy, demonstrated the potential utility of multisorbent plasma perfusion over uncoated spherical charcoal, and an endotoxin removing adsorbent (polymyxin B-sepharose). Timing, duration and frequency of treatment impacted liver cell proliferative response as compared to untreated fulminant hepatic failure paired controls (Ryan et al., 2001). 

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