Direct hemoperfusion with a polymyxin B-immobilized cartridge in intestinal warm ischemia reperfusion

Abstract

AIM:To investigate the effectiveness of direct hemoperfusion with polymyxin B-immobilized fibers (DHP-PMX therapy) on warm ischemia-reperfusion (I/R) injury of the small intestine. METHODS:The proximal jejunum and distal ileum of mongrel dogs were resected. Warm ischemia was performed by clamping the superior mesenteric artery (SMA) and vein (SMV) for 2 h. Blood flow to the proximal small intestine was restored 1 h after reperfusion, and the distal small intestine was used as a stoma. The experiment was discontinued 6 h after reperfusion. The dogs were divided into two groups: the DHP-PMX group (n = 6, DHP-PMX was performed for 180 min; from 10 min prior to reperfusion to 170 min after reperfusion) and the control group (n = 5). The rate pressure product (RPP), SMA blood flow, mucosal tissue blood flow, and intramucosal pH (pHi) were compared between the two groups. The serum interleukin (IL)-10 levels measured 170 min after reperfusion were also compared. RESULTS: The RPP at 6 h after reperfusion was significantly higher in the PMX group than in the control group (12 174 ± 1832 mmHg/min vs 8929 ± 1797 mmHg/min, P < 0.05). The recovery rates of the SMA blood flow at 1 and 6 h after reperfusion were significantly better in the PMX group than in the control group (61% ± 7% vs 44% ± 4%, P < 0.05, and 59% ± 5% vs 35% ± 5%, P < 0.05, respectively).The recovery rate of the mucosal tissue blood flow and the pHi levels at 6 h after reperfusion were significantly higher in the PMX group (61% ± 8% vs 31% ± 3%, P < 0.05 and 7.91 ± 0.06 vs 7.69 ± 0.08, P < 0.05, respectively). In addition, the serum IL-10 levels just before DHP-PMX removal were significantly higher in the PMX group than in the control group (1 569 ± 253 pg/mL vs 211 ± 40 pg/mL, P < 0.05).

Intraoperative endotoxin adsorption for visceral malperfusion complicating acute type A aortic dissection

“…Although there is no clinical evidence regarding the effect of PMX-DHP on reperfusion injury, there is an experimental study demonstrating that PMX-DHP signifi cantly reduced mesenteric reperfusion injury. 9 Endotoxin adsorption is a safe treatment with few adverse effects, as a pilot study demonstrated, 10 and incorporating it into the CPB is technically simple and easy. 7…”

The Effect of Nicorandil on Small Intestinal Ischemia–Reperfusion Injury in a Canine Model

“…Especially in situations of small intestinal transplantation, IR of the graft is an inevitable consequence of the surgical process, and the reduction of IR injury to the graft is a crucial factor in determining the success of small intestinal transplantation. We have already reported some studies on reducing IR injury of the small intestine [3][4][5][6]; however, those reports were still not sufficient to inhibit IR injury completely.…”

Polymyxin B hemoperfusion as a feasible therapy after source control in abdominal septic shock

“…Polymyxin B (PMX) is an antibiotic, which binds to LPS of GNB and inactivates the endotoxin with increased affinity. Hemofiltration with PMX hemoperfusion (PMX-HP, Toraymyxin, Toray Industries, Tokyo, Japan) immobilized to a polysterene-derived fiber was developed in Japan in the 1990s, to selectively adsor and remove the endotoxin of GNB in the blood stream[5,7-9]. Since 2017, our institution have used the PMX-HP in selected patients who underwent surgery for the treatment of septic shock originated from abdominal peritonitis.…”