Endotoxin Adsorbent Therapy in Severe COVID-19 Pneumonia

Peerapornratana, Sadudee; Sirivongrangson, Phatadon; Tungsanga, Somkanya; Tiankanon, Kanitha; Kulvichit, Win; Putcharoen, Opass; Kellum, John A.; Srisawat, Nattachai

doi:10.1159/000515628

Cited by 16 publications

(9 citation statements)

References 38 publications

(43 reference statements)

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“…Clinical improvement was observed after endotoxin adsorbent therapy in six critically ill patients with COVID-19 and an elevated EAA level. All six patients survived [94]. PMX HP performed in 12 patients with COVID-19 resulted in a decrease in disease severity in 58.3% of the patients on day 14 after the first treatment.…”

Section: Covid-19 and Endotoxemiamentioning

confidence: 93%

The Rationale and Current Status of Endotoxin Adsorption in the Treatment of Septic Shock

Śmiechowicz

2022

JCM

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Lipopolysaccharide, the main component of the outer membrane of Gram-negative bacteria is a highly potent endotoxin responsible for organ dysfunction in sepsis. It is present in the blood stream not only in Gram-negative infections, but also in Gram-positive and fungal infections, presumably due to sepsis-related disruption of the intestinal barrier. Various pathways, both extra- and intracellular, are involved in sensing endotoxin and non-canonical activation of caspase-mediated pyroptosis is considered to have a major role in sepsis pathophysiology. Endotoxin induces specific pathological alterations in several organs, which contributes to poor outcomes. The adverse consequences of endotoxin in the circulation support the use of anti-endotoxin therapies, yet more than 30 years of experience with endotoxin adsorption therapies have not provided clear evidence in favor of this treatment modality. The results of small studies support timely endotoxin removal guided by measuring the levels of endotoxin; unfortunately, this has not been proven in large, randomized studies. The presence of endotoxemia can be demonstrated in the majority of patients with COVID-19, yet only case reports and case series describing the effects of endotoxin removal in these patients have been published to date. The place of blood purification therapies in the treatment of septic shock has not yet been determined.

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Section: Covid-19 and Endotoxemiamentioning

confidence: 93%

The Rationale and Current Status of Endotoxin Adsorption in the Treatment of Septic Shock

Śmiechowicz

2022

JCM

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“…The antibiotic treatment is a possible adjunctive option both to attenuate LGE effects and the delayed NET degradation in periodontitis with the severe COVID-19. Endotoxin adsorbent therapy in severe COVID-19 pneumonia has been applied, but despite some amelioration, the clinical benefit remains unclear ( 115 ). In contrast, antibiotic therapy is uncomplicated and has few or no side effects.…”

Section: Moderation Of Circulating Nets In Periodontitis Patients Wit...mentioning

confidence: 99%

Periodontitis-Derived Dark-NETs in Severe Covid-19

et al. 2022

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The frequent severe COVID-19 course in patients with periodontitis suggests a link of the aetiopathogenesis of both diseases. The formation of intravascular neutrophil extracellular traps (NETs) is crucial to the pathogenesis of severe COVID-19. Periodontitis is characterised by an increased level of circulating NETs, a propensity for increased NET formation, delayed NET clearance and low-grade endotoxemia (LGE). The latter has an enormous impact on innate immunity and susceptibility to infection with SARS-CoV-2. LPS binds the SARS-CoV-2 spike protein and this complex, which is more active than unbound LPS, precipitates massive NET formation. Thus, circulating NET formation is the common denominator in both COVID-19 and periodontitis and other diseases with low-grade endotoxemia like diabetes, obesity and cardiovascular diseases (CVD) also increase the risk to develop severe COVID-19. Here we discuss the role of propensity for increased NET formation, DNase I deficiency and low-grade endotoxaemia in periodontitis as aggravating factors for the severe course of COVID-19 and possible strategies for the diminution of increased levels of circulating periodontitis-derived NETs in COVID-19 with periodontitis comorbidity.

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“…In the COVID-19 pandemic, PMX-HP was also used empirically. In Thailand, PMX-HP treatment in five critically ill COVID-19 patients with ARDS showed promising results, which might help to provide a novel insight for management of these patients [38 ▪▪ ].…”

Section: In-vivo Studymentioning

confidence: 99%

Blood purification in sepsis and systemic inflammation

Feng

Peng²,

Peng

2021

Current Opinion in Critical Care

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Purpose of reviewSepsis and septic shock are life-threatening diseases with high mortality. Although efforts have made to improve the survivals, the outcomes are still frustrating. Blood purification was thought to be a promising adjunctive therapy to regulate the excessive cytokine storm or to reduce the endotoxin activity caused by sepsis. Critically ill COVID-19 characterized with the similar disease to sepsis may also benefit from blood purification. Recent findingsThe recent studies mainly focused on hemadsorption materials. The results of the clinical trials showed a tendency in decrease of cytokine levels and endotoxin activity and improvement in haemodynamics. However, the results were controversial. More evidence about blood purification in sepsis and COVID-19 are needed from currently ongoing trials and future well designed trials.

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Endotoxin Adsorbent Therapy in Severe COVID-19 Pneumonia

Cited by 16 publications

References 38 publications

The Rationale and Current Status of Endotoxin Adsorption in the Treatment of Septic Shock

The Rationale and Current Status of Endotoxin Adsorption in the Treatment of Septic Shock

Periodontitis-Derived Dark-NETs in Severe Covid-19

Blood purification in sepsis and systemic inflammation

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