Hemoperfusion with an Immobilized Polymyxin B Column Reduces the Blood Level of Neutrophil Elastase

Abstract

Background: We investigated whether direct hemoperfusion with an immobilized polymyxin B column (DHP with PMX) could reduce the blood level of neutrophil elastase. Methods: 20 sepsis patients were enrolled in the study. DHP with PMX was performed twice within a 24-hour period. Neutrophil elastase was measured 7 times. Results: Neutrophil elastase was 468 ± 75.1 µg/l, while it was 1,531 ± 201.7 µg/l immediately after the first session, declined to 351 ± 73.9 µg/l before the second session of DHP with PMX, and increased again to 599.3 ± 112.7 µg/l immediately after the second session, 328 ± 73.7 µg/l at 24 h, 264 ± 39.3 µg/l at 48 h, and 230 ± 36.1 µg/l at 72 h after DHP with PMX. The levels from 48 h onwards were significantly lower compared with that before treatment. Conclusion: DHP with PMX has an overall effect that reduces circulating neutrophil elastase levels.

HMGB-1 as a Useful Prognostic Biomarker in Sepsis-Induced Organ Failure in Patients Undergoing PMX-DHP

“…In Japan, an immobilized polymyxin B fiber column using a direct hemoperfusion (PMX-DHP; Toray Industries Inc., Tokyo, Japan) is one choice for patients with septic shock to remove endotoxins [2], if fluid resuscitation, vasopressor support, and source control as recommended by the Surviving Sepsis Campaign Guidelines [3] do not prevent progression to multi-organ failure (MOF). Many therapeutic advantages of PMX-DHP have been reported [4][5][6][7], and Vincent et al report its beneficial effect on cardiac and renal function in severe sepsis or septic shock [8]. In addition, in collaboration with Cruz et al, we report that PMX-DHP increases mean arterial pressure and PaO 2 /FiO 2 ratio, lowers mortality from sepsis, and reduces the need for dopamine [9].…”

Preliminary Report regarding the Use of Selective Sorbents in Complex Cardiac Surgery Patients with Extensive Sepsis and Prolonged Intensive Care Stay

“…Kojika et al [22] and Tani et al [30] report an obvious decrease in TNF-␣ , IL-6, IL-10 and neutrophilic elastase, and a release of metalloprotease-9 and plasminogen 1 activators after adsorption therapy. The above-mentioned parallel decrease in blood LPS levels together with the decrease of mediators release explains the reduced evidence of SIRS in these patients [31] .…”

New Trends in Polymyxin B Hemoperfusion: From 2006 to 2013

“…Reduced levels of a number of other mediators have been reported after PMX. The list includes IL-6 [12,13,14], IL-10 [13,14], IL-18 [15], TNF-α [14,16], metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 [7], plasminogen activator inhibitor-1 [14,16,17], neutrophil elastase [9,18], platelet factor-4 [15], β-thromboglobulin [15], soluble P selectin [15] and endogenous cannabinoids [15,19] such as anandamide. Several of these mediators cause lung injury, increase vascular permeability and worsen intrapulmonary shunting.…”