Aim: To demonstrate the capacity of polymyxin B-direct hemoperfusion (PMX-DHP) column Toraymyxin® 20R (PMX-20R) in removing endotoxin (LPS) from perfused blood, serum and plasma. Methods: Endotoxin-spiked bovine serum or plasma was perfused in PMX-20R as per the recommended performance testing protocol. Samples were taken at various time points to assess the amount of endotoxin removed during a 4-h session. In another set of experiments, FITC-labelled LPS (FITC-LPS) was spiked into a pool of human whole blood, followed by perfusion with the spiked blood for 2 h in order to allow FITC-LPS to bind PMX-20R. The amount of LPS was extracted from the columns and the amount of specifically bound LPS was determined by fluorometry. Results: PMX-20R columns perfused with bovine serum or plasma had an average binding rate of 88%, equivalent to approximately 12 µg of LPS. When PMX-20R was perfused with human whole blood, the columns bound an average of 20 µg of FITC-LPS. Conclusion: PMX-20R can bind LPS in all the biological fluids tested. The calculated binding capacity of 12-20 µg LPS suggests that in septic cases where endotoxin is present in the circulation, PMX-20R is able to adsorb clinically significant levels of endotoxin.

Keywords:
LPS/endotoxin adsorption, Polymyxin B-direct hemoperfusion, Toraymyxin® 20R, Endotoxin activity assay, Hemoperfusion, Sepsis
1.
Munford RS: Endotoxemia-menace, marker, or mistake? J Leukoc Biol 2016;100:687-698.
2.
Zavascki AP, Goldani LZ, Li J, Nation RL: Polymyxin B for the treatment of multidrug-resistant pathogens: a critical review. J Antimicrob Chemother 2007;60:1206-1215.
3.
Aoki H, Kodama M, Tani T, Hanasawa K: Treatment of sepsis by extracorporeal elimination of endotoxin using polymyxin B-immobilized fiber. Am J Surg 1994;167:412-417.
4.
Romaschin AD, Klein DJ, Marshall JC: Bench-to-bedside review: clinical experience with the endotoxin activity assay. Crit Care 2012;16:248.
5.
Novelli G, Ferretti G, Ruberto F, Morabito V, Pugliese F: Early management of endotoxemia using the endotoxin activity assay and polymyxin B-based hemoperfusion. Contrib Nephrol 2010;167:91-101.
6.
Klein DJ, Foster D, Schorr CA, Kazempour K, Walker PM, Dellinger RP: The EUPHRATES trial (Evaluating the Use of Polymyxin B Hemoperfusion in a Randomized controlled trial of Adults Treated for Endotoxemia and Septic shock): study protocol for a randomized controlled trial. Trials 2014;15:218.
© 2017 S. Karger AG, Basel
2017
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.