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.

1.
Munford RS: Endotoxemia-menace, marker, or mistake? J Leukoc Biol 2016;100:687-698.
[PubMed]
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.
[PubMed]
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.
[PubMed]
4.
Romaschin AD, Klein DJ, Marshall JC: Bench-to-bedside review: clinical experience with the endotoxin activity assay. Crit Care 2012;16:248.
[PubMed]
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.
[PubMed]
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.
[PubMed]
You do not currently have access to this content.