Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients

Chizuru Yamashita, Kazuhiro Moriyama, Daisuke Hasegawa, Yoshitaka Hara, Naohide Kuriyama, Tomoyuki Nakamura, Junpei Shibata, Hidefumi Komura, Osamu Nishida

Research output: Contribution to journalArticle

Abstract

Background: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale observational studies and meta-analyses have also been reported in the last several years. Summary: To date, 3 multicenter RCTs on PMX hemoperfusion have been conducted outside of Japan. All of them enrolled postoperative patients with sepsis or septic shock secondary to intra-abdominal infection. However, confidence in the level of evidence provided by these RCTs is very low. Results from recent propensity-matched analyses and meta-analyses indicate that PMX hemoperfusion may improve survival outcomes among patients with sepsis. LPS is an important causative PAMP in sepsis; it triggers the immune response. PMX adsorbs LPS by using a polymyxin B-immobilized fiber that has high affinity for LPS. Moreover, PMX has other mechanisms of action, such as endogenous cannabinoid and activated neutrophil and monocyte adsorption, monocyte surface antigen alteration, and regulation of apoptosis in renal tubular cells. Furthermore, clinical research shows that PMX hemoperfusion can improve patients' hemodynamic status and pulmonary oxygenation and can sustain its endotoxin adsorption capability beyond 2 h. Improved pulmonary oxygenation among patients with sepsis-associated acute respiratory distress syndrome is linked to the effectiveness of PMX hemoperfusion in treating acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF).

Original languageEnglish
Pages (from-to)215-222
Number of pages8
JournalContributions to Nephrology
Volume196
DOIs
Publication statusPublished - 01-01-2018

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Hemoperfusion
Polymyxin B
Critical Illness
Sepsis
Lipopolysaccharides
Adsorption
Meta-Analysis
Monocytes
Intraabdominal Infections
Lung
Idiopathic Pulmonary Fibrosis
Multiple Organ Failure
Cannabinoids
Adult Respiratory Distress Syndrome
Surface Antigens
Septic Shock
Endotoxins
Observational Studies
Japan
Neutrophils

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Yamashita, Chizuru ; Moriyama, Kazuhiro ; Hasegawa, Daisuke ; Hara, Yoshitaka ; Kuriyama, Naohide ; Nakamura, Tomoyuki ; Shibata, Junpei ; Komura, Hidefumi ; Nishida, Osamu. / Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients. In: Contributions to Nephrology. 2018 ; Vol. 196. pp. 215-222.
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abstract = "Background: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale observational studies and meta-analyses have also been reported in the last several years. Summary: To date, 3 multicenter RCTs on PMX hemoperfusion have been conducted outside of Japan. All of them enrolled postoperative patients with sepsis or septic shock secondary to intra-abdominal infection. However, confidence in the level of evidence provided by these RCTs is very low. Results from recent propensity-matched analyses and meta-analyses indicate that PMX hemoperfusion may improve survival outcomes among patients with sepsis. LPS is an important causative PAMP in sepsis; it triggers the immune response. PMX adsorbs LPS by using a polymyxin B-immobilized fiber that has high affinity for LPS. Moreover, PMX has other mechanisms of action, such as endogenous cannabinoid and activated neutrophil and monocyte adsorption, monocyte surface antigen alteration, and regulation of apoptosis in renal tubular cells. Furthermore, clinical research shows that PMX hemoperfusion can improve patients' hemodynamic status and pulmonary oxygenation and can sustain its endotoxin adsorption capability beyond 2 h. Improved pulmonary oxygenation among patients with sepsis-associated acute respiratory distress syndrome is linked to the effectiveness of PMX hemoperfusion in treating acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF).",
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Yamashita, C, Moriyama, K, Hasegawa, D, Hara, Y, Kuriyama, N, Nakamura, T, Shibata, J, Komura, H & Nishida, O 2018, 'Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients', Contributions to Nephrology, vol. 196, pp. 215-222. https://doi.org/10.1159/000485725

Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients. / Yamashita, Chizuru; Moriyama, Kazuhiro; Hasegawa, Daisuke; Hara, Yoshitaka; Kuriyama, Naohide; Nakamura, Tomoyuki; Shibata, Junpei; Komura, Hidefumi; Nishida, Osamu.

In: Contributions to Nephrology, Vol. 196, 01.01.2018, p. 215-222.

Research output: Contribution to journalArticle

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T1 - Evidence and Perspectives on the Use of Polymyxin B-Immobilized Fiber Column Hemoperfusion among Critically Ill Patients

AU - Yamashita, Chizuru

AU - Moriyama, Kazuhiro

AU - Hasegawa, Daisuke

AU - Hara, Yoshitaka

AU - Kuriyama, Naohide

AU - Nakamura, Tomoyuki

AU - Shibata, Junpei

AU - Komura, Hidefumi

AU - Nishida, Osamu

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Sepsis frequently leads to multiple organ failure due to the uncontrolled amplification and spread of inflammation, even if the infectious source is controlled. Lipopolysaccharide (LPS), a typical pathogen-associated molecular pattern (PAMP), is adsorbed by the polymyxin B-immobilized fiber column (PMX). PMX has been used for decades in Europe. Results of a North American randomized controlled trial (RCT) on PMX have recently been announced in a press release; results of large-scale observational studies and meta-analyses have also been reported in the last several years. Summary: To date, 3 multicenter RCTs on PMX hemoperfusion have been conducted outside of Japan. All of them enrolled postoperative patients with sepsis or septic shock secondary to intra-abdominal infection. However, confidence in the level of evidence provided by these RCTs is very low. Results from recent propensity-matched analyses and meta-analyses indicate that PMX hemoperfusion may improve survival outcomes among patients with sepsis. LPS is an important causative PAMP in sepsis; it triggers the immune response. PMX adsorbs LPS by using a polymyxin B-immobilized fiber that has high affinity for LPS. Moreover, PMX has other mechanisms of action, such as endogenous cannabinoid and activated neutrophil and monocyte adsorption, monocyte surface antigen alteration, and regulation of apoptosis in renal tubular cells. Furthermore, clinical research shows that PMX hemoperfusion can improve patients' hemodynamic status and pulmonary oxygenation and can sustain its endotoxin adsorption capability beyond 2 h. Improved pulmonary oxygenation among patients with sepsis-associated acute respiratory distress syndrome is linked to the effectiveness of PMX hemoperfusion in treating acute exacerbations of idiopathic pulmonary fibrosis (AE-IPF).

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