Abstract
Severe sepsis results in high morbidity and mortality. Immunomodulation strategies could be an adjunctive therapy to treat sepsis. Endotoxin is a component of gram-negative bacteria and plays an important role in the pathogenesis of septic shock when it is recognized by immune cells. Removal of endotoxin could be an effective adjunctive approach to the management of sepsis. Devices to adsorb endotoxin or inflammatory cytokines have been designed as a strategy to treat severe sepsis, especially sepsis caused by gram-negative bacteria. Polymyxin B-immobilized cartridge has been successfully used to treat patients with sepsis of abdominal origin. Although this cartridge was conceived to adsorb endotoxin, several other immunological mechanisms have been elucidated, and this device has also yielded promising results in patients with nonseptic respiratory failure. In this paper, we summarize the immune modulation actions of Polymyxin B-immobilized cartridge to explore its potential usefulness beyond endotoxin elimination.
Highlights
This review aims to summarize the immune modulation actions of Polymyxin B-immobilized cartridge to understand the potential usefulness of this device beyond endotoxin elimination
When the same authors investigated the effects of Polymyxin Bimmobilized cartridge (PMX) hemoperfusion in a retrospective multicenter study of 160 patients with acute exacerbation of idiopathic pulmonary fibrosis or interstitial pneumonia, they found that the PaO2/FiO2 ratio significantly increased after PMX hemoperfusion [18]
Many studies have shown that PMX hemoperfusion is a promising strategy for immunomodulation in septic shock, and two ongoing clinical trials will be key in determining its usefulness
Summary
The recognition of endotoxin by immune cells is important in the pathogenesis of septic shock [10, 11] Conventional therapy such as antibiotics and surgical procedures to remove the source of infection is crucial for Mediators of Inflammation treating sepsis, but these approaches cannot reverse the effects of the bacterial toxins already released into blood or of the endogenous mediators produced by the host in response to bacteria. Devices to remove endotoxin or inflammatory cytokines have been designed as a strategy to reduce the morbidity and mortality associated with sepsis, especially with sepsis due to gram-negative bacteria. This review aims to summarize the immune modulation actions of Polymyxin B-immobilized cartridge to understand the potential usefulness of this device beyond endotoxin elimination
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