Novel Insights into the Direct Removal of Endotoxin by Polymyxin B HemoperfusionRomaschin A.D.a · Obiezu-Forster C.V.b · Shoji H.d · Klein D.J.c
aDivision of Biochemistry and Keenan Research Centre for Biomedical Science, St. Michael's Hospital, bSpectral Medical Inc., cDepartment of Critical Care and Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Canada; dDivision of Emergency and Critical Care Medicine, Toray Medical Co., Ltd., Tokyo, Japan
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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.
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