Hemoperfusion with Polymyxin B- Immobilized Fiber Attenuates the Increased Plasma Levels of Thrombomodulin and von Willebrand Factor from Patients with Septic Shock

Abstract

Aims: The present study assessed whether plasma levels of thrombomodulin and von Willebrand factor (vWF) are altered in patients with septic shock and whether treatment with polymyxin B-immobilized fiber (PMX-F) affects these levels. Methods: Twenty-four patients with septic shock and 20 normal healthy controls were included in this study. Plasma levels of thrombomodulin and vWF were measured by enzyme immunoassay (EIA). The treatments with direct hemoperfusion using PMX-F column on patients with septic shock were repeated twice for 2 h each. Healthy controls were not subjected to hemoperfusion. Results: 13 of 24 patients with septic shock survived (survival rate was 54.2%). Levels of blood endotoxin decreased significantly from 41.2 ± 4.8 pg/ml at baseline to 13.2 ± 3.6 pg/ml after direct hemoperfusion. Systolic blood pressure increased significantly from 82 ± 6 mm Hg at baseline to 118 ± 12 mm Hg after treatment. The patients with septic shock demonstrated significantly increased plasma levels of thrombomodulin (p < 0.001) and vWF (p < 0.001) compared with those in healthy controls. These increased levels of plasma thrombomodulin and vWF in patients with septic shock decreased significantly after treatment with PMX-F (p < 0.01). Conclusion: These data suggest that plasma thrombomodulin and vWF may be related to septic shock and that PMX-F is effective in reducing these factors in patients with septic shock.

Newly Developed Immobilized Polymyxin B Fibers Improve the Survival of Patients with Sepsis

“…Recently, Ebihara et al [27] clearly demonstrated that PMX-F significantly decreased blood endotoxin levels, associated with a remarkable improvement in survival rate. Moreover, that group provided scientific evidence that treatment with PMX-F attenuates the increased plasma levels of thrombomodulin and von Willebrand factor in patients with septic shock [28]. Recently, Kodama et al [29] clearly demonstrated results similar to our present data.…”

Effects of Polymyxin B-Immobilized Fiber Hemoperfusion on Amino Acid Imbalance in Septic Encephalopathy

“…On the basis of previous studies, we reported that PMX-F treatment is effective in reducing myocardial damage, systemic permeability, endothelial cell damage, and platelet damage in patients with sepsis [5,6,16,17]. In the present study, amino acid imbalance was ameliorated by PMX-F treatment due, in part, to a reduction of the plasma endotoxin levels.…”

Treatment with polymyxin B-immobilized fiber reduces platelet activation in septic shock patients: Decrease in plasma levels of soluble P-selectin, platelet factor 4 and β-thromboglobulin

“…In septic shock, some investigators have reported increased levels of E-selectin and adhesion molecules in both plasma and in the supernatant of cultured vascular endothelial cells [17,18]. We have shown previously that plasma levels of von Willebrand factor and thrombomodulin, which are thought to be indicators of endothelial cell injury, were significantly increased in patients with septic shock [19]. In addition, we have shown that plasma MMP-9 concentrations and monocyte MMP-9 mRNA levels may be useful prognostic markers in septic shock [8].…”