title: Hemoperfusion with an immobilized polymyxin B fiber column inhibits activation of vascular endothelial cells.
abstract: Involvement of the activation of neutrophils and vascular endothelial cells in the pathology of sepsis has recently been reported. We therefore investigated whether direct hemoperfusion (DHP) with a polymyxin B immobilized fiber column (PMX) could reduce the level of plasminogen activator inhibitor-1 (PAI-1), an index of vascular endothelial cell activation. Twelve sepsis patients satisfying the following criteria were enrolled in the study: (i) stable global oxygen metabolism (oxygen delivery index>500 mL/min/m2 and oxygen consumption index>120 mL/min/m2); (ii) abnormal tissue oxygen metabolism (PCO2 gap: gastric mucosal PCO2 minus arterial PCO2 difference>8 mm Hg); and (iii) mean blood pressure>or=60 mm Hg. Direct hemoperfusion with PMX was performed twice (for 3 h each time) within 24 h. Plasminogen activator inhibitor-1 was measured a total of 5 times: before PMX-DHP, immediately after the first DHP with PMX session (3 h after the start), and 24, 48, and 72 h afterward. The PAI-1 value was 150+/-30.0 ng/mL before DHP with PMX, 178+/-60.0 ng/mL immediately after DHP with PMX, 90+/-22.1 ng/mL at 24 h after, 65+/-21.0 ng/mL at 48 h after, and 64+/-18.3 ng/mL 72 h after. The values were significantly lower from 48 h onward compared with baseline. These data suggest that DHP with PMX inhibits vascular endothelial cell activation.
authors.affiliation: Department of Emergency and Critical Care Medicine, Nihon University School of Medicine, Tokyo, Japan. hkushi@med.nihon-u.ac.jp
authors.forename: Hidehiko
authors.initials: H
authors.lastname: Kushi
authors.forename: Jun
authors.initials: J
authors.lastname: Nakahara
authors.forename: Takahiro
authors.initials: T
authors.lastname: Miki
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Okamoto
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saito
authors.forename: Kastuhisa
authors.initials: K
authors.lastname: Tanjo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D042783:Endothelial Cells / Q000187:drug effects*; D005260:Female; D006464:Hemoperfusion / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D011112:Polymyxin B / Q000008:administration & dosage / Q000627:therapeutic use*; D018805:Sepsis / Q000097:blood / Q000628:therapy*
chemical_list: D000900:Anti-Bacterial Agents; D017395:Plasminogen Activator Inhibitor 1; D011112:Polymyxin B