Extracorporeal Endotoxin Removal For The Treatment of Sepsis:Endotoxin Adsorption Cartridge (Toraymyxin)

  title={Extracorporeal Endotoxin Removal For The Treatment of Sepsis:Endotoxin Adsorption Cartridge (Toraymyxin)},
  author={Hisataka Shoji},
  journal={Therapeutic Apheresis and Dialysis},
  • H. Shoji
  • Published 1 February 2003
  • Medicine, Biology
  • Therapeutic Apheresis and Dialysis
Abstract:  Toray Industries Inc. has developed an endotoxin removalcartridge (Toraymyxin) composed of a polymyxin B immobilized, fibrousadsorbent. Toraymyxin has been listed as a blood purification medicaldevice for endotoxin removal to be reimbursed by the Japanese nationalhealth insurance since 1994. Toraymyxin can be applied to patientswith endotoxemia or suspected gram‐negative infection, which fulfilllthe conditions of Systemic Inflammatory Response Syndrome (SIRS)and have septic shock… 
Endotoxin adsorption: Direct hemoperfusion with the polymyxin B-immobilized fiber column (PMX).
Extracorporeal removal of endotoxin: the polymyxin B-immobilized fiber cartridge.
PMX is a selective blood endotoxin removal cartridge composed of polymyxin B covalently bonded to polystyrene-derivative fibers that has a strong affinity to endotoxin and is able to bind the lipid A portion of endotoxin through ionic and hydrophobic interactions.
Clinical effects of polymyxin B-immobilized fiber column in septic patients.
Preliminary results suggest direct hemoperfusion with polymyxin-B-immobilized fiber with PMX-F therapy appears to significantly lower endotoxin levels, improve blood pressure, and reduce mortality, however, publication bias and lack of blinding need to be considered.
History and current status of polymyxin B‐immobilized fiber column for treatment of severe sepsis and septic shock
It is revealed that PMX significantly decreased mortality in patients with severe sepsis and septic shock, and Combination of PMX with continuous hemodiafiltration and longer duration of PMx might be an effective strategy to improve survival in such patients.
Endotoxin removal devices for the treatment of sepsis and septic shock.
Commentary A targeted extracorporeal therapy for endotoxemia: the time has come
A meta-analysis examining a novel treatment of sepsis and septic shock predicated on the removal of endotoxin from the bloodstream finds that polymyxin B hemoperfusion may have favorable effects on survival and hemodynamics.
Efficacy of polymyxin B-immobilized fiber hemoperfusion for patients with septic shock caused by Gram-negative bacillus infection
It is concluded that PMX-based endotoxin adsorption within 24 hours from ICU admission was not associated with mortality among patients with septic shock due to GNB.
Use of an endotoxin adsorber in the treatment of severe abdominal sepsis
LPS adsorption may represent a significant improvement in the treatment of Gram‐negative sepsis and further studies are planned.
Endotoxin Removal: History of a Mission
  • C. Ronco
  • Medicine, Biology
    Blood Purification
  • 2014
This review will outline the meaning of the targeted approach to endotoxin, both highlighting the specific immunologic effect of endotoxin removal by polymyxin B and the evidence of clinical improvements following this kind of therapy in terms of recovery of organ function.
Effect Over Time of Endotoxin Adsorption Therapy in Sepsis
It is concluded that PMX‐DHP is expected to have important implications in terms of correction of clinical conditions; improvement of hemodynamics; possible anti‐inflammatory effect; and possible improvement of oxygen metabolism in tissues.


Extracorporeal endotoxin removal by polymyxin B immobilized fiber cartridge: designing and antiendotoxin efficacy in the clinical application.
  • H. Shoji, T. Tani, K. Hanasawa, M. Kodama
  • Medicine, Biology
    Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis
  • 1998
An extracorporeal hemoadsorption cartridge, the PMX cartridge, to eliminate endotoxin from peripheral blood circulation using a polymyxin B covalently immobilized fiber (PMX-F) as an adsorbent, expected to be effective in the intervention for the treatment of septic shock.
Treatment of sepsis by plasma endotoxin removal: hemoperfusion using a polymyxin-B immobilized column
PMX treatment showed a correlation between reduction of plasma endotoxin level and the improvement of septic syndrome, especially cardiovascular impairments, and this new therapy seemed to influence the outcome of severe sepsis or septic MOF patients with endotoxemia.
Therapeutic apheresis for septic patients with organ dysfunction: hemoperfusion using a polymyxin B immobilized column.
A prospective clinical study was performed to evaluate a new method of treatment of endotoxin shock, a column containing polystyrene fibers with covalently bound immobile polymyxin B that removes circulating endotoxin by adsorption using direct hemoperfusion.
Endotoxin removal by direct hemoperfusion with an adsorbent column using polymyxin B-immobilized fiber ameliorates systemic circulatory disturbance in patients with septic shock.
  • K. Uriu, A. Osajima, K. Kaizu
  • Medicine, Biology
    American journal of kidney diseases : the official journal of the National Kidney Foundation
  • 2002
Clinical profiles of patients with septic shock and findings indicate that the improvement in hyperdynamic circulation was related directly to endotoxin removal by the PMX-F column, and endotoxin has an important role in the development of hyperd dynamic circulation in patients with gram-negative septicshock.
Newly Developed Immobilized Polymyxin B Fibers Improve the Survival of Patients with Sepsis
It is concluded that treatment with PMX-F in patients with sepsis is effective and prolongs the survival rate when applied at an early stage of septicaemia, however, in severe sepsi, this therapy does not improve the survival rates.
Experimental study of extracorporeal perfusion for septic shock.
Hemoperfusion over Polymyxin B immobilized fibers can detoxify circulatory endotoxin, resulting in improvement of systemic and organic disorders caused by sepsis.
Direct hemoperfusion using a polymyxin B immobilized column improves acute respiratory distress syndrome
In ARDS patients, PMX‐DHP improved circulatory disturbance and oxygenation despite the underlying diseases, and the mortality improved compared with that before induction of PMX-DHP.
Endotoxin Removal by Polymyxin‐B Immobilized Polystyrene‐Derivative Fibers During In Vitro Hemoperfusion of 10% Human Plasma
An impressive in vitro removal of ET by PMX-20R from 10% human plasma containing either purified E. coli ET or E. aeruginosa or K. pneumoniae is suggested, using whole blood challenged with gram-negative bacteria.
Correlation between Plasma Endotoxin, Plasma Cytokines, and Plasminogen Activator Inhibitor-1 Activities in Septic Patients
PMX adsorbed plasma endotoxins and contributed to reductions in plasma proinflammatory cytokine levels and to improved clinical parameters during the 2-hour treatment, particularly in survivors whose plasma endotoxin levels were adequately reduced.
Treatment of gram-negative bacteremia and septic shock with HA-1A human monoclonal antibody against endotoxin. A randomized, double-blind, placebo-controlled trial. The HA-1A Sepsis Study Group.
HA-1A is safe and effective for the treatment of patients with sepsis and gram-negative bacteremia and analyses that stratified according to the severity of illness at entry showed improved survival with HA- 1A treatment in both severely ill and less severely ill patients.