In the fields of
sepsis and systemic
inflammation,
endotoxin might be the most studied molecule since the term was coined by Richard Pfeiffer in 1892. Paradoxically measuring
endotoxin in humans and finding an effective treatment for
endotoxemia have remained challenging. While advances have been made in understanding the mechanisms of how this simple molecule can trigger an intense immune cascade, there is an ever growing need to develop better treatments. Studies measuring
endotoxin levels in patients with
septic shock have consistently demonstrated that there is a dose-response relationship between
endotoxin levels and adverse outcomes. A rapid assay to measure
endotoxin activity has been available for more than a decade, but few studies have synergized the assay with a therapeutic.
Polymyxin B hemoperfusion (PMX-HP) leverages a molecule with high affinity for
endotoxin with a technique to eliminate exposure.
Polymyxin is bound and immobilized to fibers within a cartridge and administered as an extracorporeal
therapy via veno-venous
hemoperfusion. Clinical evidence of its use is plentiful yet inconsistent in studies based on an outcome for mortality at 28 days. Herein, we describe targeted patient selection using the
endotoxin activity assay and clinical phenotyping followed by adsorption of
endotoxin using the PMX-HP for endotoxemic
sepsis.