Immunomodulation in sepsis: the role of endotoxin removal by polymyxin B-immobilized cartridge

Elisabeth Esteban, Ricard Ferrer, Laia Alsina, Antonio Artigas, Elisabeth Esteban, Ricard Ferrer, Laia Alsina, Antonio Artigas

Abstract

Severe sepsis results in high morbidity and mortality. Immunomodulation strategies could be an adjunctive therapy to treat sepsis. Endotoxin is a component of gram-negative bacteria and plays an important role in the pathogenesis of septic shock when it is recognized by immune cells. Removal of endotoxin could be an effective adjunctive approach to the management of sepsis. Devices to adsorb endotoxin or inflammatory cytokines have been designed as a strategy to treat severe sepsis, especially sepsis caused by gram-negative bacteria. Polymyxin B-immobilized cartridge has been successfully used to treat patients with sepsis of abdominal origin. Although this cartridge was conceived to adsorb endotoxin, several other immunological mechanisms have been elucidated, and this device has also yielded promising results in patients with nonseptic respiratory failure. In this paper, we summarize the immune modulation actions of Polymyxin B-immobilized cartridge to explore its potential usefulness beyond endotoxin elimination.

Figures

Figure 1
Figure 1
Proinflammatory and anti-inflammatory responses to endotoxin. Red asterisk: immunological mechanisms described for Polymyxin-B hemoperfusion in this review; TLR: toll-like receptor; IL: interleukin; Treg: T regulatory lymphocytes; TNFα: tumor necrosis factor alpha; HMGB1: high mobility group box protein 1; PAF: platelet activator factors; PAI: plasminogen activator inhibitor; ALI: acute lung injury.

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