Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
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Controlled Clinical Trial
Vascular endothelial growth factor and soluble fms-like tyrosine kinase-1 in septic shock patients treated with direct hemoperfusion with a polymyxin B-immobilized fiber column.
Sepsis is characterized by a systemic inflammatory response to a microbial pathogen. In sepsis, capillary permeability is a tightly regulated feature of microcirculation in all organ beds and is fundamentally altered. We investigated the vascular endothelial growth factor (VEGF) level as a vascular permeability factor and the soluble fms-like tyrosine kinase-1 (Flt-1) level as an antagonist of the VEGF receptors. ⋯ In survivors, the soluble Flt-1 level at the end of DHP-PMX therapy was significantly lower than that at the start. On the other hand, in non-survivors, there was no significant difference between the ending and starting soluble Flt-1 levels. The soluble Flt-1 level may be a suitable marker of disease severity and mortality.
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Extracorporeal photopheresis (ECP) has been demonstrated to be clinically effective for the treatment of steroid-refractory graft-versus-host-disease (GvHD). Recently, a murine model suggested that ECP may modulate the allo-reactivity, seen in GvHD, by enhancement of T regulatory cells. T regulatory cells are an important component of immune tolerance and reduced levels of them have been observed in chronic GvHD. ⋯ Following three months of ECP, increases in the absolute counts of total lymphocytes, CD4(+) and CD8(+) T cells and T regulatory cells were observed; however, no selective statistical increase in the percentage of T regulatory cell numbers was observed within the CD4(+) T cell compartment. ECP induces an increase in T regulatory cell numbers; however, this is not specific as there is also an enhancement of both total lymphocyte and CD4(+) T cell numbers. The positive effect of ECP may therefore depend on a more generic re-adjustment of immune homeostasis.
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Clinical Trial
Early hemoperfusion with a polymyxin b column improves gastric intramucosal pH in sepsis.
This study had two purposes. One was to assess gastric intramucosal pH (pHi) after early goal-directed therapy in patients with sepsis and septic shock. The other was to determine whether direct hemoperfusion with a polymyxin B fiber column (DHP-PMX) could improve the pHi if it remained low after early goal-directed therapy. ⋯ In patients with sepsis and septic shock, the pHi remained low after early goal-directed therapy; however, it was significantly improved from 24 h after the start of DHP-PMX and was normalized from 48 h onwards. These findings suggest that DHP-PMX improves pHi. Because this was a prospective uncontrolled observational study on a limited number of patients, larger multicenter clinical trials are required to more accurately assess the benefits of DHP-PMX.
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The optimum time for commencement of direct hemoperfusion with a polymyxin B immobilized fiber column (DHP-PMX) in patients with sepsis remains unclear. We retrospectively studied the response to DHP-PMX in relation to parameters of oxygen metabolism in 48 patients with sepsis who were divided into two groups. In the effective group (N = 36), the mean blood pressure increased by at least 10 mm Hg after DHP-PMX. ⋯ These parameters were then compared between the two groups. Only VO(2)I showed a significant difference between the two groups, and all patients in the effective group had a VO(2)I of 100 mL/min/m(2) or more. Based on these results, DHP-PMX should be introduced during the period when VO(2)I is still equal to or greater than 100 mL/min/m(2).