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?:abstract
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Evidence for endotoxin removal therapy with polymyxin B immobilized column (PMX) has been accumulated these more than two decades However, the evidence level is still weak RCT is currently on going in US The targeted patient’s population with high, but some definitive range of blood endotoxin level and organ dysfunction score who is likely to benefit from PMX therapy could be clarified through this trial Recently, PMX has been used for the different kind of patients’ population such as acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF) and septic shock due to viral infection such as H1N1 Improvement of hemodynamics and oxygenation have been reported in these patients’ population as same as the case of endotoxemic septic shock Under the current SARS-CoV-2 pandemic, it is reported PMX was applied for COVID-19 patient The reduction of inflammatory state of the patient and the improvement of chest radiographic findings were observed Interestingly, the effective action of PMX therapy looks happening in a similar fashion for these different kinds of patient’s population The comprehensive mechanism of action to explain this clinical effectiveness is urgently needed to be studied PMX has a multi-faceted action such as endotoxin removal, removal of pro- and anti-inflammatory mediators, improvement of coagulation abnormality, removal of proapoptotic factor and immunomodulatory effect due to monocyte and neutrophil removal It is required to study how these actions could lead to the improvement of each organ dysfunction
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