Apheresis of activated leukocytes with an immobilized polymyxin B filter in patients with septic shock

Shock. 2010 Nov;34(5):461-6. doi: 10.1097/SHK.0b013e3181e14ca0.


In this study, we examined the effects of direct hemoperfusion through filters with immobilized polymyxin B (PMX-DHP) on leukocyte function and plasma levels of cytokines in patients with septic shock. We found that PMX-DHP caused increased expression of C-X-C chemokine receptor 1 (CXCR1) and CXCR2, along with decreased expression of CD64 and CD11b, by circulating neutrophils in patients with septic shock. Plasma levels of cytokines, including interleukin 6 (IL-6), IL-8, IL-10, and high-mobility group box 1, were elevated in patients with septic shock compared with healthy controls, but cytokine levels were not altered by PMX-DHP. These results suggest that PMX-DHP influences neutrophils via a mechanism that does not involve cytokine. Ex vivo perfusion of heparinized blood from patients with sepsis and septic shock through PMX filters in a laboratory circuit caused a significant decrease in neutrophil and monocyte counts. After 120 min of perfusion, neutrophils, monocytes, and lymphocytes were decreased by 78%, 70%, and 10%, respectively, compared with baseline values. Flow cytometric analysis indicated that activated neutrophils with high levels of CD11b/CD64 expression and low levels of CXCR1/CXCR2 expression showed preferential adhesion to PMX filters. Neutrophils isolated from the blood after ex vivo PMX perfusion caused less damage to an endothelial cell monolayer than cells from sham-treated blood, whereas neutrophil phagocytosis of opsonized Escherichia coli was unaffected. These results indicate that PMX-DHP selectively removes activated neutrophils and reduces the ability of circulating cells to cause endothelial damage. Selective removal of activated neutrophils using PMX-DHP may improve the systemic inflammatory response in patients with septic shock.

Publication types

  • Clinical Trial

MeSH terms

  • Acute Lung Injury / prevention & control
  • Aged
  • Antigens, Surface / analysis
  • Cells, Cultured / pathology
  • Cytokines / blood
  • Endothelial Cells / pathology
  • Escherichia coli
  • Female
  • Filtration / instrumentation*
  • Flow Cytometry
  • HMGB1 Protein / blood
  • Hemoperfusion / instrumentation
  • Hemoperfusion / methods*
  • Humans
  • Leukapheresis / instrumentation*
  • Leukapheresis / methods
  • Leukocyte Count
  • Leukocytes / metabolism
  • Lymphocyte Activation*
  • Male
  • Middle Aged
  • Neutrophils / drug effects*
  • Neutrophils / immunology
  • Neutrophils / physiology
  • Opsonin Proteins / immunology
  • Phagocytosis
  • Polymyxin B*
  • Shock, Septic / blood
  • Shock, Septic / immunology
  • Shock, Septic / therapy*


  • Antigens, Surface
  • Cytokines
  • HMGB1 Protein
  • Opsonin Proteins
  • Polymyxin B