血中エンドトキシン除去カラム(PMX)の有用性と意義の確立に向けた多角的アプローチ(<特集>敗血症とアフェレシス)

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  • Multidirectional Approach to Establish the Usefulness and Significance of an Endotoxin Removal Device (PMX)

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PMX is now used clinically for the treatment of severe sepsis and septic shock not only in Japan, but also outside Japan, mainly in Europe and some Asian countries. Evidence-based medicine is becoming more and more important around the world, and definitive evidence of the efficacy of PMX is needed. The studies such as the EUPHRATES trial in North America and ABDO-MIX in France are currently recruiting patients. These studies are expected to give a definitive answer about the effectiveness of PMX. The complete mechanism of action of PMX remains unclear, although multiple effects are now being studied. An FDA approved blood endotoxin measurement method (EAA) demonstrated reduction of blood endotoxin level following treatments with PMX. EAA has also been shown to be a useful biomarker for patient selection, identifying those most likely to benefit from PMX treatments. Other humoral mediator levels known to induce organ dysfunction were decreased after PMX treatment. Immunoactive or immunodepressed monocyte and/or neutrophils could be removed with PMX, which may give an immunomodulatory effect leading to the normalization of immune status. Multiple approaches are still needed to arrive at a complete explanation for the mechanism of action of PMX.

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