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Removing Endotoxin Services
Among the various strategies studied to eliminate endotoxin, Polymyxin-B hemoperfusion has been the most effective in blocking the toxic effects of endotoxin by virtue of its electrochemical affinity with Lipid A (common to all species of endotoxin). However, systemic use of Polymyxin-B is limited by severe nephro- and neurotoxicity.
The interaction between Polymyxin-B and Lipid A of endotoxin is governed primarily by forces which include:
- Ionic: guides the formation of the link/bond;
- Hydrophobic: breaks the spatial order of the acyl chains of LPS and neutralizes the toxicity, transforming LPS and Polymyxin-B into a single unimolecular compound.
PMX (Toraymyxin PMX-20R) removes endotoxin from the blood using the electrochemical properties of Polymyxin-B, while avoiding known side effects of its systemic administration. The PMX cartridge contains polystyrene composite woven fibre with Polymyxin-B immobilized on the surface through covalent bonding. The blood flows radially and uniformly through the fibres at a rate of 80-120 mL/min before exiting the cartridge. The recommended dosing of hemoperfusion is two 2-hour hemoperfusion events in a 24 hour period. The in-vitro adsorption capacity (human blood) was measured as 20 μg (Romaschin et al., 2017).
PMX selectively adsorbs circulating endotoxin, thereby helping to rebalance the innate immune system.[1] Removal of endotoxin leads to a decrease in inflammatory mediator levels (shown in the figure), as well as an improvement in vascular function and hemodynamics.