The use of a hemoperfusion column that removes endotoxin and cytokines in the complex therapy of widespread peritonitis complicated by septic shock

А clinical case of septic shock treatment with new approved for clinical use hemoperfusion columns Efferon LPS of multi-purpose action, which are capable of removing LPS and cytokines from the blood, is presented. A 75-year-old patient 8 hours after surgery for widespread peritonitis, which developed due to obturation intestinal obstruction and rupture of the cecum, in a state of septic shock (SOFA 10, sympathomimetic support with norepinephrine 0.56 μg/kg per minute) underwent in addition to the treatment 2 sessions of hemoperfusion (120 minutes each) with an interval of two days. The next day after the first session of hemoperfusion, blood pressure returned to normal. Over the next 5 days, impaired organ functions gradually recovered (SOFA dynamics from 10 to 1 point) and the level of procalcitonin in the blood decreased from 98 to 5 ng/ml. A decrease in the concentration of IL-6 in the blood was noted: from 1686 to 1388 pg/ml after the first session, from 692 to 411 pg/ml after the second and up to 350 pg/ml on the following days. The content of CD14+ blood monocytes also decreased: from 0.13·109/l to 0.03·109/l after the first session and from 0.30·109/l to 0.18·109/l after the second. The patient was in intensive care for 8 days and was discharged from the hospital after 24 days. The use of hemoperfusion column for the adsorption of cytokines and LPS in an extremely severe patient with septic shock was safe. One of the effects of using the column was the removal of LPS-activated CD14+ monocytes and CD14+ granulocytes from the blood, which helped to reduce systemic inflammation and the severity of multiple organ disorders.

LIGANDS FOR SELECTIVE REMOVAL OF LIPOPOLYSACCHARIDES FROM GRAM NEGATIVE BACTERIA

Bacterial lipopolysaccharides (LPS) are highly toxic molecules released during the lysis of bacterial cells. They play important role in the pathogenesis of sepsis, and can contaminate pharmaceuticals, so removing them from aqueous solutions and biological fluids is an extremely important task. Structure of LPS and its toxicity for various animals are presented in this review. Various low- and high-molecular ligands, suitable for efficient binding and removal LPS from solutions are studied and demonstrated. The main attention is paid to the relationship between the chemical structure of the ligand and its ability to form strong complexes with LPS and the principles of creating selective ligands for the depyrogenation of pharmaceutical substances and the creation of hemoperfusion columns for the sepsis therapy.