Editorial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Respirol. Mar 28, 2015; 5(1): 1-3
Published online Mar 28, 2015. doi: 10.5320/wjr.v5.i1.1
Polymyxin B-immobilized fiber columns: A column to breathe new life into the treatment of interstitial lung disease?
Katsuaki Asakawa, Toshinori Takada
Katsuaki Asakawa, Toshinori Takada, Division of Respiratory Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
Toshinori Takada, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan
Author contributions: Asakawa K and Takada T equally contributed to this paper.
Conflict-of-interest: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Toshinori Takada, MD, PhD, Professor, Director of the Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata 951-8520, Japan. ttakada@med.niigata-u.ac.jp
Telephone: +81-25-2270379 Fax: +81-25-2270417
Received: December 4, 2014
Peer-review started: December 7, 2014
First decision: December 26, 2014
Revised: January 6, 2015
Accepted: January 18, 2015
Article in press: January 20, 2015
Published online: March 28, 2015
Processing time: 109 Days and 1.5 Hours
Abstract

Acute exacerbations of idiopathic pulmonary fibrosis (IPF) is a severe respiratory condition with high mortality rate. Direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX-DHP) was originally introduced for the treatment of septic shock. Application of PMX-DHP to the treatment of acute exacerbations of IPF may improve oxygenation and survival of the patients with the disease. In addition to acute exacerbations of IPF, PMX-DHP has been applied to acute respiratory failure from various causes; an amyopathic dermatomyositis patient who developed rapidly progressive interstitial lung disease (ILD) with elevated anti-CADM-140/MDA5 autoantibody and a patient with severe amiodarone pulmonary toxicity. It is also demonstrated that PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive ILDs in a case-control setting. PMX treatment decreases not only various circulating molecules but also inflammatory cells, in particular activated monocytes, producing such mediators. Although the incidence of acute exacerbations of IPF is too low for proper randomization, in order to test the effects of PMX-DHP on the disease, a cohort or case-control analytic study needs to be conducted, preferably from more than one center or research group.

Keywords: Acute exacerbation; Idiopathic pulmonary fibrosis; Polymyxin B; Hemoperfusion; Interstitial lung disease

Core tip: Application of direct hemoperfusion with polymyxin B-immobilized fiber columns (PMX-DHP) to the treatment of acute exacerbations of idiopathic pulmonary fibrosis may improve oxygenation and survival of the patients with the disease. PMX-DHP performed on the first day of steroid pulse therapy may improve the prognosis of patients with rapidly progressive interstitial lung diseases in a case-control setting. PMX treatment decreases not only various circulating molecules but also inflammatory cells, in particular activated monocytes, producing such mediators. In order to test the effects of PMX-DHP on the disease, a cohort or case-control analytic study needs to be conducted, preferably from more than one center or research group.