Mechanisms of polymyxin B endotoxin removal from extracorporeal blood flow: molecular interactions.

The outer leaflet of Gram-negative bacteria membrane contains a great amount of lipopolysaccharides, also known as endotoxins, which play a central role in the pathogenesis of septic shock. It has been demonstrated that the polymyxin B (PMB) molecule has both antibacterial and antiendotoxin capabilities; in fact, it is able to compromise the bacterial outer membrane and bind lipopolysaccharides, thereby neutralizing its toxic effects. Extracorporeal hemoperfusion treatments based on cartridges containing PMB-immobilized fibers (Toraymyxin PMX-F; Toray Industries, Tokyo, Japan) are used to remove endotoxins circulating in the blood flow. In this study, we focused on the characterization of the interactions occurring in the formation of the PMB-endotoxin complex at the molecular level. In particular, the molecular mechanics approach was used to evaluate the interaction energy and eventually the interaction force between the two molecules. PMB was faced with five molecular portions of lipopolysaccharides differing in their structure. The interaction energy occurring for each molecular complex was calculated at different intermolecular distances and the binding forces were estimated by fitting interaction energy data. Results show that the short-range interactions between PMB and endotoxins are mediated mainly by hydrophobic forces, while in the long term, the complex formation is driven by ionic forces only. Maximum binding forces calculated via molecular mechanics for the PMB-endotoxin complex are in the range of 1.39-3.79 nN. Understanding the interaction mechanism of the single molecular complex is useful both in order to figure out the molecular features of such interaction and to perform higher scale level analysis, where such nanoscale detail is impractical but could be used to account for molecular behavior at a coarse level of discretization.