Therapeutic plasma exchange has been reported to reduce key pro-inflammatory cytokines in patients with septic shock.24,46 Knaup et al used a prospective single-center, open-label, nonrandomized pilot study to investigate the role of TPE in patients with early septic shock (onset less than 12 hours) who required high doses of norepinephrine.46 Not only was TPE well tolerated without any adverse events, but it also reduced key pro-inflammatory cytokines and a key permeability factor, including IL-6, IL-1β, and angiopoietin-2.46 This evidence concerns the gene IL1B and septic shock.