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Stauber RE, Paar M, Balazs I, Horvath A, Feldbacher N, Posch A, Rainer F, Stadlbauer V, Oettl K. Effect of albumin infusion on oxidative albumin modification and albumin binding capacity in chronic liver failure. Basic Clin Pharmacol Toxicol 2024; 134:375-384. [PMID: 38093476 DOI: 10.1111/bcpt.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/28/2023]
Abstract
Oxidative albumin modification and impaired albumin binding function have been described both in chronic liver failure and for therapeutic albumin solutions. The aim of the present study was to evaluate the effect of albumin infusion on redox state and binding function of circulating albumin. We studied 20 patients with cirrhosis who routinely received albumin infusions for prevention of post-paracentesis circulatory dysfunction or treatment of hepatorenal syndrome. We measured albumin fractions by redox state of cysteine-34 and albumin binding properties using dansylsarcosine as site II ligand. Therapeutic albumin solutions showed high contents of human nonmercaptalbumin-1 and human nonmercaptalbumin-2, exceeding the respective values in our patients with decompensated cirrhosis. An initial protocol for the first nine patients sampled at baseline, 24 h and 48 h after albumin infusion revealed no significant changes of oxidized albumin species or albumin binding properties. However, a modified protocol for the remaining 11 patients sampled at baseline, <1 h after and 24 h after albumin infusion revealed short-lived changes of oxidized albumin species while no changes in albumin binding properties were observed. In conclusion, therapeutic albumin infusion transiently changed albumin redox state but did not improve binding function of circulating albumin in chronic liver failure.
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Affiliation(s)
- Rudolf E Stauber
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Margret Paar
- Division of Medicinal Chemistry, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
| | - Irina Balazs
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- CBmed Center of Biomarker Research in Medicine, Graz, Austria
| | - Angela Horvath
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- CBmed Center of Biomarker Research in Medicine, Graz, Austria
| | - Nicole Feldbacher
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- CBmed Center of Biomarker Research in Medicine, Graz, Austria
| | - Andreas Posch
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Florian Rainer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Vanessa Stadlbauer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- CBmed Center of Biomarker Research in Medicine, Graz, Austria
| | - Karl Oettl
- Division of Medicinal Chemistry, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Graz, Austria
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Castillo GM, Yao Y, Guerra RE, Jiang H, Nishimoto-Ashfield A, Lyubimov AV, Alfaro JF, Striker KA, Buynov N, Schwabl P, Bolotin EM. Subcutaneous therapy for portal hypertension: PHIN-214, a partial vasopressin receptor 1A agonist. Biomed Pharmacother 2024; 171:116068. [PMID: 38176129 PMCID: PMC10953113 DOI: 10.1016/j.biopha.2023.116068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024] Open
Abstract
Cirrhosis is a liver disease that leads to increased intrahepatic resistance, portal hypertension (PH), and splanchnic hyperemia resulting in ascites, variceal bleeding, and hepatorenal syndrome. Terlipressin, a prodrug that converts to a short half-life vasopressin receptor 1 A (V1a) full agonist [8-Lys]-Vasopressin (LVP), is an intravenous treatment for PH complications, but hyponatremia and ischemic side effects require close monitoring. We developed PHIN-214 which converts into PHIN-156, a more biologically stable V1a partial agonist. PHIN-214 enables once-daily subcutaneous administration without causing ischemia or tissue necrosis and has a 10-fold higher therapeutic index than terlipressin in healthy rats. As V1a partial agonists, PHIN-214 and PHIN-156 exhibited maximum activities of 28 % and 42 % of Arginine vasopressin (AVP), respectively. The potency of PHIN-156 and LVP relative to AVP is comparable for V1a (5.20 and 1.65 nM, respectively) and V1b (102 and 115 nM, respectively) receptors. However, the EC50 of PHIN-156 to the V2 receptor was 26-fold higher than that of LVP, indicating reduced potential for dilutional hyponatremia via V2 agonism compared to terlipressin/LVP. No significant off-target binding to 87 toxicologically relevant receptors were observed when evaluated in vitro at 10 µM concentration. In bile duct ligated rats with PH, subcutaneous PHIN-214 reduced portal pressure by 13.4 % ± 3.4 in 4 h. These collective findings suggest that PHIN-214 could be a novel pharmacological treatment for patients with PH, potentially administered outside of hospital settings, providing a safe and convenient alternative for managing PH and its complications.
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Affiliation(s)
| | - Yao Yao
- PharmaIN Corp., Bothell, Washington 98011, USA
| | | | - Han Jiang
- PharmaIN Corp., Bothell, Washington 98011, USA
| | | | - Alexander V Lyubimov
- University of Illinois, Toxicology Research Laboratory, Department of Pharmacology, Chicago 60612, USA
| | | | | | | | - Philipp Schwabl
- Medical University of Vienna, Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Vienna, Austria
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Paar M, Fengler VH, Reibnegger G, Schnurr K, Waterstradt K, Schwaminger SP, Stauber RE, Oettl K. Determination of binding characteristics as a measure for effective albumin using different methods. Biochim Biophys Acta Gen Subj 2023:130427. [PMID: 37454915 DOI: 10.1016/j.bbagen.2023.130427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND & AIMS Transport functions of albumin are of clinical and pharmacological interest and are determined by albumin's properties like posttranslational modifications or bound ligands. Both are affected in pathological conditions and in therapeutic grade albumin solutions. The term effective albumin concentration was introduced as a measure of functionally intact albumin. Our aim was to evaluate the impact of ligands and modifications with different approaches as a measure of effective albumin. APPROACH & RESULTS We used a spin labelled fatty acid and dansylsarcosine to characterize binding properties of albumin i) prepared from plasma of patients and healthy control donors, ii) measured directly out of plasma, iii) research grade albumin, iv) in vitro modified albumin, and v) therapeutic infusion solutions before and after removal of stabilizers. Bilirubin is the main determinant for binding function in patients' albumin. In in vitro prepared albumin bound fatty acids correlated with impaired binding. Human nonmercaptalbumin1, not human nonmercaptalbumin2, showed reduced binding properties. Binding and transport function of therapeutic albumin was severely impaired and restored by filtration. Glycation of research grade albumin had no effect on the binding of dansylsarcosine and only a minor effect on fatty acid binding. CONCLUSIONS Our results suggest that effective albumin -in terms of binding properties- is primarily determined by bound ligands and only to a minor extent by posttranslational modifications. Characterizing albumin directly from plasma better reflects the physiological situation whereas in the case of therapeutic grade albumin stabilizers should be removed to make its binding properties accessible.
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Affiliation(s)
- Margret Paar
- Medical University of Graz, Otto Loewi Research Center, Division of Medicinal Chemistry, Neue Stiftingtalstrasse 6, 8010, Graz, Austria
| | - Vera H Fengler
- University of Graz, Institute of Molecular Biosciences, Humboldtstrasse 50, 8010, Graz, Austria
| | - Gilbert Reibnegger
- Medical University of Graz, Otto Loewi Research Center, Division of Medicinal Chemistry, Neue Stiftingtalstrasse 6, 8010, Graz, Austria
| | - Kerstin Schnurr
- MedInnovation GmbH, Wissenschaftsstandort Berlin-Adlershof (WISTA), Groß-Berliner Damm 151, 12487 Berlin, Germany
| | - Katja Waterstradt
- MedInnovation GmbH, Wissenschaftsstandort Berlin-Adlershof (WISTA), Groß-Berliner Damm 151, 12487 Berlin, Germany
| | - Sebastian P Schwaminger
- Medical University of Graz, Otto Loewi Research Center, Division of Medicinal Chemistry, Neue Stiftingtalstrasse 6, 8010, Graz, Austria; BioTechMed-Graz, Mozartgasse 12, 8010 Graz, Austria
| | - Rudolf E Stauber
- Medical University of Graz, Department of Internal Medicine, Division of Gastroenterology and Hepatology, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Karl Oettl
- Medical University of Graz, Otto Loewi Research Center, Division of Medicinal Chemistry, Neue Stiftingtalstrasse 6, 8010, Graz, Austria.
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Randomized controlled trials of acupuncture for the treatment of essential hypertension: a meta-analysis. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2022. [DOI: 10.1007/s11726-022-1330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
To systematically assess the efficacy and safety of acupuncture therapy for essential hypertension.
Methods
A computerized literature search of the Chinese National Knowledge Infrastructure (CNKI), Chongqing VIP Database (CQVIP), Wanfang Academic Journal Full-text Database (Wanfang), China Biology Medicine Disc (CBM), PubMed, EMBASE, and Cochrane Library was conducted to retrieve randomized controlled clinical trials on acupuncture as the main intervention for the treatment of essential hypertension published from the inception of the database to 30 January 2021. The risk-of-bias assessment was carried out for each included study according to the Cochrane Handbook. Data analysis was performed using Review Manager 5.4.1 and Stata 15.0.
Results
After the screening, 46 randomized controlled trials involving a total of 3 859 subjects were included. Primary outcomes included changes in the diastolic blood pressure after intervention [eight studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group [mean difference (MD)=1.45, 95% confidence interval (CI) (0.48, 2.43), P=0.004, fixed effects model; I2=39%] and changes in the systolic blood pressure after intervention {11 studies showed that the acupuncture plus antihypertensive drug group was better than the antihypertensive drug monotherapy group [MD=8.60, 95%CI (7.12, 10.07), P<0.00001, fixed effects model; I2=26%]}. The secondary outcome was antihypertensive efficacy, 12 studies of acupuncture monotherapy group [risk ratio (RR)=1.20, 95%CI (1.12, 1.28), P<0.00001, fixed effects model; I2=36%] and 15 studies of acupuncture combined with antihypertensive drug group [RR=1.27, 95%CI (1.20, 1.34), P<0.00001, fixed effects model; I2=6%] showed better results than the antihypertensive drug monotherapy group in antihypertensive efficacy. In terms of the adverse events, four studies showed that the acupuncture monotherapy group had fewer adverse events than the antihypertensive drug monotherapy group [RR=0.10, 95%CI (0.04, 0.25), P<0.00001, fixed effects model; I2=0%].
Conclusion
Acupuncture combined with antihypertensive drugs is superior to antihypertensive drugs alone in reducing blood pressure, and acupuncture therapy is effective and safe for the treatment of essential hypertension with fewer side effects. However, there is still a lack of high-quality multicenter randomized double-blinded controlled trials in this field. Rigorous large-sample clinical trials are needed to validate these findings.
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Correcting a widespread error: Neuroprotectant N-acetyl-L-tryptophan does not bind to the neurokinin-1 receptor. Mol Cell Neurosci 2022; 120:103728. [DOI: 10.1016/j.mcn.2022.103728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022] Open
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Farrugia A, Mori F. Therapeutic solutions of human albumin - The possible effect of process-induced molecular alterations on clinical efficacy and safety. J Pharm Sci 2022; 111:1292-1308. [PMID: 35276228 DOI: 10.1016/j.xphs.2022.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 03/04/2022] [Accepted: 03/04/2022] [Indexed: 12/14/2022]
Abstract
Human albumin solutions were developed as therapeutic during the Second World War to address blood loss due to battlefield injury. This indication was based on the recognition that albumin provided most of the oncotic capacity of human plasma. For the succeeding sixty years, this formed the basis for the use of albumin in traumatology and emergency medicine. In more recent times, the pharmacological properties arising from albumin's complex structure have become a focus of attention by clinical researchers. In particular, albumin, through anti-inflammatory and anti-oxidant properties, has been proposed as an agent for the treatment of sepsis, cirrhosis and other inflammatory states. Some evidence for these indications has accrued from a number of small clinical trials and observational studies. These studies have not been confirmed in other large trials. Together with other investigators, we have shown that the process of plasma fractionation results in alterations in the structure of albumin, including those parts of the molecule involved in anti-oxidant and anti-inflammatory effects. Albumin products from diverse manufacturers show heterogeneity in their ability to address these effects. In this article, we review the historical development of albumin solutions, pointing out the variations in fractionation chemistries which different manufacturers have adopted. We suggest ways by which the manufacturing processes have contributed to variations in the physico-chemical properties of molecule. We review the outcomes of clinical studies assessing the role of albumin in ameliorating conditions such as sepsis and cirrhosis, and we speculate as to the extent which heterogeneity in the products may have contributed to variable clinical outcomes. Finally, we argue for a change in the perception of the plasma product industry and its regulatory overseers. Historically, albumin has been viewed as a generic commodity, with different preparations being interchangeable in their clinical application. We suggest that this implied biosimilarity is not necessarily applicable for different albumin solutions. The use of albumin, in indications other than its historical role as a plasma expander, can only be validated by clinical investigation of each separate albumin product.
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Affiliation(s)
- Albert Farrugia
- Faculty of Health and Medical Sciences, The University of Western Australia, 35 Stirling Highway, Crawley WA 6009, Perth, Australia.
| | - Filippo Mori
- Kedrion S.p.A., Research and Innovation Department, Via di Fondovalle, Loc., Bolognana 55027, Gallicano (LU), Italy
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Mikkat S, Dominik A, Stange J, Eggert M. Comparison of accompanying proteins in different therapeutic human serum albumin preparations. Biologicals 2020; 64:41-48. [DOI: 10.1016/j.biologicals.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/16/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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Tramarin A, Tedesco D, Naldi M, Baldassarre M, Bertucci C, Bartolini M. New insights into the altered binding capacity of pharmaceutical-grade human serum albumin: site-specific binding studies by induced circular dichroism spectroscopy. J Pharm Biomed Anal 2019; 162:171-178. [DOI: 10.1016/j.jpba.2018.09.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/03/2018] [Accepted: 09/11/2018] [Indexed: 12/16/2022]
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Harm S, Schildböck C, Hartmann J. Removal of stabilizers from human serum albumin by adsorbents and dialysis used in blood purification. PLoS One 2018; 13:e0191741. [PMID: 29364955 PMCID: PMC5783404 DOI: 10.1371/journal.pone.0191741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/10/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Human serum albumin (HSA) is a monomeric multi-domain protein that possesses an extraordinary binding capacity. It plays an important role in storing and transporting endogenous substances, metabolites, and drugs throughout the human circulatory system. Clinically, HSA is used to treat a variety of diseases such as hypovolemia, shock, burns, hemorrhage, and trauma in critically ill patients. Pharmaceutical-grade HSA contains the stabilizers sodium caprylate and N-acetyltryptophanate to protect the protein from oxidative stress and to stabilize it for heat treatment which is applied for virus inactivation. MATERIAL AND METHODS The aim of this study was to determine if the two stabilizers can be depleted by adsorbent techniques. Several, adsorbents, some of them are in clinical use, were tested in batch and in a dynamic setup for their ability to remove the stabilizers. Furthermore, the removal of the stabilizers was tested using a pediatric high flux dialyzer. RESULTS The outcome of this study shows that activated charcoal based adsorbents are more effective in removal of N-acetylthryptophanate, whereas polystyrene based adsorbents are better for the removal of caprylate from HSA solutions. An adsorbent cartridge which contains a mix of activated charcoal and polystyrene based material could be used to remove both stabilizers effectively. After 4 hours treatment with a high flux dialyzer, N-acetyltryptophanate was totally removed whereas 20% of caprylate remained in the HSA solution.
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Affiliation(s)
- Stephan Harm
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria
- * E-mail:
| | - Claudia Schildböck
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
| | - Jens Hartmann
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
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Sponholz C, Matthes K, Rupp D, Backaus W, Klammt S, Karailieva D, Bauschke A, Settmacher U, Kohl M, Clemens MG, Mitzner S, Bauer M, Kortgen A. Molecular adsorbent recirculating system and single-pass albumin dialysis in liver failure--a prospective, randomised crossover study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:2. [PMID: 26728364 PMCID: PMC4699252 DOI: 10.1186/s13054-015-1159-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/06/2015] [Indexed: 12/17/2022]
Abstract
Background The aim of extracorporeal albumin dialysis (ECAD) is to reduce endogenous toxins accumulating in liver failure. To date, ECAD is conducted mainly with the Molecular Adsorbents Recirculating System (MARS). However, single-pass albumin dialysis (SPAD) has been proposed as an alternative. The aim of this study was to compare the two devices with a prospective, single-centre, non-inferiority crossover study design with particular focus on reduction of bilirubin levels (primary endpoint) and influence on paraclinical and clinical parameters (secondary endpoints) associated with liver failure. Methods Patients presenting with liver failure were screened for eligibility and after inclusion were randomly assigned to be started on either conventional MARS or SPAD (with 4 % albumin and a dialysis flow rate of 700 ml/h). Statistical analyses were based on a linear mixed-effects model. Results Sixty-nine crossover cycles of ECAD in 32 patients were completed. Both systems significantly reduced plasma bilirubin levels to a similar extent (MARS: median −68 μmol/L, interquartile range [IQR] −107.5 to −33.5, p = 0.001; SPAD: −59 μmol/L, −84.5 to +36.5, p = 0.001). However, bile acids (MARS: −39 μmol/L, −105.6 to −8.3, p < 0.001; SPAD: −9 μmol/L, −36.9 to +11.4, p = 0.131), creatinine (MARS: −24 μmol/L, −46.5 to −8.0, p < 0.001; SPAD: −2 μmol/L, −9.0 to +7.0/L, p = 0.314) and urea (MARS: −0.9 mmol/L, −1.93 to −0.10, p = 0.024; SPAD: −0.1 mmol/L, −1.0 to +0.68, p = 0.523) were reduced and albumin-binding capacity was increased (MARS: +10 %, −0.8 to +20.9 %, p < 0.001; SPAD: +7 %, −7.5 to +15.5 %, p = 0.137) only by MARS. Cytokine levels of interleukin (IL)-6 and IL-8 and hepatic encephalopathy were altered by neither MARS nor SPAD. Conclusions Both procedures were safe for temporary extracorporeal liver support. While in clinical practice routinely assessed plasma bilirubin levels were reduced by both systems, only MARS affected other paraclinical parameters (i.e., serum bile acids, albumin-binding capacity, and creatinine and urea levels). Caution should be taken with regard to metabolic derangements and electrolyte disturbances, particularly in SPAD using regional citrate anti-coagulation. Trial registration German Clinical Trials Register (www.drks.de) DRKS00000371. Registered 8 April 2010. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1159-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Sponholz
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
| | - Katja Matthes
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
| | - Dina Rupp
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
| | - Wolf Backaus
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany.
| | | | - Diana Karailieva
- Institute of Clinical Chemistry and Laboratory Diagnostics, Jena University Hospital, Jena, Germany. .,Center for Sepsis Control and Care, Integrated Treatment and Research Center, Jena University Hospital, Jena, Germany.
| | - Astrid Bauschke
- Division of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
| | - Utz Settmacher
- Division of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany.
| | - Matthias Kohl
- Department of Medical and Life Sciences, Furtwangen University, Villingen-Schwenningen, Germany.
| | - Mark G Clemens
- Center for Sepsis Control and Care, Integrated Treatment and Research Center, Jena University Hospital, Jena, Germany. .,The Liver-Biliary-Pancreatic Center, Carolinas Medical Center, Charlotte, NC, USA. .,Department of Biology, University of North Carolina at Charlotte, Charlotte, NC, USA.
| | - Steffen Mitzner
- Division of Nephrology, Department of Medicine, Rostock University Medical Centre, Rostock, Germany. .,Fraunhofer Institute for Cell Therapy and Immunology, Extracorporeal Immunomodulation Project Group, Rostock, Germany.
| | - Michael Bauer
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany. .,Center for Sepsis Control and Care, Integrated Treatment and Research Center, Jena University Hospital, Jena, Germany.
| | - Andreas Kortgen
- Department of Anaesthesiology and Critical Care Medicine, Jena University Hospital, Erlanger Allee 101, 07747, Jena, Germany. .,Center for Sepsis Control and Care, Integrated Treatment and Research Center, Jena University Hospital, Jena, Germany.
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Pfensig C, Dominik A, Borufka L, Hinz M, Stange J, Eggert M. A New Application for Albumin Dialysis in Extracorporeal Organ Support: Characterization of a Putative Interaction Between Human Albumin and Proinflammatory Cytokines IL-6 and TNFα. Artif Organs 2015; 40:397-402. [PMID: 26365493 DOI: 10.1111/aor.12557] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Albumin dialysis in extracorporeal organ support is often performed in the treatment of liver failure as it facilitates the removal of toxic components from the blood. Here, we describe a possible effect of albumin dialysis on proinflammatory cytokine levels in vitro. Initially, albumin samples were incubated with different amounts of cytokines and analyzed by enzyme-linked immunosorbent assay (ELISA). Analysis of interleukin 6 (IL-6) and tumor necrosis factor alpha (TNFα) levels indicated that increased concentrations of albumin reduce the measureable amount of the respective cytokines. This led to the hypothesis that the used proinflammatory cytokines may interact with albumin. Size exclusion chromatography of albumin spiked with cytokines was carried out using high-performance liquid chromatography analysis. The corresponding fractions were evaluated by immunoblotting. We detected albumin and cytokines in the same fractions indicating an interaction of the small-sized cytokines IL-6 and TNFα with the larger-sized albumin. Finally, a two-compartment albumin dialysis in vitro model was used to analyze the effect of albumin on proinflammatory cytokines in the recirculation circuit during 6-h treatment. These in vitro albumin dialysis experiments indicated a significant decrease of IL-6, but not of TNFα, when albumin was added to the dialysate solution. Taken together, we were able to show a putative in vitro interaction of human albumin with the proinflammatory cytokine IL-6, but with less evidence for TNFα, and demonstrated an additional application for albumin dialysis in liver support therapy where IL-6 removal might be indicated.
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Affiliation(s)
- Claudia Pfensig
- Center for Extracorporeal Organ Support (CEOS), Department of Internal Medicine, University of Rostock, Rostock, Germany
| | - Adrian Dominik
- Center for Extracorporeal Organ Support (CEOS), Department of Internal Medicine, University of Rostock, Rostock, Germany
| | - Luise Borufka
- Center for Extracorporeal Organ Support (CEOS), Department of Internal Medicine, University of Rostock, Rostock, Germany
| | - Michael Hinz
- Division of Nephrology, Department of Medicine, Rostock University Medical Center, Rostock, Germany
| | - Jan Stange
- Division of Nephrology, Department of Medicine, Rostock University Medical Center, Rostock, Germany
| | - Martin Eggert
- Center for Extracorporeal Organ Support (CEOS), Department of Internal Medicine, University of Rostock, Rostock, Germany
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Impact of Residual Impurities and Contaminants on Protein Stability. J Pharm Sci 2014; 103:1315-30. [DOI: 10.1002/jps.23931] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 02/03/2023]
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Selden C, Spearman CW, Kahn D, Miller M, Figaji A, Erro E, Bundy J, Massie I, Chalmers SA, Arendse H, Gautier A, Sharratt P, Fuller B, Hodgson H. Evaluation of encapsulated liver cell spheroids in a fluidised-bed bioartificial liver for treatment of ischaemic acute liver failure in pigs in a translational setting. PLoS One 2013; 8:e82312. [PMID: 24367515 PMCID: PMC3867376 DOI: 10.1371/journal.pone.0082312] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/23/2013] [Indexed: 12/16/2022] Open
Abstract
Liver failure is an increasing problem. Donor-organ shortage results in patients dying before receiving a transplant. Since the liver can regenerate, alternative therapies providing temporary liver-support are sought. A bioartificial-liver would temporarily substitute function in liver failure buying time for liver regeneration/organ-procurement. Our aim: to develop a prototype bioartificial-liver-machine (BAL) comprising a human liver-derived cell-line, cultured to phenotypic competence and deliverable in a clinical setting to sites distant from its preparation. The objective of this study was to determine whether its use would improve functional parameters of liver failure in pigs with acute liver failure, to provide proof-of-principle. HepG2 cells encapsulated in alginate-beads, proliferated in a fluidised-bed-bioreactor providing a biomass of 4-6 × 10(10)cells, were transported from preparation-laboratory to point-of-use operating theatre (6000 miles) under perfluorodecalin at ambient temperature. Irreversible ischaemic liver failure was induced in anaesthetised pigs, after portal-systemic-shunt, by hepatic-artery-ligation. Biochemical parameters, intracranial pressure, and functional-clotting were measured in animals connected in an extracorporeal bioartificial-liver circuit. Efficacy was demonstrated comparing outcomes between animals connected to a circuit containing alginate-encapsulated cells (Cell-bead BAL), and those connected to circuit containing alginate capsules without cells (Empty-bead BAL). Cells of the biomass met regulatory standards for sterility and provenance. All animals developed progressive liver-failure after ischaemia induction. Efficacy of BAL was demonstrated since animals connected to a functional biomass (+ cells) had significantly smaller rises in intracranial pressure, lower ammonia levels, more bilirubin conjugation, improved acidosis and clotting restoration compared to animals connected to the circuit without cells. In the +cell group, human proteins accumulated in pigs' plasma. Delivery of biomass using a short-term cold-chain enabled transport and use without loss of function over 3 days. Thus, a fluidised-bed bioreactor containing alginate-encapsulated HepG2 cell-spheroids improved important parameters of acute liver failure in pigs. The system can readily be up-scaled and transported to point-of-use justifying development at clinical scale.
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Affiliation(s)
- Clare Selden
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Catherine Wendy Spearman
- Division of Hepatology, Department of Medicine, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Delawir Kahn
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Malcolm Miller
- Department of Anaesthetics, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Anthony Figaji
- Department Neurosurgery, Red Cross Children's Hospital, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Eloy Erro
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - James Bundy
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Isobel Massie
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Sherri-Ann Chalmers
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Hiram Arendse
- Department of Surgery, University of Cape Town, Groote Schuur Hospital, Cape Town, Western Cape, South Africa
| | - Aude Gautier
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Peter Sharratt
- Biochemistry Department, University of Cambridge, Cambridge, United Kingdom
| | - Barry Fuller
- Division of Surgery and Interventional Science, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
| | - Humphrey Hodgson
- University College London Institute for Liver & Digestive Health, University College London Medical School, Royal Free Hospital Campus, Hampstead, London, United Kingdom
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