Protective Effects of Microencapsulation (Coating) on Platelet Depletion and Particulate Embolism in the Clinical Applications of Charcoal Haemoperfusion. In: Kenedi RM, Courtney JM, Gaylor JDS, Gilchrist T, Gerard SM, editors. Artificial Organs. London: Macmillan Education UK; 1977. pp. 164-77. [DOI: 10.1007/978-1-349-03458-1_21]

An Evolutionary Review of Hemoperfusion Adsorbents: Materials, Preparation, Functionalization, and Outlook

Accumulation of pathogenic factors in the blood may cause irreversible damage and may even be life-threatening. Hemoperfusion is an effective technique for eliminating pathogenic factors, which is widely used in the treatment of various diseases including liver failure, renal failure, sepsis, and others. Hemoperfusion adsorbents are crucial in this process as they specifically bind and remove the target pathogenic factors. This review describes the development of hemoperfusion adsorbents, detailing the different properties exhibited by inorganic materials, organic polymers, and new materials. Advances in natural and synthetic polymers and novel materials manufacturing techniques have driven the expansion of hemoperfusion adsorbents in clinical applications. Stimuli-responsive (smart responsive) adsorbents with controllable molecular binding properties have many promising and environmentally friendly biomedical applications. Knowledge gaps, future research directions, and prospects for hemoperfusion adsorbents are discussed.

The Effect of Hemoperfusion over Uncoated and Polymer — Coated Charcoal on Hematological Levels in the Conscious Rat

An investigation has been made of the suitability of a rat hemoperfusion system for the evaluation of hematological changes induced by charcoal hemoperfusion. The investigation studied the influence on erythrocyte, leucocyte and thrombocyte levels of repeated hemoperfusion over Norit RBX1 charcoal, hemoperfusion over polymer-coated Norit RBX1 and hemoperfusion over uncoated spherical charcoal. Controls included animals subjected to hemoperfusion through empty columns and animals cannulated only. The results indicate that changes in erythrocyte and leucocyte levels are due principally to passage of blood through the extracorporeal circuit rather than contact with the adsorbent but that changes in thrombocyte levels are dependent on the type of charcoal and the nature and extent of polymer coating. The investigation suggests that the rat hemoperfusion system is a suitable procedure for the assessment of the compatibility of adsorbents to be used in hemoperfusion.

Tailor-made agarose-based reactive beads for hemoperfusion and plasma perfusion

Composite beads of approximately 1 mm diameter, made of crosslinked agarose and containing Fuller's Earth or zirconium oxide powders, were prepared and used in extracorporeal systems for blood detoxification. The former was used for the removal of Paraquat, while the latter was used to remove inorganic phosphate from hyperphosphatemic animals with or without acute renal failure. The high surface area of the powder, combined with the low resistance to diffusion in the crosslinked agarose matrix, are highly advantageous. The crosslinking provides high mechanical strength, heat stability, prolonged shelf life, good blood flow characteristics, and prevents the release of fine particles into the blood. Crosslinked agarose beads of 1 mm diameter, containing chemically-bound heparin were also prepared, and used as a model for direct contact removal of LDL-cholesterol from the blood of familial hypercholesterolemic patients by hemoperfusion. The high capacity of these beads (over 5 mg LDL/mL beads) indicates that this clinical modality can replace the highly expensive plasmapheresis procedure presently used.

A reciprocating, single-needle hemodialyzer with bidirectional flow of sorbent suspension

Previous theoretical analysis has indicated that adequate mass transfer is possible in a dialyzer with reciprocating membrane motion provided that the dialysate concentration of uremic substances is kept low. Earlier models have utilized a collection of sorbents (charcoal, urease, and a cation exchanger) constrained next to the dialyzer membranes. We have designed a new dialyzer with a sorbent suspension having free access from a reservoir to the spaces between membrane packages. At a treatment rate of 150 ml/min/m2, the in vitro creatinine clearance is 75 ml/min/m2, which agrees within experimental accuracy with the theoretical prediction. The creatinine clearance, flow resistance, and compliance of the dialyzer are constant during four to six hours of testing. In vivo tests have been performed during urea and creatinine infusion in a normal dog and in a dog with 3/4 nephrectomy. The in vivo creatinine clearance agrees within 10% with the in vitro clearance. Sodium, potassium, calcium, and bicarbonate fluxes are acceptable for patients in renal failure. The new design allows a higher capacity for urea and creatinine, since larger amounts of sorbent may be used.

Adsorption characteristics of plasma fibronectin in relationship to biological activity

We studied the adsorption properties of plasma fibronectin (pFN) on wettable tissue culture (TC) dishes and nonwettable bacteriological (BAC-T) dishes in relationship to its biological activity of promoting fibroblast spreading. The binding of pFN to the dish surfaces was found to be very tight and partially resistant to treatments with 1M NaOH, 2% SDS, 8M urea, or 6M guanidine HCl. Only the combination of trypsin (1 mg/ml) followed by 1M NaOH resulted in complete recovery of surface bound material. The amount of surface bound pFN did not directly correlate with its activity when comparing TC and BAC-T dishes. At low concentrations, more pFN adsorbed onto the surfaces of BAC-T dishes than TC dishes, but the adsorbed material was biologically less active on BAC-T dishes. At high concentrations, pFN adsorbed similarly on both dish surfaces reaching a maximum level of 320 ng/cm2 or 4.4 x 10(11) molecules/cm2. The possibility was considered that pFN unfolded into an inactive conformation when adsorbed on BAC-T dishes at a low concentration but that at high concentrations, molecular packing requirements prevented unfolding. Evidence in favor of this hypothesis was the observation that addition of 50 micrograms/ml of serum albumin simultaneously with low pFN concentrations resulted in adsorption of pFN on BAC-T dishes in an active conformation even though the amount of adsorbed pFN decreased. Competition experiments between pFN and other proteins were carried out, and it was found that pFN has a much higher affinity for BAC-T or TC dish surfaces than albumin or fibrinogen. It was also found that mild heat denaturation of albumin increased its affinity for the surface by an order of magnitude.