Hemocompatible hemoadsorbent for effective removal of protein-bound toxin in serum

[Application of Modified Polyether Sulfone Microspheres in Hyperbilirubinemia]

Objective

To design and prepare a high efficiency bilirubin adsorbent with good mechanical properties and biocompatibility.

Methods

In this study, quaternary ammonium pyridine was designed and synthesized, and then modified polyether sulfone microspheres, or PES/p(4-VP-co-N-VP)@6 microspheres, were prepared by phase conversion and electrostatic spraying. The morphology of the polymer components and the microspheres were studied by means of nuclear magnetic resonance (NMR) spectroscopy and scanning electron microscopy. The basic properties of the microspheres and their bilirubin adsorption efficiency were tested, and the adsorption mechanism was further explored. Blood cell counts and the clotting time of the microspheres were also measured.

Results

The diameter of the modified polyether sulfone microspheres prepared in the study was approximately 700-800 μm. Compared with the original PES microspheres, the surface and internal structure of PES/p(4-VP-co-N-VP)@6 microspheres did not change significantly, and they also had a loose porous structure, with some micropores scattered around in addition to irregular large pores. Compared with the control group, the bilirubin removal effect of the modified microspheres was (94.91±0.73)% after static adsorption in bilirubin PBS buffer solution for 180 min, with the difference being statistically significant (P<0.0001). According to the findings for the clotting time, the activated partial thromboplastin time (APTT) of the blank plasma group, the control PES group, and the modified PES microsphere group were (27.57±1.25) s, (28.47±0.45) s, and (30.4±0.872) s, respectively, and the difference between the experimental group and the other two groups was statistically significant (P<0.01, P<0.05). There was no significant change in red blood cell and white blood cell counts.

Conclusion

The microspheres prepared in the study have high efficiency in bilirubin adsorption, excellent mechanical properties and thermal stability, and good blood biocompatibility, and are expected to be used in the clinical treatment of patients with liver failure.

TiO2/Polystyrene Nanocomposite Antibacterial Material as a Hemoperfusion Adsorbent for Efficient Bilirubin Removal and Prevention of Bacterial Infection

The use of hemoperfusion adsorbents for the removal of bilirubin in patients with liver failure has become a critical treatment. However, the insufficient clearance of bilirubin and the possibility of bacterial infection during hemoperfusion limit the application. In this work, we designed a novel antibacterial bilirubin adsorbent (PSVT) through the suspension polymerization reaction between double-bond functionalized TiO2 nanoparticles and styrene. PSVT showed an excellent bilirubin adsorption ability and antibacterial performance, ensuring efficient clearance of bilirubin in liver failure patients during hemoperfusion and preventing bacterial infection. The experimental results indicated that TiO2 was uniformly dispersed in the microspheres, which improved the mesoporous structure and increased the specific surface area. Composite adsorbent PSVT showed an exceptional bilirubin adsorption capacity, with the maximum adsorption capacity reaching 24.3 mg/g. In addition, the introduction of TiO2 endowed PSVT with excellent antibacterial ability; the ultimate antibacterial rates against Escherichia coli and Staphylococcus aureus reached 97.31 and 96.47%, respectively. In summary, PSVT served as a novel antibacterial bilirubin adsorbent with excellent bilirubin clearance capacity and antibacterial performance, providing excellent application prospects for treating liver failure patients.

Reusable Zwitterionic Porous Organic Polymers for Bilirubin Removal in Serum

Herein, we report a straightforward strategy to construct reusable, hemocompatible, and highly efficient bilirubin adsorbents by installing zwitterionic modules into a porous organic polymer (POP) for hemoperfusion application. Three types of zwitterions with different amounts are used to evaluate their impacts on the characteristics of POPs, including carboxybetaine methacrylate (CB), sulfobetaine methacrylate (SB), and 2-methacryloyloxyethyl phosphorylcholine (MPC). Results show that zwitterions can improve hemocompatibility, hydrophilicity, and bilirubin uptake of the POP. Among all zwitterionic POPs, POP-CB-40% exhibits the best bilirubin uptake, ∼46.5 times enhancement compared with the non-zwitterionic POP in 100% serum. This enhancement can be attributed to the improved hydrophilicity and protein resistance ability in biological solutions. More importantly, the reusability test shows that POP-CB-40% maintains ∼99% of bilirubin uptake capacity at fifth recycling in 100% serum. Findings in this work provide a guideline for the design of biocompatible and efficient POP-based bilirubin adsorbents for hemoperfusion therapy.

Metal-organic framework (UiO-66 and UiO-66-NH2)-based adsorbents for bilirubin removal used in hemoperfusion

Excessive accumulation of bilirubin in patients with hyperbilirubinemia can lead to tissue and organ damage and neurological diseases, and is even life-threatening in severe cases. Hemoperfusion is an effective method for removing bilirubin, but clinically used hemoperfusion adsorbents have unsatisfactory adsorption capacity and kinetics. In order to obtain a safe and efficient bilirubin adsorbent, Zr-based Metal-Organic Framework (MOF) material UiO-66 with high specific surface area and aqueous medium stability was prepared and modified with varying degrees of amination to improve its adsorption capacity. According to adsorption experiments in aqueous solution and simulated plasma, it was confirmed that the unsaturated coordinated zirconium in UiO-66 can effectively induce the aggregation and precipitation of free bilirubin unbound to albumin and the amino group on UiO-66-NH2 has a strong affinity for albumin bound bilirubin. The adsorption effect of UiO-66-NH2 with a high degree of amino modification is significantly stronger than that of UiO-66-NH2 with a low degree of modification. In simulated plasma with a bilirubin concentration of 40 mg dL-1, the adsorption capacities of UiO-66 and UiO-66-NH2-1.9 can reach 69.08 mg g-1 and 81.13 mg g-1. The adsorption isotherm fitting and adsorption kinetics fitting results also show that UiO-66 and UiO-66-NH2 are good adsorbents for bilirubin. In dynamic adsorption, the adsorbents also showed good performance and did not affect the protein in the plasma. The hemolysis test, coagulation time test, and cytotoxicity test confirmed that the bilirubin adsorbents based on UiO-66 and UiO-66-NH2 have good blood compatibility and biocompatibility. This study provides new ideas for the development of a novel bilirubin adsorbent and a theoretical basis for the study of bilirubin adsorption mechanisms.

Protein/Polysaccharide Composite toward Multi-in-One Toxin Removal in Blood with Self-Anticoagulation and Biocompatibility

Biocompatible adsorbents play an essential role in hemoperfusion. Nevertheless, there are no hemoperfusion adsorbents that can simultaneously remove small and medium toxins, including bilirubin, urea, phosphor, heavy metals, and antibiotics. This bottleneck significantly impedes the miniaturization and portability of hemoperfusion materials and devices. Herein, a biocompatible protein-polysaccharide complex is reported that exhibits "multi-in-one" removal efficacy for liver and kidney metabolism wastes, toxic metal ions, and antibiotics. Through electrostatic interactions and polysaccharide-mediated coacervation, adsorbents can be prepared by simply mixing lysozyme (LZ) and sodium alginate (SA) together in seconds. The LZ/SA absorbent presented high adsorption capacities for bilirubin, urea, and Hg2+ of up to 468, 331, and 497 mg g-1 , respectively, and the excellent anti-protein adsorption endowed LZ/SA with a record-high adsorption capacity for bilirubin in the interference of serum albumin to simulate the physiological environment. The LZ/SA adsorbent also has effective adsorption capacity for heavy metals (Pb2+ , Cu2+ , Cr3+ , and Cd2+ ) and multiple antibiotics (terramycin, tetracycline, enrofloxacin, norfloxacin, roxithromycin, erythromycin, sulfapyrimidine, and sulfamethoxazole). Various adsorption functional groups exposed on the adsorbent surface significantly contribute to the excellent adsorption capacity. This fully bio-derived protein/alginate-based hemoperfusion adsorbent has great application prospects in the treatment of blood-related diseases.

Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy

Hyperbilirubinemia, presenting as jaundice, is a life-threatening critical illness in newborn babies and acute severe hepatic failure patients. Over the past few decades, extracorporeal hemoadsorption by adsorbent therapy has been widely applied in the treatment of hyperbilirubinemia. The capability of hemoadsorption depends on the adsorbents. Most of the clinically used bilirubin adsorbents are made up of styrene/divinylbenzene copolymer and quaternary ammonium salt, which usually have poor biocompatibility and weak mechanical strength. To overcome the drawbacks of commercial polymer adsorbents, advanced synthetic and natural polymers with/without nanomaterials have been designed, and novel adsorbent fabrication technologies have also been developed. In this review, the adsorption mechanism of bilirubin adsorbents has been summarized, which is the basic criterion in adsorbent development. Furthermore, the preparation method, adsorption mechanism, relative merits and practicability of the emerging bilirubin adsorbents have been evaluated. Based on the existing studies, this work highlights the future direction of the efforts on how to design and develop bilirubin adsorbents with good overall clinical performance. Perhaps this study can change traditional perspectives and propose new strategies for bilirubin clearance from the aspects of pathogenic mechanisms, metabolic pathways, and material-based innovation.

Zwitterionic Biomaterials

The term "zwitterionic polymers" refers to polymers that bear a pair of oppositely charged groups in their repeating units. When these oppositely charged groups are equally distributed at the molecular level, the molecules exhibit an overall neutral charge with a strong hydration effect via ionic solvation. The strong hydration effect constitutes the foundation of a series of exceptional properties of zwitterionic materials, including resistance to protein adsorption, lubrication at interfaces, promotion of protein stabilities, antifreezing in solutions, etc. As a result, zwitterionic materials have drawn great attention in biomedical and engineering applications in recent years. In this review, we give a comprehensive and panoramic overview of zwitterionic materials, covering the fundamentals of hydration and nonfouling behaviors, different types of zwitterionic surfaces and polymers, and their biomedical applications.

Freezing-triggered gelation of quaternized chitosan reinforced with microfibrillated cellulose for highly efficient removal of bilirubin

The highly efficient removal of bilirubin from blood by hemoperfusion for liver failure therapy remains a challenge in the clinical field due to the low adsorption capacity and poor hemocompatibility of currently used carbon-based adsorbents. Polysaccharide-based cryogels seem to be promising candidates for hemoperfusion adsorbents owing to their inherited excellent hemocompatibility. However, the weak mechanical strength and relatively low adsorption capacity of polysaccharide-based cryogels limited their application in bilirubin adsorption. In this work, we presented a freezing-triggered strategy to fabricate QCS/MFC cryogels, which were formed by quaternized chitosan (QCS) crosslinked with divinylsulfonyl methane (BVSM) and reinforced with microfibrillated cellulose (MFC). Ice crystal exclusions triggered the chemical crosslinking to generate the cryogels with dense pore walls. The obtained QCS/MFC cryogels were characterized by FTIR, SEM, stress-strain test, and hemocompatibility assay, which exhibited interconnected macroporous structures, excellent shape-recovery and mechanical performance, and outstanding blood compatibility. Due to the quaternary ammonium functionalization of chitosan, the QCS/MFC showed a high adsorption capacity of 250 mg g^-1 and a short adsorption equilibrium time of 3 h. More importantly, the QCS/MFC still exhibited high adsorption efficiency (over 49.7%) in the presence of 40 g L^-1 albumin. Furthermore, the QCS/MFC could also maintain high dynamic adsorption efficiency in self-made hemoperfusion devices. This facile approach provides a new avenue to develop high-performance hemoperfusion adsorbents for bilirubin removal, showing great promise for the translational therapy of hyperbilirubinemia.

Supramolecular Organic Frameworks as Adsorbents for Efficient Removal of Excess Bilirubin in Hemoperfusion

Excess bilirubin accumulates in the bodies of patients suffering from acute liver failure (ALF) to cause much irreversible damage and bring about serious clinical symptoms such as kernicterus, hepatic coma, or even death. Hemoperfusion is a widely used method for removing bilirubin from the blood, but clinically used adsorbents have unsatisfactory adsorption capacity and kinetics. In this study, we prepared four supramolecular organic framework microcrystals SOF-1-4 via slow evaporation of their aqueous solutions under infrared light. SOF-1-4 possess good regularity and excellent stability. We demonstrate that all the four SOFs could serve as adsorbents for bilirubin with fast adsorption kinetics within 20 min and ultrahigh adsorption capacity of 609.1 mg g^-1, driven by electrostatic interaction and hydrophobicity. The superior adsorption performance of the SOFs outperformed most of the reported bilirubin adsorbents. Remarkably, SOF-3 could remove about 90% of bilirubin in the presence of 40 g L^-1 BSA with a minimal loss of albumin and was thus further processed to a bead-shaped composite with a diameter of 2 mm with poly(ether sulfone) (PES). This PES-loaded SOF could efficiently adsorb bilirubin to the normal level from human plasma with an adsorption equilibrium concentration of 7.8 mg L^-1 in 6 h through a dynamic hemoperfusion process. This work provides a new vitality for the development of novel bilirubin adsorbents for hemoperfusion therapy.

Recent Advances in Mechanical Reinforcement of Zwitterionic Hydrogels

As a nonspecific protein adsorption material, a strong hydration layer provides zwitterionic hydrogels with excellent application potential while weakening the interaction between zwitterionic units, leading to poor mechanical properties. The unique anti-polyelectrolyte effect in ionic solution further restricts the application value due to the worsening mechanical strength. To overcome the limitations of zwitterionic hydrogels that can only be used in scenarios that do not require mechanical properties, several methods for strengthening mechanical properties based on enhancing intermolecular interaction forces and polymer network structure design have been extensively studied. Here, we review the works on preparing tough zwitterionic hydrogel. Based on the spatial and molecular structure design, tough zwitterionic hydrogels have been considered as an important candidate for advanced biomedical and soft ionotronic devices.

Biocompatible Composite Microspheres of Chitin/Ordered Mesoporous Carbon CMK3 for Bilirubin Adsorption and Cell Microcarrier Culture

Extra bilirubin in the blood can provoke serious illness in patients with severe liver disease. Hemoperfusion is an effective method to remove the extra bilirubin, but its application is limited by the low adsorption efficiency and poor biocompatibility of available adsorbent materials. In this study, chitin/ordered mesoporous carbon CMK3 (Ch/CMK3) microspheres were successfully prepared. Results of characterization experiments indicated that these composite microspheres possess a multilayered porous nanofibrous structure with an extremely large specific surface area (300.19 m² g^-1 ) and large pore size. Notably, the Ch/CMK3 microspheres demonstrated a high bilirubin adsorption capacity (228.19 mg g^-1 ) in phosphate buffer solution, and an outstanding bilirubin removal ratio (76.78%±4.40%) in the plasma of rabbits with hyperbilirubinemia without affecting the protein components. More importantly, the Ch/CMK3 microspheres showed no effect on other blood components, no cytotoxicity, and no systemic toxicity to mice. Cell coculture experiments revealed that the microspheres could provide a three-dimensional (3D) space to promote cell adhesion, proliferation, and nutrient exchange. These Ch/CMK3 microspheres featuring a strong ability for bilirubin adsorption and good biocompatibility could be a promising candidate in biomedical applications such as hemoperfusion, cell microcarrier, and 3D tissue engineering. This article is protected by copyright. All rights reserved.

Hierarchical core-shell nanoplatforms constructed from Fe3O4@C and metal-organic frameworks with excellent bilirubin removal performance

Hemoperfusion has become the third-generation treatment strategy for patients suffering from hyperbilirubinemia, but adsorbents used for bilirubin removal mostly face intractable problems, such as unsatisfactory adsorption performance and poor hemocompatibility. Metal-organic frameworks (MOFs) are promising adsorbents for hemoperfusion due to their high specific surface areas and easily modified organic ligands. However, their microporous properties and separation have hampered their application. Here, a novel hierarchical core-shell nanoplatform (named Double-PEG) with tailored binding sites and pore sizes based on Fe3O4@C and Uio66-NH2 was constructed. Notably, Double-PEG showed excellent bilirubin uptake of up to 1738.30 mg g-1 and maintained excellent bilirubin removal efficiency in simulated biological solutions. A study on the adsorption mechanism showed that the adsorption of Double-PEG towards bilirubin tended to be chemical adsorption and in accordance with the Langmuir model. Besides, the good separability, recyclability, cytotoxicity and hemocompatibility of Double-PEG show great potential in hemoperfusion therapy. The finding of this study may provide a novel insight into the application of MOF materials in the field of hemoperfusion.

Fabrication of a novel nitrogen-containing porous carbon adsorbent for protein-bound uremic toxins removal

Protein-bound uremic toxins (PBUTs), the presence of which in the blood is an important risk factor for the progression of chronic kidney disease (CKD), have not been cleared efficiently via traditional hemodialysis methods until now. In this study, biosafe and efficient nitrogen-containing porous carbon adsorbent (NPCA) beads for the clearance of PBUTs were prepared from porous acrylonitrile/divinylbenzene cross-linked copolymer beads followed by pyrolysis. The resulting NPCA beads were characterized via SEM, XPS and nitrogen adsorption/desorption tests. The results demonstrated that the NPCA beads possessed a mesoporous/microporous hierarchical structure with rich nitrogen functional groups on their surfaces and realized efficient PBUTs adsorption in human plasma. More importantly, the efficacy of PBUTs removal was substantially higher than those of commercial adsorbents that are commonly used in clinical uremia treatments. The NPCA beads also exhibited satisfactory removal efficacy towards middle-molecular-weight uremic toxins. The PBUTs removal mechanism of the NPCA beads is ascribed to effective competition between nitrogen-containing NPCA and proteins for PBUT binding. According to hemocompatibility assays, the NPCA beads possessed satisfactory in vitro hemocompatibility. This nitrogen-containing porous carbon adsorbent is an attractive and promising material for blood purification applications in the treatment of clinical uremia.

Polymyxin B engineered polystyrene-divinylbenzene microspheres for the adsorption of bilirubin and endotoxin

Hemoperfusion is an important strategy for liver disease treatment. Polystyrene-divinylbenzene (PS-DVB) microspheres are widely applied as absorbents in hemoperfusion to efficiently remove the important toxin bilirubin. However, as another common toxin, endotoxin will remain during this process and cause endotoxemia. Therefore, simultaneous removal of both bilirubin and endotoxin is highly desirable. In the present study, we engineered PS-DVB microspheres with polymyxin B sulfate (PMB) to meet this goal. After modification, the novel PMB-engineered (P-PMB) microspheres displayed excellent biocompatibility and hemocompatibility. Notably, compared to PS-DVB microspheres, P-PMB microspheres exhibited markedly stronger detoxification of both bilirubin and endotoxin, increasing by 17.03% and 42.57%, respectively. Overall, we believe that the novel P-PMB microspheres have considerable potential for liver disease treatment in clinical practice.

A new adsorbent for hemoperfusion was successfully prepared by grafting polymyxin B (PMB) on the surface of polystyrene divinylbenzene (PS-DVB) microspheres. It showed good biocompatibility and could adsorb both bilirubin and endotoxin.

A novel anticoagulant affinity membrane for enhanced hemocompatibility and bilirubin removal

Affinity membrane is widely employed to promote specific adsorption of toxins and reduce the blood purification therapeutic time. However, it suffers from insufficient toxin binding and low hemocompatibility. Herein, a novel anticoagulant affinity membrane (AAM) was developed to clear bilirubin from human blood in a pore-flow-through way. Firstly, a nylon net membrane with a regularly arranged pore as the matrix was coated with poly(pyrrole-3-carboxylic acid) via chemical vapor deposition (CVD) method. Then, poly(L-arginine) (PLA) as a highly specific ligand of bilirubin, was immobilized onto the surface of the composited membrane after the modification of heparin. Owing to the 3-dimensional molecular architecture of PLA, up to 86.1 % of bilirubin was efficiently cleared. Besides, the AAM exhibited effective anticoagulant activity in the measurement of clotting time, with suppressed thrombus formation, low hemolysis ratio, minimized platelet and leukocyte adhesion, and excellent biosafety. Therefore, the AAM has enormous potential in blood purification therapy for enhancing hemocompatibility and bilirubin removal.

Plant protein modified natural cellulose with multiple adsorption effects used for bilirubin removal

In this study, bacterial cellulose (BC)/soy protein isolate (SPI) composite membranes were prepared by in situ cross-linked polymerization, and used as efficient blood compatible adsorbents to remove bilirubin. The obtained composite membranes were successively characterized by FTIR, SEM, AFM, contact angle test and hemolysis assay, which exhibited unique protein coated 3D fibrous network structures, hydrophobic surfaces and outstanding blood compatibility due to the incorporation of SPI. The BC/SPI membranes with high SPI content showed high adsorption efficiency, short adsorption equilibrium time (2 h) and multiple adsorption effects on bilirubin. The adsorption rate for free bilirubin of BC/SPI5 membrane could reach 78.8% when the bilirubin concentration was 100 mg L^-1, while it increased to over 96.5% when the initial bilirubin concentration exceeded 400 mg L^-1. More importantly, the BC/SPI5 membrane still exhibited high adsorption rate (over 70%) in presence of albumin. Furthermore, the composite membrane could also maintain high dynamic adsorption efficiency in self-made hemoperfusion devices. This novel naturally-derived membrane is an economical and efficient absorbent for the remove of bilirubin, and will provide new ideas for therapy of hemoperfusion without plasma separation process.

A zwitterionic hydrogel coated titanium surface with high-efficiency endothelial cell selectivity for rapid re-endothelialization

Coronary stent implantation is an effective procedure for percutaneous coronary intervention treatment. However, its long-term safety and efficacy are still hindered by the in-stent restenosis and late thrombus formation. Herein, an anti-biofouling and endothelial cell selective zwitterionic hydrogel coating was developed to simultaneously enhance the nonspecific resistance and rapid re-endothelialization of the titanium surface. An endothelial cell selective peptide, REDV, could be simply conjugated on the zwitterionic carboxybetaine (CB) hydrogel to prepare the REDV/CB coating. It was found that the REDV/CB hydrogel layer maintained antifouling properties, which could inhibit the protein adsorption, bacterial adhesion, platelet activation and aggregation, and smooth muscle cell proliferation. More importantly, the co-culture study confirmed that the conjugated REVD peptide could specifically capture endothelial cells and promote their migration and proliferation, and simultaneously decrease the adhesion and proliferation of smooth muscle cells. Therefore, the antifouling and endothelial cell selective coating proposed in this work provides a promising strategy to develop an intravascular stent for promoted re-endothelialization and inhibited neointimal hyperplasia in clinical applications.

Amides and Heparin-Like Polymer Co-Functionalized Graphene Oxide Based Core @ Polyethersulfone Based Shell Beads for Bilirubin Adsorption

Excessive bilirubin in the body of patient with liver dysfunction or metabolic obstruction may cause jaundice with irreversible brain damage, and new type of adsorbent for bilirubin is under frequent investigation. Herein, graphene oxide based core @ polyethersulfone-based shell beads are fabricated by phase inversion method, amides and heparin-like polymer are introduced to functionalize the core-shell beads. The beads are successfully prepared with obvious core-shell structure, adequate thermostability and porous shell. Clotting times and protein adsorption are investigated to inspect the hemocompatibility property of the beads. The adsorption of bilirubin is systematically investigated by evaluating the effects of contacting time, initial concentration and temperature on the adsorption, which exhibits improved bilirubin adsorption amount for the beads with amides contained cores or/and shells. It is worth believing that the amides and heparin-like polymer co-functionalized core-shell beads may be utilized in the field of hemoperfusion for bilirubin adsorption.

Metal-Organic Framework Traps with Record-High Bilirubin Removal Capacity for Hemoperfusion Therapy

Adsorption-based hemoperfusion has been widely used to remove toxins from the blood of patients suffering acute liver failure (ALF). However, its detoxification effect has been severely hampered by the unsatisfactory adsorption performance of clinically used porous adsorbents, such as activated carbon (AC) and adsorption resin. Herein, two cage-based metal-organic frameworks (MOFs), PCN-333 (constructed from 4,4,4-s-triazine-2,4,6-triyl-tribenzoic acid (H₃TATB) ligands and Al₃ metal clusters) and MOF-808 (constructed from 1,3,5-benzenetricarboxylic acid (H₃BTC) ligands and Zr₆ metal clusters), are introduced for highly efficient hemoperfusion. They possess negligible hemolytic activity and can act as "bilirubin traps" to achieve outstanding adsorption performance toward bilirubin, a typical toxin related to ALF. Notably, PCN-333 shows a record-high adsorption capacity (∼1003.8 mg g^-1) among various bilirubin adsorbents previously reported. More importantly, they can efficiently adsorb bilirubin in bovine serum albumin (BSA) solution or even in 100% fetal bovine serum (FBS) due to their high selectivity. Strikingly, the adsorption rate and capacity of PCN-333 in biological solutions are approximately four times faster and 69 times higher than those of clinical AC, respectively. Findings in this work pave a new avenue to overcome the challenge of low adsorption efficiency and capacity in hemoperfusion therapy.