Construction of Kevlar nanofiber/graphene oxide composite beads as safe, self-anticoagulant, and highly efficient hemoperfusion adsorbents

Biomimetic Porous MXene Antibacterial Adsorbents with Enhanced Toxins Trapping Ability for Hemoperfusion

2D transition metal carbides and nitrides, i.e., MXene, are recently attracting wide attentions and presenting competitive performances as adsorbents used in hemoperfusion. Nonetheless, the nonporous texture and easily restacking feature limit the efficient adsorption of toxin molecules inside MXene and between layers. To circumvent this concern, here a plerogyra sinuosa biomimetic porous titanium carbide MXene (P-Ti3C2) is reported. The hollow and hierarchically porous structure with large surface area benefits the maximum access of toxins as well as trapping them inside the spherical cavity. The cambered surface of P-Ti3C2 prevents layers restacking, thus affording better interlaminar adsorption. In addition to enhanced toxin removal ability, the P-Ti3C2 is found to selectively adsorb more middle and large toxin molecules than small toxin molecules. It possibly originates from the rich Ti-deficient vacancies in the P-MXene lattice that increases the affinity with middle/large toxin molecules. Also, the vacancies as active sites facilitate the production of reactive oxygen under NIR irradiation to promote the photodynamic antibacterial performance. Then, the versatility of P-MXene is validated by extension to niobium carbide (P-Nb2C). And the simulated hemoperfusion proves the practicability of the P-MXene as polymeric adhesives-free adsorbents to eliminate the broad-spectrum toxins.

Heparin-Mimetic Chitooligosaccharides-Based Monoliths Obtained from C/W Emulsions: Hemocompatibility and Toxin Removal Ability

Hemoperfusion (HP) is one of the most prominent therapies for treating uremia, hyperbilirubinemia, and acute drug toxicity. The comprehensive performance of currently used porous HP adsorbents needs to be improved due to the impediment to their synthesis strategy. Herein, green carbon dioxide-in-water high internal phase emulsions (C/W HIPEs) were utilized and emulsified with poly(vinyl alcohol) (PVA) for the formation of a heparin-mimetic chitosan oligosaccharides/poly(acrylamide-co-sodium 4-styrenesulfonate) [COS/P(AM-co-SSS)] monolith, which exhibited good mechanical properties, stable swelling performance, hydrophilic properties, anticoagulant effect, and low hemolysis. It showed a strong toxin adsorption capacity (415.2 mg/g for creatinine, 199.3 mg/g for urea, 279.5 mg/g for bilirubin, and 160 mg/g for tetracycline). The adsorption process of porous COS/P(AM-co-SSS) followed the pseudo-second-order kinetic and Langmuir isotherm models. Moreover, the porous materials had a strong electrostatic force on creatinine. The removal of creatinine by simulated in vitro blood perfusion was 80.2% within 30 min. This work provides a green preparation strategy for developing novel HP materials, highlighting their potential application value in blood and environmental purification.

MOFs-alginate/polyacrylic acid/poly (ethylene imine) heparin-mimicking beads as a novel hemoadsorbent for bilirubin removal in vitro and vivo models

Metal-organic frameworks (MOFs) have a potential application in blood purification, but their microcrystalline nature has hampered their industrial application. Here, novel MOFs-polymer beads based on UiO, sodium alginate, polyacrylic acid, and poly (ethylene imine) were prepared and applied as a whole blood hemoadsorbent for the first time. The amidation among polymers immobilized UiO66-NH₂ into the network of the optimal product (SAP-3), and the NH₂ of UiO66-NH₂ significantly increased the removal rate (70 % within 5 min) of SAP-3 on bilirubin. The adsorption of SAP-3 on bilirubin mainly obeyed the pseudo-second-order kinetic, Langmuir isotherm and Thomas models with a maximum adsorption capacity (q_m) of 63.97 mg·g^-1. Experimental and density functional theory simulation results show that bilirubin was mainly adsorbed by UiO66-NH₂via electrostatic force, hydrogen bonding, and π-π interactions. Notably, the adsorption in vivo show that the total bilirubin removal rate in the whole blood of the rabbit model was up to 42 % after 1 h of adsorption. Given its excellent stability, cytotoxicity, and hemocompatibility, SAP-3 has a great potential in hemoperfusion therapy. This study proposes an effective strategy for settling the powder property of MOFs and could provide experimental and theoretical references for application of MOFs in blood purification.

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.

A breakthrough trial of an artificial liver without systemic heparinization in hyperbilirubinemia beagle models

The development of wearable artificial livers was restricted to device miniaturization and bleeding risk with water-soluble anticoagulants. Herein, a double-deck column filled with solid anticoagulant microspheres and Kevlar porous microspheres (KPMs, bilirubin adsorbents) was connected with the principle machine of wearable artificial liver (approximately 9 kg) to treat hyperbilirubinemia beagles for the first time. With the initial normal dose of heparin, the double-deck column could afford 3 h hemoperfusion in whole blood without thrombus formation. The removal efficiency of the double-deck column for total bilirubin (TBIL) was 31.4%. Interestingly, the excessive amounts of hepatocyte metabolites were also decreased by approximately 25%. The "anticoagulant + column" realized safe and effective whole blood hemoperfusion without the plasma separation system and heparin pump; however, the proposed principle machine of wearable artificial liver and "anticoagulant + column" cannot completely replace the bio-liver now. The intelligence of the device and the versatility of the adsorbent need to be improved; moreover, advanced experimental techniques need to be developed to validate the survival rates in animals. Overall, this study is a meaningful trial for the development of wearable artificial livers in the future.

Molecularly-imprinted hydrogel beads via self-sacrificing micro-reactors as safe and selective bilirubin adsorbents

For patients who are suffering from liver dysfunction or metabolic obstruction, excessive bilirubin (BIL) in their bodies may cause jaundice with irreversible cerebral injury. Traditional exchange transfusion and photodynamic therapy pose a risk of serious adverse reactions or limited curative effects. Therefore, as a generally used treatment, hemoperfusion (HP) purifies patients' blood with solid adsorbents. However, the development of clinical BIL absorbents is greatly impeded by low selectivity and unsatisfactory blood compatibility. Herein, inspired by oviparity, we propose BIL-imprinted poly(acrylic acid-co-sodium p-styrenesulfonate)-reduced graphene oxide (PAA-SS-rGO@BIL) hydrogel beads as BIL adsorbents via self-sacrificing micro-reactors. In the micro-reactors, cross-linked polymerization is achieved and a solidified gel is formed. The received hydrogel beads show outstanding selective adsorption capabilities toward BIL due to the recognition sites, and π-π and hydrophobic interactions. Such hydrogel beads possess superior blood compatibility owing to their bioinspired heparin-mimicking gel structure. Simulated BIL selective adsorption experiments in vitro demonstrate that the BIL concentrations in the plasma of a patient with severe jaundice can be restored to a moderate level within 3 hours. Therefore, hydrogel beads offer new options for clinical BIL adsorption.

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.

Surface Modification of Reduced Graphene Oxide Beads: Integrating Efficient Endotoxin Adsorption and Improved Blood Compatibility

As a pathogenic toxin, endotoxins are the culprit for endotoxemia and can be generally removed from the blood by hemoperfusion. Reduced graphene oxide (rGO) is a promising endotoxin sorbent for hemoperfusion owing to its excellent adsorption capacity, but it has the side effect of nonspecific adsorption and low blood compatibility. Polymyxin B (PMB) acts as an organic affinity ligand that can specifically bind endotoxins. As a natural anticoagulant, heparin (Hep) can reduce the risk of coagulation and improve the blood compatibility of materials. Herein, an rGO bead adsorbent was prepared by coupling with PMB and Hep and used for endotoxin adsorption; in this, polydopamine (pDA) served as an active coating for immobilization of PMB and further coupling with Hep. The physicochemical characteristics indicated that PMB and Hep were successfully immobilized on rGO beads with a hierarchical pore structure. PMB endowed rGO beads with higher adsorption capacity (143.84 ± 3.28 EU/mg) and good adsorption selectivity for endotoxins. Hep significantly improved the blood compatibility of rGO beads. These modified rGO beads also achieved good adsorption capacity and adsorption selectivity for endotoxins in plasma, serum, or blood. Therefore, rGO/pDA/PMB/Hep beads are potential adsorbents for endotoxins in hemoperfusion.

Targeted perfusion adsorption for hyperphosphatemia using mixed matrix microspheres (MMMs) encapsulated NH2-MIL-101(Fe)

Hyperphosphatemia, a common complication of chronic renal failure patients, is described as an excess amount of serum phosphate >4.5 mg dL-1. Current therapy for hyperphosphatemia is limited by low removal efficiency, secondary hyperparathyroidism, uremic bone disease, and the promotion of vascular and visceral calcifications. Metal organic frameworks (MOFs) have aroused great interest in the field of blood purification because of their strong specific adsorption. Herein, we prepared mixed matrix microspheres (MMMs) encapsulated NH2-MIL-101(Fe) with specific adsorption to blood phosphate. Simultaneously, a heparinoid copolymer poly (acrylic acid-sodium 4-vinylbenzenssulfonate) (P(AA-SSNa)) was incorporated to improve the hemocompatibility. The proposed MMMs exhibited excellent phosphate adsorption capacity both in aqueous and human plasma environments. They also showed comprehensive hemocompatibility e.g. low tendency of protein adsorption, low hemolysis rate and extended blood coagulation time. In general, we envision that the MMMs are potentially suitable as highly efficient hemoperfusion adsorbents for hyperphosphatemia treatment.