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Johnston KA, Pino CJ, Chan G, Ketteler SK, Goldstein SL, Humes HD. Immunomodulatory therapy using a pediatric dialysis system ameliorates septic shock in miniature pigs. Pediatr Res 2023; 93:89-96. [PMID: 35501373 PMCID: PMC9626391 DOI: 10.1038/s41390-022-02061-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/01/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Application of the immunomodulatory selective cytopheretic device (SCD) to enhance renal replacement therapy and improve outcomes of acute kidney injury in pediatric patients is impeded by safety concerns. Therapy using a pediatric hemodialysis system could overcome these limitations. METHODS Yucatan minipigs (8-15 kg) with induced septic shock underwent continuous hemodiafiltration with the CARPEDIEM™ pediatric hemodialysis system using regional citrate anticoagulation (RCA) with or without SCD (n = 5 per group). Circuit function plus hemodynamic and hematologic parameters were assessed for 6 h. RESULTS SCD was readily integrated into the CARPEDIEM™ system and treatment delivered for 6 h without interference with pump operation. SCD-treated pigs maintained higher blood pressure (p = 0.009) commensurate with lesser degree of lactic acidosis (p = 0.008) compared to pigs only receiving hemodiafiltration. Renal failure occurred in untreated pigs while urine output was sustained with SCD therapy. Neutrophil activation levels and ss-SOFA scores at 6 h trended lower in the SCD-treated cohort. CONCLUSIONS SCD therapy under RCA was safely administered using the CARPEDIEM™ pediatric hemodialysis system for up to 6 h and no circuit compatibility issues were identified. Sepsis progression and organ dysfunction was diminished with SCD treatment in this model supportive of therapeutic benefit of this immunomodulatory therapy. IMPACT SCD therapy with regional citrate anticoagulation has the potential to be administered safely to patients weighing <20 kg using the Carpediem renal replacement therapy platform. Use of a renal replacement therapy platform designed specifically for neonates/infants overcomes safety concerns for delivery of SCD treatment in this population. SCD therapy using the Carpediem renal replacement therapy platform retained the suggestive efficacy seen in larger children and adults to reduce organ injury and dysfunction from sepsis.
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Affiliation(s)
- Kimberly A. Johnston
- Department of Internal Medicine, Division of Nephrology University of Michigan Ann Arbor, Michigan,,Innovative Biotherapies, Ann Arbor, Michigan
| | - Christopher J. Pino
- Department of Internal Medicine, Division of Nephrology University of Michigan Ann Arbor, Michigan,,Innovative Biotherapies, Ann Arbor, Michigan
| | - Goldia Chan
- Unit for Laboratory Animal Medicine University of Michigan Ann Arbor, Michigan
| | - Skylar K. Ketteler
- Department of Internal Medicine, Division of Nephrology University of Michigan Ann Arbor, Michigan,,Innovative Biotherapies, Ann Arbor, Michigan
| | - Stuart L. Goldstein
- Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio;,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. David Humes
- Department of Internal Medicine, Division of Nephrology University of Michigan Ann Arbor, Michigan,,Innovative Biotherapies, Ann Arbor, Michigan,,Corresponding author: H. David Humes M.D. Department of Internal Medicine Division of Nephrology 4520 MSRB I 1150 West Medical Center Drive Ann Arbor MI 48109 office: (734) 763-5120, fax: 734-763-4851.
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Farina M, Alexander JF, Thekkedath U, Ferrari M, Grattoni A. Cell encapsulation: Overcoming barriers in cell transplantation in diabetes and beyond. Adv Drug Deliv Rev 2019; 139:92-115. [PMID: 29719210 DOI: 10.1016/j.addr.2018.04.018] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 03/19/2018] [Accepted: 04/25/2018] [Indexed: 02/07/2023]
Abstract
Cell-based therapy is emerging as a promising strategy for treating a wide range of human diseases, such as diabetes, blood disorders, acute liver failure, spinal cord injury, and several types of cancer. Pancreatic islets, blood cells, hepatocytes, and stem cells are among the many cell types currently used for this strategy. The encapsulation of these "therapeutic" cells is under intense investigation to not only prevent immune rejection but also provide a controlled and supportive environment so they can function effectively. Some of the advanced encapsulation systems provide active agents to the cells and enable a complete retrieval of the graft in the case of an adverse body reaction. Here, we review various encapsulation strategies developed in academic and industrial settings, including the state-of-the-art technologies in advanced preclinical phases as well as those undergoing clinical trials, and assess their advantages and challenges. We also emphasize the importance of stimulus-responsive encapsulated cell systems that provide a "smart and live" therapeutic delivery to overcome barriers in cell transplantation as well as their use in patients.
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Immunomodulatory Device Promotes a Shift of Circulating Monocytes to a Less Inflammatory Phenotype in Chronic Hemodialysis Patients. ASAIO J 2017; 62:623-30. [PMID: 27258222 DOI: 10.1097/mat.0000000000000400] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Patients with end-stage renal disease (ESRD) on chronic hemodialysis (HD) suffer accelerated morbidity and mortality rates caused by cardiovascular disease and infections. Chronic inflammation plays a critical role in these poor outcomes. The activated monocyte (MO) has become a prime therapeutic target to modulate this inflammatory process. A selective cytopheretic device (SCD) was evaluated to assess its effects on the circulating MO pool. A pilot trial was undertaken in 15 ESRD patients on HD with C-reactive protein (CRP) levels greater than 5 mg/dl. An excellent safety profile was observed with no decline in leukocyte (LE) or platelet counts. The effect of SCD therapy on MO phenotypes in these patients was determined on peripheral blood MO utilizing flow cytometry. SCD therapy promoted a shift in MO phenotype from predominantly CD14 expressing MO at baseline/pre-SCD therapy to CD14 expressing MO post-SCD therapy. A significant shift in MO population phenotype afforded by a single SCD therapy session was observed (p < 0.013). In a subset of patients (n = 7) presenting with type 2 diabetes mellitus (T2D), this persistent decline in MO CD14 expression was sustained as long as 2 weeks posttherapy. These results demonstrate that the SCD therapy has the potential to modulate the chronic proinflammatory state in ESRD patients.
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Selewski DT, Goldstein SL, Fraser E, Plomaritas K, Mottes T, Terrell T, Humes HD. Immunomodulatory Device Therapy in a Pediatric Patient With Acute Kidney Injury and Multiorgan Dysfunction. Kidney Int Rep 2017; 2:1259-1264. [PMID: 29270537 PMCID: PMC5733826 DOI: 10.1016/j.ekir.2017.06.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- David T Selewski
- University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Erin Fraser
- University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Katie Plomaritas
- University of Michigan Health System, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA
| | - Theresa Mottes
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Tara Terrell
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - H David Humes
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Innovative BioTherapies, Inc., Ann Arbor, Michigan, USA.,CytoPherx, Inc., Ann Arbor, Michigan, USA
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Westover AJ, Johnston KA, Buffington DA, Humes HD. An Immunomodulatory Device Improves Insulin Resistance in Obese Porcine Model of Metabolic Syndrome. J Diabetes Res 2016; 2016:3486727. [PMID: 27819007 PMCID: PMC5081446 DOI: 10.1155/2016/3486727] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 07/31/2016] [Indexed: 01/07/2023] Open
Abstract
Obesity is associated with tissue inflammation which is a crucial etiology of insulin resistance. This inflammation centers around circulating monocytes which form proinflammatory adipose tissue macrophages (ATM). Specific approaches targeting monocytes/ATM may improve insulin resistance without the adverse side effects of generalized immunosuppression. In this regard, a biomimetic membrane leukocyte processing device, called the selective cytopheretic device (SCD), was evaluated in an Ossabaw miniature swine model of insulin resistance with metabolic syndrome. Treatment with the SCD in this porcine model demonstrated a decline in circulating neutrophil activation parameters and monocyte counts. These changes were associated with improvements in insulin resistance as determined with intravenous glucose tolerance testing. These improvements were also reflected in lowering of homeostatic model assessment- (HOMA-) insulin resistant (IR) scores for up to 2 weeks after SCD therapy. These results allow for the planning of first-in-man studies in obese type 2 diabetic patients.
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Affiliation(s)
- Angela J. Westover
- Innovative BioTherapies, Inc., 650 Avis Drive, Suite 300, Ann Arbor, MI 48108, USA
| | - Kimberly A. Johnston
- Innovative BioTherapies, Inc., 650 Avis Drive, Suite 300, Ann Arbor, MI 48108, USA
| | | | - H. David Humes
- Innovative BioTherapies, Inc., 650 Avis Drive, Suite 300, Ann Arbor, MI 48108, USA
- Department of Internal Medicine, University of Michigan Medical School, 4520C MSRB I, SPC 5651, 1150 W. Medical Center Dr., Ann Arbor, MI 48109, USA
- *H. David Humes:
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Tumlin JA, Galphin CM, Tolwani AJ, Chan MR, Vijayan A, Finkel K, Szamosfalvi B, Dev D, DaSilva JR, Astor BC, Yevzlin AS, Humes HD. A Multi-Center, Randomized, Controlled, Pivotal Study to Assess the Safety and Efficacy of a Selective Cytopheretic Device in Patients with Acute Kidney Injury. PLoS One 2015; 10:e0132482. [PMID: 26244978 PMCID: PMC4526678 DOI: 10.1371/journal.pone.0132482] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/14/2015] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Acute kidney injury (AKI) is a highly morbid condition in critically ill patients that is associated with high mortality. Previous clinical studies have demonstrated the safety and efficacy of the Selective Cytopheretic Device (SCD) in the treatment of AKI requiring continuous renal replacement therapy in the intensive care unit (ICU). DESIGN, SETTING, PATIENTS A randomized, controlled trial of 134 ICU patients with AKI, 69 received continuous renal replacement therapy (CRRT) alone and 65 received SCD therapy. RESULTS No significant difference in 60-day mortality was observed between the treated (27/69; 39%) and control patients (21/59; 36%, with six patients lost to follow up) in the intention to treat (ITT) analysis. Of the 19 SCD subjects (CRRT+SCD) and 31 control subjects (CRRT alone) who maintained a post-filter ionized calcium (iCa) level in the protocol's recommended range (≤ 0.4 mmol/L) for greater or equal to 90% of the therapy time, 60-day mortality was 16% (3/19) in the SCD group compared to 41% (11/27) in the CRRT alone group (p = 0.11). Dialysis dependency showed a borderline statistically significant difference between the SCD treated versus control CRRT alone patients maintained for ≥ 90% of the treatment in the protocol's recommended (r) iCa target range of ≤ 0.4 mmol/L with values of, 0% (0/16) and 25% (4/16), respectively (P = 0.10). When the riCa treated and control subgroups were compared for a composite index of 60 day mortality and dialysis dependency, the percentage of SCD treated subjects was 16% versus 58% in the control subjects (p<0.01). The incidence of serious adverse events did not differ between the treated (45/69; 65%) and control groups (40/65; 63%; p = 0·86). CONCLUSION SCD therapy may improve mortality and reduce dialysis dependency in a tightly controlled regional hypocalcaemic environment in the perfusion circuit. TRIAL REGISTRATION ClinicalTrials.gov NCT01400893 http://clinicaltrials.gov/ct2/show/NCT01400893.
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Affiliation(s)
- James A. Tumlin
- Department of Medicine, UT College of Medicine, University of Tennessee, 960 East Third Street, Suite 100, Chattanooga, TN, 37403, United States of America
| | - Claude M. Galphin
- Department of Medicine, UT College of Medicine, University of Tennessee, 960 East Third Street, Suite 100, Chattanooga, TN, 37403, United States of America
| | - Ashita J. Tolwani
- Department of Medicine, UAB School of Medicine, University of Alabama, 1720 2nd Ave. S. FOT 1203, Birmingham, AL, 35294–3412, United States of America
| | - Micah R. Chan
- Department of Medicine, University of Wisconsin, UW Med Fndtn. Centennial Bldg. 5148 MFCB, 1685 Highland Ave., Madison, WI, 53705–2281, United States of America
| | - Anitha Vijayan
- Washington University School of Medicine, 660 S Euclid Ave., St Louis, MO, 63110, United States of America
| | - Kevin Finkel
- UT Health Science Center, University of Texas, 6410 Fannin St., Ste. 606, Houston, TX, 77030, United States of America
| | - Balazs Szamosfalvi
- Henry Ford Health System, Henry Ford Hospital, CFP-509, 2799 West Grand Blvd., Detroit, MI, 48202–2608, United States of America
| | - Devasmita Dev
- Dallas VA Medical Center, 4500 S. Lancaster Rd., Dallas, TX, 75216, United States of America
| | - J. Ricardo DaSilva
- CytoPherx, Inc., 401 W. Morgan Rd., Ann Arbor, MI, 48108, United States of America
| | - Brad C. Astor
- Department of Medicine, University of Wisconsin, UW Med Fndtn. Centennial Bldg. 5148 MFCB, 1685 Highland Ave., Madison, WI, 53705–2281, United States of America
- Department of Population Health Sciences, University of Wisconsin, Health Sciences Learning Center, 750 Highland Ave., Madison, WI, 53705, United States of America
| | - Alexander S. Yevzlin
- Department of Medicine, University of Wisconsin, UW Med Fndtn. Centennial Bldg. 5148 MFCB, 1685 Highland Ave., Madison, WI, 53705–2281, United States of America
- CytoPherx, Inc., 401 W. Morgan Rd., Ann Arbor, MI, 48108, United States of America
| | - H. David Humes
- CytoPherx, Inc., 401 W. Morgan Rd., Ann Arbor, MI, 48108, United States of America
- Department of Medicine, University of Michigan, 4520 MSRB I, Box 0651, 1150 W. Medical Center Drive, Ann Arbor, MI, 48109, United States of America
- * E-mail:
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Mehta RL, Kellum JA. Targeting recovery from acute kidney injury: executive summary from the round table conference at the 19th International Conference on Continuous Renal Replacement Therapies (Manchester Grand Hyatt, San Diego, Calif., USA, March 2-3, 2014). Nephron Clin Pract 2014; 127:1-116. [PMID: 25343811 DOI: 10.1159/000365735] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Ravindra L Mehta
- Division of Nephrology-Hypertension, Department of Medicine, University of California San Diego, San Diego, Calif., USA
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Biotechnological challenges of bioartificial kidney engineering. Biotechnol Adv 2014; 32:1317-1327. [PMID: 25135479 DOI: 10.1016/j.biotechadv.2014.08.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 08/05/2014] [Accepted: 08/09/2014] [Indexed: 12/14/2022]
Abstract
With the world-wide increase of patients with renal failure, the development of functional renal replacement therapies have gained significant interest and novel technologies are rapidly evolving. Currently used renal replacement therapies insufficiently remove accumulating waste products, resulting in the uremic syndrome. A more preferred treatment option is kidney transplantation, but the shortage of donor organs and the increasing number of patients waiting for a transplant warrant the development of novel technologies. The bioartificial kidney (BAK) is such promising biotechnological approach to replace essential renal functions together with the active secretion of waste products. The development of the BAK requires a multidisciplinary approach and evolves at the intersection of regenerative medicine and renal replacement therapy. Here we provide a concise review embracing a compact historical overview of bioartificial kidney development and highlighting the current state-of-the-art, including implementation of living-membranes and the relevance of extracellular matrices. We focus further on the choice of relevant renal epithelial cell lines versus the use of stem cells and co-cultures that need to be implemented in a suitable device. Moreover, the future of the BAK in regenerative nephrology is discussed.
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Humes HD, Buffington D, Westover AJ, Roy S, Fissell WH. The bioartificial kidney: current status and future promise. Pediatr Nephrol 2014; 29:343-51. [PMID: 23619508 DOI: 10.1007/s00467-013-2467-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 01/10/2023]
Abstract
The rapid understanding of the cellular and molecular bases of organ function and disease processes will be translated in the next decade into new therapeutic approaches to a wide range of clinical disorders, including acute and chronic renal failure. Central to these new therapies are the developing technologies of cell therapy and tissue engineering, which are based on the ability to expand stem or progenitor cells in tissue culture to perform differentiated tasks and to introduce these cells into the patient either via extracorporeal circuits or as implantable constructs. Cell therapy devices are currently being developed to replace the filtrative, metabolic, and endocrinologic functions of the kidney lost in both acute and chronic renal failure. This review summarizes the current state of development of a wearable or implantable bioartificial kidney. These devices have the promise to be combined to produce a wearable or implantable bioartificial kidney for full renal replacement therapy that may significantly diminish morbidity and mortality in patients with acute or chronic kidney disease.
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Affiliation(s)
- H David Humes
- Innovative BioTherapies, Inc., 650 Avis Dr., Suite 300, Ann Arbor, MI, 48108, USA,
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Abstract
Treating or preventing AKI requires treating or preventing a rise in serum creatinine as well as the immediate and remote clinical consequences associated with AKI. Because a substantial number of patients with AKI progress to ESRD, identifying patients likely to progress and halting progression are important goals for treating AKI. Many therapies for AKI are being developed, including RenalGuard Therapy, which aims to maintain high urine output; α-melanocyte-stimulating hormone, with anti-inflammatory and antiapoptotic activities; alkaline phosphatase, which detoxifies proinflammatory substances; novel, small interfering RNA, directed at p53 activation; THR-184, a peptide agonist of bone morphogenetic proteins; removal of catalytic iron, important in free-radical formation; and cell-based therapies, including mesenchymal stem cells in vivo and renal cell therapy in situ. In this review, we explore what treatment of AKI really means, discuss the emerging therapies, and examine the windows of opportunity for treating AKI. Finally, we provide suggestions for accelerating the pathways toward preventing and treating AKI, such as establishing an AKI network, implementing models of catalytic philanthropy, and directing a small percentage of the Medicare ESRD budget for developing therapies to prevent and treat AKI and halt progression of CKD.
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Affiliation(s)
- Gur P Kaushal
- Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences and Renal Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
| | - Sudhir V Shah
- Division of Nephrology, Department of Internal Medicine, University of Arkansas for Medical Sciences and Renal Section, Medicine Service, Central Arkansas Veterans Healthcare System, Little Rock, Arkansas
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