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Keles E, Fidan K, Yenicesu I, Kalkan G. Successful application of CytoSorb ® hemadsorption in an immunocompromised teenager with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis. Int J Artif Organs 2019; 42:765-769. [PMID: 31277560 DOI: 10.1177/0391398819858174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE CytoSorb® hemadsorption is an adjunctive therapy in order to reduce elevated cytokine levels of interleukin-6, interleukin-1, and tumor necrosis factor alpha. Here we present a successful administration of CytoSorb® hemadsorption in an immunocompromised pediatric patient with collapsing glomerulopathy, acute respiratory distress syndrome, and sepsis. DATA SOURCES Clinical observations of one patient. STUDY SELECTION Case report. DATA EXTRACTION Data sources are clinical observation during patient management and patient's medical records if needed. The patient's consent was obtained prior to the study. DATA SYNTHESIS A 17-year-old male with diarrhea was admitted to the hospital and was later found to have elevated creatinine levels and proteinuria. The renal biopsy was consistent with collapsing glomerulopathy and treatment with multi immunosuppressive agents including corticosteroids, mycophenolate mofetil, and rituximab coupled with several courses of hemodialysis and plasmapheresis were administered. During the hospital stay, Stenotrophomonas maltophilia bacteremia from the blood and the catheter cultures were identified. No clinical response was achieved, and patient developed severe sepsis despite antibiotics, intravenous immunoglobulin, and supportive management including albumin, platelet and erythrocyte concentrations, and fresh frozen plasma. CytoSorb® hemadsorption was then added to the ongoing treatment for three consecutive days. Subsequent to CytoSorb® hemadsorption, immediate laboratory and clinical response were observed. CONCLUSION This is the successful clinical report of an immunocompromised teenager with collapsing nephropathy, sepsis, and multi-organ dysfunction syndrome treated with a combination of renal replacement therapy and CytoSorb® hemadsorption. The usage of CytoSorb® hemadsorption represents a novel approach to improve survival of the patients with multiple organ dysfunction and sepsis.
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Affiliation(s)
- Elif Keles
- Department of Pediatrics, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Kibriya Fidan
- Division of Pediatric Nephrology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Idil Yenicesu
- Division of Pediatric Hematology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Gokhan Kalkan
- Division of Pediatric Critical Care, Gazi University Faculty of Medicine, Ankara, Turkey
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Seredych M, Haines B, Sokolova V, Cheung P, Meng F, Stone L, Mikhalovska L, Mikhalovsky S, Mochalin VN, Gogotsi Y. Graphene-Based Materials for the Fast Removal of Cytokines from Blood Plasma. ACS APPLIED BIO MATERIALS 2018; 1:436-443. [DOI: 10.1021/acsabm.8b00151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Mykola Seredych
- Department of Materials Science & Engineering and A.J. Drexel Nanomaterials Institute, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Bernard Haines
- Department of Materials Science & Engineering and A.J. Drexel Nanomaterials Institute, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Viktoriia Sokolova
- Department of Materials Science & Engineering and A.J. Drexel Nanomaterials Institute, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Paul Cheung
- Department of Materials Science & Engineering and A.J. Drexel Nanomaterials Institute, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Fayan Meng
- Department of Materials Science & Engineering and A.J. Drexel Nanomaterials Institute, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Lon Stone
- Consultants Rx, Dana Point, California 92629, United States
| | - Lyuba Mikhalovska
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Lewes Road, Brighton BN2 4GJ, United Kingdom
| | - Sergey Mikhalovsky
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Lewes Road, Brighton BN2 4GJ, United Kingdom
| | - Vadym N. Mochalin
- Department of Chemistry, Missouri University of Science & Technology, Rolla, Missouri 65409, United States
- Department of Materials Science & Engineering, Missouri University of Science & Technology, Rolla, Missouri 65409, United States
| | - Yury Gogotsi
- Department of Materials Science & Engineering and A.J. Drexel Nanomaterials Institute, Drexel University, Philadelphia, Pennsylvania 19104, United States
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Schenk H, Müller-Deile J, Schmitt R, Bräsen JH, Haller H, Schiffer M. Removal of focal segmental glomerulosclerosis (FSGS) factor suPAR using CytoSorb. J Clin Apher 2017; 32:444-452. [PMID: 28370393 DOI: 10.1002/jca.21538] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 01/06/2023]
Abstract
Treatment of primary focal segmental glomerulosclerosis (FSGS) and its recurrence after kidney transplantation associated with rapid deterioration of kidney function remains to be challenging despite advances in immunosuppressive therapy. The presence of circulating factors has been postulated to be a pivotal player in the pathogenesis of FSGS, although suPAR and CLCF-1 have been identified as the most promising causative factors. The potential therapeutic effect of suPAR elimination in an FSGS patient using CytoSorb, a hemoadsorption device that gained attention in the cytokine elimination in septic patients, was studied. Efficiency of total plasma exchange to remove suPAR was determined. CytoSorb hemoadsorption caused a 27.33% reduction of the suPAR level in a single treatment, whereas total plasma exchange showed a suPAR level reduction of 25.12% (n = 3; 95% confidence interval, 0.2777-0.8090; P < 0.01), which may indicate therapeutic potential in the treatment of primary FSGS and its recurrence in a kidney transplant.
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Affiliation(s)
- Heiko Schenk
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Janina Müller-Deile
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Roland Schmitt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | | | - Hermann Haller
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Mario Schiffer
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
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Daga Ruiz D, Fonseca San Miguel F, González de Molina FJ, Úbeda-Iglesias A, Navas Pérez A, Jannone Forés R. Plasmapheresis and other extracorporeal filtration techniques in critical patients. Med Intensiva 2017; 41:174-187. [PMID: 28062169 DOI: 10.1016/j.medin.2016.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 10/24/2016] [Accepted: 10/28/2016] [Indexed: 12/18/2022]
Abstract
Plasmapheresis is an extracorporeal technique that eliminates macromolecules involved in pathological processes from plasma. A review is made of the technical aspects, main indications in critical care and potential complications of plasmapheresis, as well as of other extracorporeal filtration techniques such as endotoxin-removal columns and other devices designed to eliminate cytokines or modulate the inflammatory immune response in critical patients.
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Affiliation(s)
- D Daga Ruiz
- Servicio de Medicina Intensiva, Hospital Universitario Virgen de la Victoria, Campus de Teatinos, S/N, 29010 Málaga, Spain
| | - F Fonseca San Miguel
- Servicio de Medicina Intensiva, Hospital Universitario Araba, Calle Olaguibel, 29, 01004 Vitoria-Gasteiz, Spain
| | - F J González de Molina
- Servicio de Medicina Intensiva, Hospital Universitari Mútua Terrassa, Plaça Dr. Robert 5, 08220 Terrassa, Spain.
| | - A Úbeda-Iglesias
- Servicio de Medicina Intensiva, Hospital Punta de Europa, Crta. Getares, S/N, 11207 Algeciras, Spain
| | - A Navas Pérez
- Servicio de Medicina Intensiva. Corporació Sanitària Parc Taulí, Parc Taulí, 1, 08208 Sabadell, Spain
| | - R Jannone Forés
- Servicio de Medicina Intensiva, Hospital La Fe, Avinguda de Fernando Abril Martorell, 106, 46026 Valencia, Spain
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Adsorption and separation of HCV particles by novel affinity aptamer-functionalized adsorbents. J Chromatogr B Analyt Technol Biomed Life Sci 2016; 1017-1018:174-181. [DOI: 10.1016/j.jchromb.2016.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/16/2016] [Accepted: 03/03/2016] [Indexed: 01/11/2023]
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Zhang J, Peng Z, Maberry D, Volpe J, Kimmel JD, Federspiel WJ, Kellum JA. Effects of hemoadsorption with a novel adsorbent on sepsis: in vivo and in vitro study. Blood Purif 2015; 39:239-245. [PMID: 25833160 DOI: 10.1159/000381006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/17/2015] [Indexed: 01/14/2023]
Abstract
BACKGROUND/AIMS Hemoadsorption may improve outcomes for sepsis by removing circulating cytokines. We tested a new sorbent used for hemoadsorption. METHODS CTR sorbent beads were filled into columns of three sizes: CTR0.5 (0.5 ml), CTR1 (1.0 ml) and CTR2 (2.0 ml) and tested using IL-6 capture in vitro. Next, rats were subjected to cecal ligation and puncture and randomly assigned to hemoadsorption with CTR0.5, CTR1, CTR2 or sham treatment. Plasma biomarkers were measured. RESULTS In vitro, IL-6 removal was accelerated with increasing bead mass. In vivo, TNF, IL-6, IL-10, high mobility group box1, and cystatin C were significantly lower 24 h after CTR2 treatment. Seven-day survival rate was 50, 64, 63, and 73% for the sham, CTR0.5, CTR1, CTR2, respectively. CONCLUSION CTR appeared to have a favorable effect on kidney function despite no immediate effects on cytokine removal. However, CTR2 beads did result in a late decrease of cytokines.
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Basu R, Pathak S, Goyal J, Chaudhry R, Goel RB, Barwal A. Use of a novel hemoadsorption device for cytokine removal as adjuvant therapy in a patient with septic shock with multi-organ dysfunction: A case study. Indian J Crit Care Med 2014; 18:822-4. [PMID: 25538418 PMCID: PMC4271283 DOI: 10.4103/0972-5229.146321] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
CytoSorb(®) (CytoSorbents Corporation, USA) is a novel sorbent hemoadsorption device for cytokine removal. The aim of this study was to examine the clinical use of CytoSorb(®) in the management of patient with septic shock. We used this device as an adjuvant to stabilize a young patient with multi-organ failure and severe sepsis with septic shock. A 36-year-old female patient was hospitalized with the complaints of malaise, general body ache, and breathing difficulty and had a medical history of diabetes mellitus type II, hypertension, obstructive sleep apnea, hypothyroidism and morbid obesity. She was diagnosed to have septic shock with multi-organ dysfunction (MODS) and a low perfusion state. CytoSorb(®) hemoadsorption column was used as an attempt at blood purification. Acute physiology and chronic health evaluation score, MODS score, and sequential organ failure assessment score were measured before and after the device application. CytoSorb application as an adjuvant therapy could be considered in septic shock.
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Affiliation(s)
- Reshma Basu
- Department of Critical Care, Sector-51, Gurgaon, Haryana, India
| | - Sunjay Pathak
- Department of Artemis Health Institute, Sector-51, Gurgaon, Haryana, India
| | - Jyoti Goyal
- Department of Artemis Health Institute, Sector-51, Gurgaon, Haryana, India
| | - Rajeev Chaudhry
- Department of Artemis Health Institute, Sector-51, Gurgaon, Haryana, India
| | - Rati B Goel
- Department of Artemis Health Institute, Sector-51, Gurgaon, Haryana, India
| | - Anil Barwal
- Department of Artemis Health Institute, Sector-51, Gurgaon, Haryana, India
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8
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Pestaña D, Ojeda N, Padrón OM, Higuera E, Rey T, Aldecoa C. [Usefulness of haemoperfusion in the treatment of the severe septic patient: an update]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:336-343. [PMID: 23044210 DOI: 10.1016/j.redar.2012.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 08/30/2012] [Indexed: 06/01/2023]
Abstract
Haemoperfusion is an extracorporeal technique that removes endotoxin and/or inflammatory mediators by means of an adsorptive mechanism during the passage of the blood through a porous filter. Most of the studies in the literature use polymyxin B as the adsorptive agent. This treatment is based on the assumption that the removal of endotoxin and inflammatory mediators from the circulation attenuates the inflammatory response in sepsis. This review summarizes the theoretical basis, and the experimental and clinical results published to date with the use of haemoperfusion. Although most of the studies show positive results, some doubts have arisen about the suitability of the methods described (small number of cases, low quality of the experimental design, and excessive mortality in the control groups). There are also some inconsistencies regarding the theoretical basis of its use (lack of positive effects after the removal of endotoxin from the circulation using alternative mechanisms, discrepancies regarding the best moment to initiate the therapy, unexplained beneficial effects in the absence of increased endotoxin levels). It is the opinion of the authors that haemoperfusion represents a promising therapy for the treatment of sepsis, but consider that its usefulness requires confirmation in well designed studies before being included in protocols.
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Affiliation(s)
- D Pestaña
- Servicio de Anestesiología y Reanimación, Hospital Universitario Ramón y Cajal, Madrid, España.
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Nanoporous Activated Carbon Beads and Monolithic Columns as Effective Hemoadsorbents for Inflammatory Cytokines. Int J Artif Organs 2013; 36:624-32. [DOI: 10.5301/ijao.5000231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2013] [Indexed: 11/20/2022]
Abstract
The aim of the present study was to develop and investigate nanoporous activated carbon materials for their ability to adsorb inflammatory cytokines directly from blood, for a range of therapeutic applications, including: systemic inflammatory response syndrome (SIRS) related to sepsis, cardio-pulmonary by-pass surgery, or ischemic reperfusion injury. Building on the previously established relationship between the porous structure of beaded polymer-derived activated carbon and its capacity to adsorb inflammatory molecules, we have developed and characterized monolithic porous carbon columns produced from the same polymer precursor matrix as carbon microbeads. The monolithic columns developed were assessed for their ability to adsorb inflammatory molecules from blood in a circulating system. Preliminary findings demonstrated good removal of the inflammatory cytokines IL-8 (100% removal), IL-6 (80% removal), and TNF (51% removal) from blood. The efficiency of cleansing is dependent on the size of the adsorbed molecule and the porous structure of the monolith, highlighting their potential for use as a hemoadsorption device.
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10
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Christaki E, Anyfanti P, Opal SM. Immunomodulatory therapy for sepsis: an update. Expert Rev Anti Infect Ther 2012; 9:1013-33. [PMID: 22029521 DOI: 10.1586/eri.11.122] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Currently the treatment mainstay of sepsis is early and appropriate antibiotic therapy, accompanied by aggressive fluid administration, the use of vasopressors when needed and the prompt initiation of measures to support each failing organ. Activated protein C and hydrocortisone, when used accordingly can affect mortality. As the pathophysiologic events that take place during sepsis are being elucidated, new molecules that target each step of those pathways are being tested. However, a lot of those molecules affect various mediators of the sepsis cascade including inflammatory cytokines, cellular receptors, nuclear transcription factors, coagulation activators and apoptosis regulators. Over the last decade, a multitude of clinical trials and animal studies have investigated strategies that aimed to restore immune homeostasis either by reducing inflammation or by stimulating the innate and adaptive immune responses. Antibiotics, statins and other molecules with multipotent immunomodulatory actions have also been studied in the treatment of sepsis.
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Affiliation(s)
- Eirini Christaki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece.
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11
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Atan R, Crosbie D, Bellomo R. Techniques of extracorporeal cytokine removal: a systematic review of the literature. Blood Purif 2012; 33:88-100. [PMID: 22248671 DOI: 10.1159/000333845] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 09/28/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Attempts at achieving cytokine homeostasis include blood purification to deliver cytokine removal. Assessment of ex vivo studies for optimal operating conditions is a vital step. METHODS We conducted a systematic search for ex vivo studies on cytokine removal using known modalities of extracorporeal circulation. We selected 29 articles and analyzed data according to clearance, sieving coefficient, ultrafiltrate concentration and percentage removal. RESULTS We identified four main techniques for cytokine removal: standard techniques, high cut-off (HCO) techniques, adsorption techniques and combined plasma filtration adsorption. HCO hemofiltration (HCO/HF) showed greatest consistency in cytokine removal among all approaches. Mean albumin clearance with HCO filters was 3.74 ml/min. CONCLUSION Ex vivo data support the view that HCO/HF is the most consistently effective approach in terms of sieving and clearance. Further investigation of HCO/HF in randomized controlled trials in animal models and humans seems desirable.
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Affiliation(s)
- Rafidah Atan
- Department of Intensive Care, Austin Hospital, Heidelberg, Vic., Australia
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Rimmelé T, Kellum JA. Clinical review: blood purification for sepsis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:205. [PMID: 21371356 PMCID: PMC3222040 DOI: 10.1186/cc9411] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sepsis is the primary cause of death in the intensive care unit. Extracorporeal blood purification therapies have been proposed for patients with sepsis in order to improve outcomes since these therapies can alter the host inflammatory response by non-selective removal of inflammatory mediators or bacterial products or both. Recent technological progress has increased the number of techniques available for blood purification and their performance. In this overview, we report on the latest advances in blood purification for sepsis and how they relate to current concepts of disease, and we review the current evidence for high-volume hemofiltration, cascade hemofiltration, hemoadsorption, coupled plasma filtration adsorption, high-adsorption hemofiltration, and high-cutoff hemofiltration/hemodialysis. Promising results have been reported with all of these blood purification therapies, showing that they are well tolerated, effective in clearing inflammatory mediators or bacterial toxins (or both) from the plasma, and efficacious for improvement of various physiologic outcomes (for example, hemodynamics and oxygenation). However, numerous questions, including the timing, duration, and frequency of these therapies in the clinical setting, remain unanswered. Large multicenter trials evaluating the ability of these therapies to improve clinical outcomes (that is, mortality or organ failure), rather than surrogate markers such as plasma mediator clearance or transient improvement in physiologic variables, are required to define the precise role of blood purification in the management of sepsis.
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Affiliation(s)
- Thomas Rimmelé
- The CRISMA Laboratory, Department of Critical Care Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15261, USA
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Davies B, Cohen J. Endotoxin removal devices for the treatment of sepsis and septic shock. THE LANCET. INFECTIOUS DISEASES 2011; 11:65-71. [PMID: 21183148 DOI: 10.1016/s1473-3099(10)70220-6] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A substantial body of experimental and clinical evidence suggests that neutralising or removing lipopolysaccharide endotoxin would be an effective adjunctive approach to the management of Gram-negative sepsis. Polymyxins are a group of cyclic cationic polypeptide antibiotics. Although they have useful antimicrobial activity against Gram-negative bacteria, their clinical use has been limited because of toxicity. However, in addition to their antimicrobial property, polymyxins can bind to and neutralise endotoxin. Thus, investigators have explored the possibility of using polymyxin bound to a solid-phase carrier for specific haem-adsorption in patients with sepsis, thereby retaining the lipopolysaccharide-binding properties but minimising systemic toxic effects. This system has been widely used in Japan for many years, but convincing clinical evidence of efficacy is lacking. A recent Italian study has some promising data. Although polymyxin has been the principal agent used to explore this approach, other molecules have the ability to bind endotoxin, and some of these have very recently been proposed as the basis for other endotoxin-removal devices. The available evidence is reviewed to assess the potential use of such devices in clinical practice.
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Affiliation(s)
- B Davies
- Department of Clinical Microbiology and Infectious Diseases, Brighton and Sussex Medical School, Brighton and Sussex University Hospitals Trust, UK
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14
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Endotoxin elimination in sepsis: physiology and therapeutic application. Langenbecks Arch Surg 2010; 395:597-605. [DOI: 10.1007/s00423-010-0658-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 06/07/2010] [Indexed: 01/13/2023]
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Adams H, Brummelhuis W, Maassen B, van Egmond N, El Khattabi M, Detmers F, Hermans P, Braam B, Stam J, Verrips T. Specific immuno capturing of the staphylococcal superantigen toxic-shock syndrome toxin-1 in plasma. Biotechnol Bioeng 2009; 104:143-51. [PMID: 19475676 DOI: 10.1002/bit.22365] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Toxic-shock syndrome is primarily caused by the Toxic-shock syndrome toxin 1 (TSST-1), which is secreted by the Gram-positive bacterium Staphylococcus aureus. The toxin belongs to a family of superantigens (SAgs) which exhibit several shared biological properties, including the induction of massive cytokine release and V(beta)-specific T-cell proliferation. In this study we explored the possibility to use monoclonal Variable domains of Llama Heavy-chain antibodies (VHH) in the immuno capturing of TSST-1 from plasma. Data is presented that the selected VHHs are highly specific for TSST-1 and can be efficiently produced in large amounts in yeast. In view of affinity chromatography, the VHHs are easily coupled to beads, and are able to deplete TSST-1 from plasma at very low, for example, pathologically relevant, concentrations. When spiked with 4 ng/mL TSST-1 more than 96% of TSST-1 was depleted from pig plasma. These data pave the way to further explore application of high-affinity columns in the specific immuno depletion of SAgs in experimental sepsis models and in sepsis in humans.
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Affiliation(s)
- Hendrik Adams
- Faculty of Science, Department of Cellular Architecture and Dynamics, Utrecht University, Utrecht, The Netherlands
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Taniguchi T, Kurita A, Yamamoto K, Inaba H. Comparison of a cytokine adsorbing column and an endotoxin absorbing column for the treatment of experimental endotoxemia. Transfus Apher Sci 2008; 40:55-9. [PMID: 19103510 DOI: 10.1016/j.transci.2008.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The present study compared the effects of direct hemoperfusion (DHP) using a cytokine absorbing (CTR) column with those using an endotoxin absorbing (PMX) column with endotoxin-induced shock in rats. Thirty-six rats were injected intravenously with endotoxin (15 mg/kg), and then allocated into one of the following three groups: control group, treated without CTR; PMX group, treated with a PMX column for 120 min; CTR group, treated with a CTR column for 120 min. The present study showed that CTR treatment decreased the mortality rate 8h after endotoxin injection and inhibited inflammatory responses (cytokine, hemodynamics and acidosis) similar to PMX treatment.
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Affiliation(s)
- Takumi Taniguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
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Sandeman SR, Howell CA, Mikhalovsky SV, Phillips GJ, Lloyd AW, Davies JG, Tennison SR, Rawlinson AP, Kozynchenko OP. Inflammatory cytokine removal by an activated carbon device in a flowing system. Biomaterials 2008; 29:1638-44. [DOI: 10.1016/j.biomaterials.2007.12.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Accepted: 12/05/2007] [Indexed: 11/29/2022]
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Kobe Y, Oda S, Matsuda K, Nakamura M, Hirasawa H. Direct hemoperfusion with a cytokine-adsorbing device for the treatment of persistent or severe hypercytokinemia: a pilot study. Blood Purif 2007; 25:446-53. [PMID: 18037813 DOI: 10.1159/000111568] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2006] [Accepted: 07/21/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Cytokine overproduction has been noted during the aggravation of clinical conditions. Countermeasures to control hypercytokinemia are therefore important in critical care. We investigated the clinical efficacy of hemoadsorption therapy using a new cytokine-adsorbing device in critically ill patients with persistent or severe hypercytokinemia. METHODS Direct hemoperfusion using the CYT-860, a cytokine-adsorber column (CYT-860-DHP), was performed in critically ill patients with hypercytokinemia. To evaluate the efficacy of CYT-860-DHP, changes in pathological and clinical parameters were examined. RESULTS Seven patients with hypercytokinemia and a SOFA score of > or = 5 underwent CYT-860-DHP treatment. Four patients survived 28 days after CYT-860-DHP treatment. Significant decreases in blood levels of cytokines were observed. PaO2/F(I)O2 improved significantly. CONCLUSION The possibility that CYT-860-DHP treatment can reduce blood cytokine levels and thereby improve the general condition of patients was suggested. These findings warrant the initiation of a prospective randomized trial to evaluate the clinical efficacy of CYT-860-DHP treatment.
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Affiliation(s)
- Y Kobe
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
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Taniguchi T, Kurita A, Mukawa C, Yamamoto K, Inaba H. Dose-related effects of direct hemoperfusion using a cytokine adsorbent column for the treatment of experimental endotoxemia. Intensive Care Med 2006; 33:529-33. [PMID: 17160419 DOI: 10.1007/s00134-006-0471-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2006] [Accepted: 10/27/2006] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To clarify the dose-related effects of direct hemoperfusion using a cytokine adsorbent column (CTR) on the mortality and inflammatory responses to endotoxin-induced shock in rats. DESIGN Prospective and randomized study. SETTING University research laboratory. SUBJECTS Male Wistar rats. INTERVENTIONS Forty-eight rats were injected intravenously with Escherichia coli endotoxin (15 mg/kg over 2 min), and then were randomly allocated to one of the following four groups (n = 12 per group): control group, treated without CTR for 120 min; quarter-dose treatment group, treated with CTR 0.25 ml for 120 min; half-dose treatment group, treated with CTR 0.50 ml; and full-dose treatment group, treated with CTR 1.0 ml. MEASUREMENTS AND RESULTS Hemodynamics and arterial blood gases were recorded, and mortality and plasma cytokine concentrations were calculated for the 8-h observation period. The mortality rates 8 h after endotoxin injection were 92%, 58%, 42% and 17% for the control column, quarter-dose, half-dose, and full-dose CTR groups, respectively. The increases in plasma cytokine concentrations were smaller in the half-dose and full-dose CTR treatment groups than in the endotoxemic group. CONCLUSIONS The present study showed that CTR treatment dose-dependently decreased the mortality rate and inhibited inflammatory responses in vivo.
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Affiliation(s)
- Takumi Taniguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medical Science, Kanazawa University, 13-1 Takara-machi, 920-8641, Kanazawa, Japan.
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Shimizu T, Endo Y, Tsuchihashi H, Akabori H, Yamamoto H, Tani T. Endotoxin apheresis for sepsis. Transfus Apher Sci 2006; 35:271-82. [PMID: 17118710 DOI: 10.1016/j.transci.2006.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2006] [Accepted: 06/14/2006] [Indexed: 12/24/2022]
Abstract
The principle use of apheresis in the treatment of sepsis may be summarized as the removal of toxic substances and the restoration of normal organs function. It is ideal to control the early phases of inflammatory cascade when treating sepsis by removing microbial components, such as endotoxin or peptidoglycan. This review discusses endotoxin apheresis with particular emphasis on treatment using polymyxin B immobilized fiber columns (Toraymyxin) which are used widely in Japan for endotoxin removal therapy in patients with septic shock. Lixelle and CTR which have recently been shown to remove circulating bacterial components are also included in this review.
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Affiliation(s)
- Tomoharu Shimizu
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
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Howell CA, Sandeman SR, Phillips GJ, Lloyd AW, Davies JG, Mikhalovsky SV, Tennison SR, Rawlinson AP, Kozynchenko OP, Owen HLH, Gaylor JDS, Rouse JJ, Courtney JM. The in vitro adsorption of cytokines by polymer-pyrolysed carbon. Biomaterials 2006; 27:5286-91. [PMID: 16806458 DOI: 10.1016/j.biomaterials.2006.05.041] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2006] [Accepted: 05/24/2006] [Indexed: 12/17/2022]
Abstract
This study investigated a range of phenol-formaldehyde-aniline-based pyrolysed carbon matrices and their component materials, for their ability to adsorb a range of inflammatory cytokines crucial to the progression of sepsis. The efficiency of adsorption of the target molecules from human plasma was assessed and compared to that of Adsorba 300C, a commercially available cellulose-coated activated charcoal. Results indicate that a number of the primary carbon/resin materials demonstrate efficient adsorption of the cytokines studied here (TNF, IL-6 and IL-8), comparable to other adsorbents under clinical investigation. Our findings also illustrate that these adsorbent capabilities are retained when the primary particles are combined to form a pyrolysed carbon matrix. This capability will enable the engineering of the carbon matrix porosity allowing a blend of carbonised particle combinations to be tailored for maximum adsorption of inflammatory cytokines. The present findings support further investigation of this carbon material as a combined carbon-based filtration/adsorbent device for direct blood purification.
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Affiliation(s)
- Carol A Howell
- Biomedical Materials Research Group, School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, Sussex BN2 4GJ, UK
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Taniguchi T, Takemoto Y, Tsuda K, Inaba H, Yamamoto K. Effects of post-treatment with direct hemoperfusion using a CTR column on mortality and inflammatory responses to endotoxin-induced shock in rats. Blood Purif 2006; 24:460-4. [PMID: 16953106 DOI: 10.1159/000095554] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Accepted: 07/13/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND To clarify the effects of post-treatment with direct hemoperfusion using a CTR column on the mortality and inflammatory responses to endotoxin-induced shock in rats. METHODS Thirty-six male rats were randomly assigned to 1 of 3 groups (n = 12/group): the endotoxemic group, receiving intravenous Escherichia coli endotoxin (15 mg/kg over 2 min); the control column group, treated without CTR for 120 min at 2 h after endotoxin injection, and CTR-post-treatment group, treated with CTR for 120 min at 2 h after endotoxin injection. Hemodynamics, arterial blood gases, and mortality were recorded for the 8-hour observation period, and plasma cytokine concentrations were measured every 4 h. RESULTS The mortality rates were 83, 83 and 33% for the endotoxemic, control column, and CTR post-treatment groups, respectively. The increases in IL-6 concentrations were less for the CTR post-treatment group than the other 2 groups. CONCLUSION The present study shows that CTR post-treatment inhibited hypotension and elevations in IL-6 concentrations, reducing the mortality rate of rats with endotoxin-induced shock.
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Affiliation(s)
- Takumi Taniguchi
- Department of Emergency and Critical Care Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
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Shimizu T, Endo Y, Tani T. Extracorporeal cytokine apheresis for sepsis: CTR as a new therapeutic adsorbent. Crit Care Med 2006; 34:926-7. [PMID: 16505690 DOI: 10.1097/01.ccm.0000202438.76681.b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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