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Zhang L, Ma Y, Wang X, Ma LN, Ma W, Ding XC. Comparative efficacy of double plasma molecular adsorption system combined with plasma exchange versus plasma exchange in treating acute-on-chronic liver failure due to hepatitis B: A meta-analysis. J Clin Apher 2024; 39:e22140. [PMID: 39188020 DOI: 10.1002/jca.22140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/14/2024] [Accepted: 07/09/2024] [Indexed: 08/28/2024]
Abstract
This meta-analysis aims to evaluate the effectiveness of the double plasma molecular adsorption system (DPMAS) in combination with plasma exchange (PE) compared to plasma exchange alone in the treatment of Acute-on-Chronic liver failure (LF) caused by hepatitis B. Until August 31, 2023, a comprehensive search of databases including Embase, Chinese Medical Journal Full-text Database, China Biomedical Literature Database, Wan Fang Medical Network, PubMed, and the Cochrane Library was carried out using keywords like "liver failure," "acute-on-chronic liver failure," "PE," "DPMAS," and related terms. The quality of the included studies was evaluated using QUADS (quality assessment of diagnostic accuracy studies). Software Revman 5.3 was used to examine the data, while Stata 15.1 was used to run Egger's test. Following thorough screening, 452 patients who received PE alone and 429 patients who received DPMAS in addition to PE were included. Every study that was included was of a high caliber. When comparing the DPMAS plus PE group to the PE alone group, the total bilirubin reduction was considerably higher (mean difference [MD] = -49.09, 95% confidence interval [CI]: -54.84 to -43.35, p < .00001). Prothrombin activity (PTA; MD = -1.53, 95% CI: -3.29 to -0.22, p = .09), albumin (ALB; MD = -0.58, 95% CI: -1.57 to 0.41, p = .25), prothrombin time (PT; MD = -0.07, 95% CI: -1.47 to 1.34, p = .92), and platelet count (PLT; MD = -0.08, 95% CI: -1.33 to 1.66, p = .90) did not differ significantly. The improvement in international standardized ratio (INR) was significantly greater in the PE group (MD = 0.07, 95% CI (0.03, 0.10), p = .0001). When combined with DPMAS, PE has been shown to be more effective in lowering total bilirubin levels. PE can also lower INR in individuals who have hepatitis B-related ACLF. This therapeutic strategy also lessens the need for plasma transfusions.
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Affiliation(s)
- Le Zhang
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Yan Ma
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xia Wang
- Ningxia Medical University, Yinchuan, Ningxia, China
| | - Li-Na Ma
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Wanlong Ma
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
| | - Xiang-Chun Ding
- Department of Infectious Disease, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China
- Infectious Disease Clinical Research Center of Ningxia, Yinchuan, Ningxia, China
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Zhang X, Hu Y, Wang W, Ji R, Li Z, Yu W, Wu Z, Xiao Y, Guo T, Qi Z, Wang Y, Zhao C. IRGM/Irgm1 increases autophagy to inhibit activation of NLRP3 inflammasome in inflammatory injury induced acute liver failure. Cell Death Discov 2024; 10:272. [PMID: 38849356 PMCID: PMC11161524 DOI: 10.1038/s41420-024-02052-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 05/28/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
Immune-related GTPase M (IRGM) induces autophagy and suppresses inflammation, but its putative role and signaling mechanism remain undefined in the pathogenesis of liver failure. This study aimed to address how IRGM attenuates inflammatory injury by regulating autophagy in liver failure. In this study, a total of 10 patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) and 10 healthy controls were prospectively enrolled. Intrahepatic expression of IRGM/Irgm1, NLRP3 inflammasome (NLRP3, ASC, and caspase-1), autophagy-related proteins (LC3II, P62), and inflammatory cytokines (IL-1β, TNF-α) were measured. Autophagy was activated by rapamycin (4 mg/kg) in an acute liver failure (ALF) mouse model, which was used to further study the expression of Irgm1, NLRP3 inflammasome, autophagy-related proteins, and inflammatory cytokines using both qRT-PCR and Western blot analyses. Irgm1 expression was knocked down using Irgm1 short hairpin RNA (shRNA) in lipopolysaccharide (LPS)-induced AML12 cells to investigate the effects of Irgm1 deletion on autophagy and inflammation. We found that the expression of IRGM and autophagy-related proteins was significantly downregulated while the NLRP3 inflammasome was significantly upregulated in the livers of HBV-ACLF patients and the ALF mouse model (all P < 0.05). Rapamycin-induced autophagy ameliorated intrahepatic NLRP3 inflammasome activation and decreased inflammation and necrosis in the ALF mice. Irgm1 knockdown decreased autophagy and significantly upregulated NLRP3 inflammasome activation in AML12 cells (all P < 0.05). Rapamycin-induced autophagy also protected against hepatocyte injury following LPS stimulation in vitro by inhibiting NLRP3 inflammasome activation. Thus, IRGM/Irgm1 alleviates inflammation-mediated hepatocyte injury by regulating autophagy. This study provides new insight into potential molecular targets to treat liver failure.
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Affiliation(s)
- Xing Zhang
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Yangyang Hu
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Wei Wang
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Ru Ji
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Ziyue Li
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Weiyan Yu
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Zhinian Wu
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Ying Xiao
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Tingyu Guo
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Zeqiang Qi
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
| | - Yadong Wang
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China.
| | - Caiyan Zhao
- Department of Infectious Diseases, the Hebei Medical University Third Hospital, Shijiazhuang, 050051, China
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Zhang Y, Dong R, Li Y, Yang X, Liu J, Ou S, Wu W. Efficacy and safety of plasma diafiltration: Review of case reports and case series. Ther Apher Dial 2023; 27:3-11. [PMID: 35437915 DOI: 10.1111/1744-9987.13859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/17/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023]
Abstract
Plasma diafiltration (PDF), a blood purification procedure that combines dialysis with plasma filtration by a selective membrane, has been used to treat acute liver failure, sepsis, and other acute conditions. We reviewed 14 eligible case reports and case series that examined PDF in 357 patients to assess its efficacy and safety. Fourteen diseases may be indications for PDF. The primary indication in the included studies was acute liver failure without obvious inducement or cause not mentioned. Eighty-three patients reached the primary endpoint (31 deaths, 52 recoveries) and the efficacy was 62.7%. There were large changes in 16 toxins or clinical markers after PDF, including total bilirubin, IL-18, IL-6. In conclusion, PDF appears to be an effective treatment for clearance of bilirubin and other inflammatory mediators in patients with acute liver injury or a disease characterized by a systemic inflammatory state. Randomized controlled trials are needed to compare PDF with other blood purification methods, such as plasma exchange and the Molecular Adsorbent Recirculating System™.
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Affiliation(s)
- Yannan Zhang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Rui Dong
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Ying Li
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Xin Yang
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Jiang Liu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Santao Ou
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
| | - Weihua Wu
- Department of Nephrology, The Affiliated Hospital of Southwest Medical University, Sichuan Clinical Research Center for Nephropathy, Metabolic Vascular Disease Key Laboratory, Luzhou, Sichuan, China
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Lei Y, Liang Y, Zhang X, Wang X, Zhang Y, Chan YM, Tang C, Zheng Z. Alternating therapeutic plasma exchange (TPE) with double plasma molecular adsorption system (DPMAS) for the treatment of fulminant hepatic failure (FHF). Clin Case Rep 2021; 9:e05220. [PMID: 34938567 PMCID: PMC8667290 DOI: 10.1002/ccr3.5220] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/24/2021] [Accepted: 12/03/2021] [Indexed: 01/14/2023] Open
Abstract
Alternating therapeutic plasma exchange with double plasma molecular adsorption system can rapidly remove bilirubin and ammonia and supplement the essential substance from the blood, which could be used as an effective treatment for fulminant hepatic failure.
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Affiliation(s)
- Yan Lei
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yuling Liang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Xuemei Zhang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Xiaohua Wang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yu Zhang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yuk Ming Chan
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Chun Tang
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Zhihua Zheng
- Department of NephrologyCenter of Nephrology and UrologyThe Seventh Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
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Tan Y, Ye Y, Chen L. Fatal immune-related hepatitis with intrahepatic cholestasis and pneumonia associated with camrelizumab: A case report and literature review. Open Med (Wars) 2021; 16:553-557. [PMID: 33869777 PMCID: PMC8034239 DOI: 10.1515/med-2021-0267] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Camrelizumab (SHR-1210), a human monoclonal antibody against programmed death receptor 1 (PD-1), blocks the binding of PD-1 to PD-L1, consequently inhibiting immune system evasion by tumor cells. A 65-year-old man underwent radical esophagectomy 5 months ago following the diagnosis of esophageal cancer by gastroscopy. Approximately 40 days later, capecitabine was administered at a dosage of 1.5 g Po bid for 14 days, and anti-PD-1 (camrelizumab 200 mg) was administered twice. Around 20 days later, abnormal liver function was detected. He received a diagnosis of drug-induced liver injury. Chest computed tomography scanning revealed interstitial inflammatory lesions in both lower lungs. Liver biopsy revealed immune injury with ductopenia. Therefore, the diagnosis was revised as immune-related pneumonia and hepatitis associated with camrelizumab. The treatment regimen of methylprednisolone was adjusted to 40 mg/day and gradually increased to 80 mg/day. Mycophenolate mofetil was administered at a dose of 2 g/day. Consequently, chest tightness and shortness of breath resolved, and pulmonary inflammation improved. However, jaundice did not improve and continued to exacerbate. The last measured prothrombin time was 41 s, prothrombin activity was 19%, and the international normalized ratio was 4.03. The cause of death was diagnosed as liver failure, cardiopulmonary failure, and septic shock.
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Affiliation(s)
- Youwen Tan
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300, Daijiamen, Runzhou Distinct, Zhenjiang 212003, China
| | - Yun Ye
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300, Daijiamen, Runzhou Distinct, Zhenjiang 212003, China
| | - Li Chen
- Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, No. 300, Daijiamen, Runzhou Distinct, Zhenjiang 212003, China
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