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Siew LY, Lee ZY, Yunos NM, Atan R, Cove ME, Lumlertgul N, Srisawat N, Hasan MS. Outcomes of extracorporeal blood purification with oXiris® membrane in critically ill patients: A systematic review and meta-analysis. J Crit Care 2024; 83:154844. [PMID: 38901069 DOI: 10.1016/j.jcrc.2024.154844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/26/2024] [Accepted: 06/08/2024] [Indexed: 06/22/2024]
Abstract
PURPOSE To evaluate the efficacy of the novel oXiris® membrane in critically ill adult patients. METHODS We systematically searched MEDLINE, EMBASE, and CENTRAL from inception to 01/06/2023 for relevant randomised controlled trials (RCTs) and non-randomised studies of intervention (NRSI). The primary outcome was overall mortality. Random effect meta-analyses were conducted in RevMan 5.4.1. Study quality was evaluated using Cochrane's risk of bias tool. (PROSPERO: CRD42023389198). RESULTS Ten studies (2 RCTs and 8 NRSIs) with 481 patients were included. None had low risk of bias. Treatment using oXiris® was associated with reduced overall mortality (RR 0.78, 95%CI 0.62-0.98; p = 0.03; 6 NRSI). One RCT reported 28-day mortality, finding no significant difference between groups. Besides, pooled NRSIs results showed significant reductions in SOFA scores, norepinephrine dosage, and several inflammatory biomarkers (C-reactive protein [CRP], lactate, and interleukin-6 [IL-6]) post oXiris® treatment. However, other clinical outcomes (ICU and hospital length of stay, mechanical ventilation duration) were similar between groups. CONCLUSION In critically ill patients, the use of oXiris® membrane was associated with reduced overall mortality, norepinephrine dosage, CRP, IL-6, lactate levels, along with improved organ function. However, the certainty of evidence was very low, necessitating high-quality RCTs to further evaluate its efficacy in this population.
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Affiliation(s)
- Li Ying Siew
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Zheng-Yii Lee
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Cardiac Anesthesiology & Intensive Care Medicine, Charité Berlin, Germany
| | - Nor'azim Mohd Yunos
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Anaesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rafidah Atan
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Anaesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Matthew Edward Cove
- Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
| | - Nuttha Lumlertgul
- Division of Nephrology, Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Faculty of Medicine, Centre of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - Nattachai Srisawat
- Division of Nephrology, Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand; Faculty of Medicine, Centre of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand
| | - M Shahnaz Hasan
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia; Department of Anaesthesiology, Universiti Malaya Medical Centre, Kuala Lumpur, Malaysia.
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Papamichalis P, Oikonomou KG, Valsamaki A, Xanthoudaki M, Katsiafylloudis P, Papapostolou E, Skoura AL, Papamichalis M, Karvouniaris M, Koutras A, Vaitsi E, Sarchosi S, Papadogoulas A, Papadopoulos D. Liver replacement therapy with extracorporeal blood purification techniques current knowledge and future directions. World J Clin Cases 2023; 11:3932-3948. [PMID: 37388799 PMCID: PMC10303607 DOI: 10.12998/wjcc.v11.i17.3932] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 06/12/2023] Open
Abstract
Clinically, it is highly challenging to promote recovery in patients with acute liver failure (ALF) and acute-on-chronic liver failure (ACLF). Despite recent advances in understanding the underlying mechanisms of ALF and ACLF, standard medical therapy remains the primary therapeutic approach. Liver transplantation (LT) is considered the last option, and in several cases, it is the only intervention that can be lifesaving. Unfortunately, this intervention is limited by organ donation shortage or exclusion criteria such that not all patients in need can receive a transplant. Another option is to restore impaired liver function with artificial extracorporeal blood purification systems. The first such systems were developed at the end of the 20th century, providing solutions as bridging therapy, either for liver recovery or LT. They enhance the elimination of metabolites and substances that accumulate due to compromised liver function. In addition, they aid in clearance of molecules released during acute liver decompensation, which can initiate an excessive inflammatory response in these patients causing hepatic encephalopathy, multiple-organ failure, and other complications of liver failure. As compared to renal replacement therapies, we have been unsuccessful in using artificial extracorporeal blood purification systems to completely replace liver function despite the outstanding technological evolution of these systems. Extracting middle to high-molecular-weight and hydrophobic/protein-bound molecules remains extremely challenging. The majority of the currently available systems include a combination of methods that cleanse different ranges and types of molecules and toxins. Furthermore, conventional methods such as plasma exchange are being re-evaluated, and novel adsorption filters are increasingly being used for liver indications. These strategies are very promising for the treatment of liver failure. Nevertheless, the best method, system, or device has not been developed yet, and its probability of getting developed in the near future is also low. Furthermore, little is known about the effects of liver support systems on the overall and transplant-free survival of these patients, and further investigation using randomized controlled trials and meta-analyses is needed. This review presents the most popular extracorporeal blood purification techniques for liver replacement therapy. It focuses on general principles of their function, and on evidence regarding their effectiveness in detoxification and in supporting patients with ALF and ACLF. In addition, we have outlined the basic advantages and disadvantages of each system.
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Affiliation(s)
| | - Katerina G Oikonomou
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | - Asimina Valsamaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | - Maria Xanthoudaki
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | | | | | - Apostolia-Lemonia Skoura
- Department of Transfusion Medicine, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | - Michail Papamichalis
- Department of Cardiology, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
| | | | - Antonios Koutras
- 1st Department of Obstetrics and Gynecology, General Hospital of Athens “ALEXANDRA”, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Eleni Vaitsi
- Intensive Care Unit, General Hospital of Larissa, Larissa 41221, Thessaly, Greece
| | - Smaragdi Sarchosi
- Department of Anesthesiology, University Hospital of Larissa, Larissa 41110, Thessaly, Greece
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Becker S, Lang H, Vollmer Barbosa C, Tian Z, Melk A, Schmidt BMW. Efficacy of CytoSorb®: a systematic review and meta-analysis. Crit Care 2023; 27:215. [PMID: 37259160 PMCID: PMC10230475 DOI: 10.1186/s13054-023-04492-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Cytokine adsorption using the CytoSorb® adsorber has been proposed in various clinical settings including sepsis, ARDS, hyperinflammatory syndromes, cardiac surgery or recovery after cardiac arrest. The aim of this analysis is to provide evidence for the efficacy of the CytoSorb® adsorber with regard to mortality in various settings. METHODS We searched PubMed, Cochrane Library database and the database provided by Cytosorbents™ (01.1.2010-29.5.2022). We considered randomized controlled trials and observational studies with control groups. The longest reported mortality was defined as the primary endpoint. We computed risk ratios and 95%-confidence intervals and used DerSimonian and Lairds random effects model. We analysed all studies combined and divided them into the subgroups: sepsis, cardiopulmonary bypass surgery (CPB), other severe illness, SARS-CoV-2 infection and recovery from cardiac arrest. The meta-analysis was registered in advance (PROSPERO: CRD42022290334). RESULTS Of an initial 1295 publications, 34 studies were found eligible, including 1297 patients treated with CytoSorb® and 1314 controls. Cytosorb® intervention did not lower mortality (RR [95%-CI]: all studies 1.07 [0.88; 1.31], sepsis 0.98 [0.74; 1.31], CPB surgery 0.91 [0.64; 1.29], severe illness 0.95 [0.59; 1.55], SARS-CoV-2 1.58 [0.50; 4.94]). In patients with cardiac arrest, we found a significant survival advantage of the untreated controls (1.22 [1.02; 1.46]). We did not find significant differences in ICU length of stay, lactate levels, or IL-6 levels after treatment. Of the eligible 34 studies only 12 were randomized controlled trials. All observational studies showed moderate to serious risk of bias. INTERPRETATION To date, there is no evidence for a positive effect of the CytoSorb® adsorber on mortality across a variety of diagnoses that justifies its widespread use in intensive care medicine.
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Affiliation(s)
- Sören Becker
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Hannah Lang
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Clara Vollmer Barbosa
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Zhejia Tian
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Anette Melk
- Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, Hannover, Germany
| | - Bernhard M W Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
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Semak V, Eichhorn T, Weiss R, Weber V. Polyzwitterionic Coating of Porous Adsorbents for Therapeutic Apheresis. J Funct Biomater 2022; 13:jfb13040216. [PMID: 36412857 PMCID: PMC9680258 DOI: 10.3390/jfb13040216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/27/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022] Open
Abstract
Adsorbents for whole blood apheresis need to be highly blood compatible to minimize the activation of blood cells on the biomaterial surface. Here, we developed blood-compatible matrices by surface modification with polyzwitterionic polysulfobetainic and polycarboxybetainic coatings. Photoreactive zwitterionic terpolymers were synthesized by free-radical polymerization of zwitterionic, photoreactive, and fluorescent monomers. Upon UV irradiation, the terpolymers were photodeposited and mutually crosslinked on the surface of hydrophobic polystyrene-co-divinylbenzene and hydrophilic polyacrylamide-co-polyacrylate (DALI) beads. Fluorescent microscopy revealed coatings with an average thickness of 5 µm, which were limited to the bead surface. Blood compatibility was assessed based on polymer-induced hemolysis, coagulation parameters, and in vitro tests. The maintenance of the adsorption capacity after coating was studied in human whole blood with cytokines for polystyrene beads (remained capacity 25-67%) and with low-density lipoprotein (remained capacity 80%) for polyacrylate beads. Coating enhanced the blood compatibility of hydrophobic, but not of hydrophilic adsorbents. The most prominent effect was observed on coagulation parameters (e.g., PT, aPTT, TT, and protein C) and neutrophil count. Polycarboxybetaine with a charge spacer of five carbons was the most promising polyzwitterion for the coating of adsorbents for whole blood apheresis.
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Ultraporous Polyquaternium-Carboxylated Chitosan Composite Hydrogel Spheres with Anticoagulant, Antibacterial, and Rapid Endotoxin Removal Profiles for Sepsis Treatment. Biomacromolecules 2022; 23:3728-3742. [PMID: 35926229 DOI: 10.1021/acs.biomac.2c00583] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Hemoperfusion is an important method to remove endotoxins and save the lives of patients with sepsis. However, the current adsorbents for hemoperfusion have disadvantages of insufficient endotoxin adsorption capacity, poor blood compatibility, and so on. Herein, we proposed a novel emulsion templating (ET) method to prepare ultraporous and double-network carboxylated chitosan (CCS)-poly(diallyl dimethylammonium chloride) (PDDA) hydrogel spheres (ET-CCSPD), bearing both negative and positive charges. CCS was introduced to balance the strong positive charges of PDDA to improve hemocompatibility, and emulsion templates endowed the adsorbent with an ultraporous structure for enhanced adsorption efficacy. The ET-CCSPDs neither damaged blood cells nor activated complement responses. In addition, the activated partial thromboplastin time (APTT) was prolonged to 8.5 times, which was beneficial for reducing the injection of anticoagulant in patients. The ET-CCSPDs had excellent scavenging performance against bacteria and endotoxin, with removal ratios of 96.7% for E. coli and 99.8% for S. aureus, respectively, and the static removal ratio of endotoxin in plasma was as high as 99.1% (C0 = 5.50 EU/mL, critical illness level). An adsorption cartridge filled with the ET-CCSPDs could remove 84.7% of endotoxin within 1 h (C0 = 100 EU/mL in PBS). Interestingly, the ET-CCSPDs had a good inhibitory effect on the cytokines produced by endotoxin-mediated septic blood. By developing the ET method to prepare ultraporous and double-network adsorbents, the problems of low adsorption efficiency and poor blood compatibility of traditional endotoxin adsorbents have been solved, thus opening a new route to fabricate absorbents for blood purification.
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Reis T, Colares VS, Rocha E, Younes-Ibrahim M, de Lima EQ, Andrade LDC, Ponce D, Suassuna JHR, Yu L. Acute kidney injury and renal replacement therapy: terminology standardization. J Bras Nefrol 2022; 44:434-442. [PMID: 35579341 PMCID: PMC9518623 DOI: 10.1590/2175-8239-jbn-2021-0284en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/09/2022] [Indexed: 11/22/2022] Open
Abstract
The Department of Acute Kidney Injury (IRA) of the Brazilian Society of Nephrology prepared this document for the purpose of standardizing AKI terminology and dialysis modalities in the Portuguese language for Brazil. Several terms with similar meanings have been used in AKI and its dialysis modalities, causing confusion and disparities among patients, nephrologists, health institutions, private care companies, insurance companies and government entities. These disparities can impact medical care, hospital organization and care, as well as the funding and reimbursement of AKI-related procedures. Thus, consensual nomenclature and definitions were developed, including the definitions of AKI, acute kidney disease (AKD) and chronic kidney disease (CKD). Additionally, we addressed all dialysis modalities and extracorporeal procedures related to AKI, currently approved and available in the country. The Brazilian Society of Nephrology hopes that this Consensus can standardize the terminology and provide technical support to all involved in AKI care in Brazil.
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Affiliation(s)
- Thiago Reis
- Universidade de Brasília, Laboratório de Farmacologia Molecular, Brasília, DF, Brasil
- Hospital DF Star, Clínica de Doenças Renais de Brasília, Brasília, DF, Brasil
| | | | - Eduardo Rocha
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Mauricio Younes-Ibrahim
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brasil
| | | | | | - Daniela Ponce
- Universidade Estadual de São Paulo, Departamento de Clínica Médica, São Paulo, SP, Brasil
| | - José H. Rocco Suassuna
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Rio de Janeiro, RJ, Brasil
| | - Luis Yu
- Universidade de São Paulo, Faculdade de Medicina, São Paulo, SP
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Effect of N-vinylimidazole comonomer on blood plasma protein and endogenous toxin adsorption on mesoporous copolymer beads. BIOMEDICAL ENGINEERING ADVANCES 2022. [DOI: 10.1016/j.bea.2022.100027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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8
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Reis T, Colares VS, Rocha E, Younes-Ibrahim M, Lima EQD, Andrade LDC, Ponce D, Suassuna JHR, Yu L. Injúria renal aguda e métodos de suporte: padronização da nomenclatura. J Bras Nefrol 2022. [DOI: 10.1590/2175-8239-jbn-2021-0284pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo O Departamento de Injúria Renal Aguda (IRA) da Sociedade Brasileira de Nefrologia elaborou o presente documento para fins de padronização da terminologia em IRA e modalidades dialíticas na língua portuguesa para o Brasil. Diversos termos com significados semelhantes têm sido empregados em IRA e suas modalidades dialíticas, causando confusão e disparidades entre pacientes, nefrologistas, instituições de saúde, empresas privadas de assistência, seguradoras e entidades governamentais. Essas disparidades podem impactar a assistência médica, a organização e o atendimento hospitalares, assim como o financiamento e reembolso dos procedimentos relacionados com a IRA. Assim, nomenclatura e definições consensuais foram elaboradas, incluindo-se as definições de IRA, doença renal aguda (DRA) e doença renal crônica (DRC). Adicionalmente, todas as modalidades dialíticas e os procedimentos extracorpóreos relacionados a IRA, atualmente aprovados e disponíveis no país, foram abordados. A Sociedade Brasileira de Nefrologia espera que este Consenso possa padronizar a nomenclatura e prover suporte técnico para todos os atores envolvidos na assistência à IRA no Brasil.
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Affiliation(s)
- Thiago Reis
- Universidade de Brasília, Brasil; Hospital DF Star, Brasil
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De Pascale M, De Angelis MG, Boi C. Mixed Matrix Membranes Adsorbers (MMMAs) for the Removal of Uremic Toxins from Dialysate. MEMBRANES 2022; 12:203. [PMID: 35207125 PMCID: PMC8878186 DOI: 10.3390/membranes12020203] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/21/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023]
Abstract
We developed Mixed Matrix Membrane Adsorbers (MMMAs) formed by cellulose acetate and various sorbent particles (activated carbon, zeolites ZSM-5 and clinoptilolite) for the removal of urea, creatinine and uric acid from aqueous solutions, to be used in the regeneration of spent dialysate water from Hemodialysis (HD). This process would allow reducing the disproportionate amount of water consumed and permits the development of closed-loop HD devices, such as wearable artificial kidneys. The strategy of MMMAs is to combine the high permeability of porous membranes with the toxin-capturing ability of embedded particles. The water permeability of the MMMAs ranges between 600 and 1500 L/(h m2 bar). The adsorption of urea, the limiting toxin, can be improved of about nine times with respect to the pure cellulose acetate membrane. Flow experiments demonstrate the feasibility of the process in a real HD therapy session.
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Affiliation(s)
- Matilde De Pascale
- Department of Civil, Chemical Environmental and Materials Engineering, DICAM, University of Bologna, Via Terracini 28, 40131 Bologna, Italy;
| | - Maria Grazia De Angelis
- Department of Civil, Chemical Environmental and Materials Engineering, DICAM, University of Bologna, Via Terracini 28, 40131 Bologna, Italy;
- Institute for Materials and Processes, School of Engineering, University of Edinburgh, Sanderson Building, Robert Stevenson Road, Edinburgh EH9 3FB, UK
- Italian Consortium for Science and Technology of Materials (INSTM), 50121 Firenze, Italy
| | - Cristiana Boi
- Department of Civil, Chemical Environmental and Materials Engineering, DICAM, University of Bologna, Via Terracini 28, 40131 Bologna, Italy;
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Liu Y, Peng X. Multi-Functional Hypercrosslinked Polystyrene as High-Performance Adsorbents for Artificial Liver Blood Purification. Front Chem 2022; 9:789814. [PMID: 35111728 PMCID: PMC8801601 DOI: 10.3389/fchem.2021.789814] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/26/2021] [Indexed: 12/29/2022] Open
Abstract
In artificial liver blood purification system, highly efficient removal of multiple toxic metabolites from whole blood by hemoperfusion still remains a challenge in the clinical field, due to the limited unspecific absorptive capacity and low biocompatibility of adsorbents. In this work, a new pyridinyl-modified hypercrosslinked polystyrene (HCP) adsorbent, named HCP(St-DVB-VP), was constructed directly through a Friedel-Crafts post-crosslinking reaction using a small-molecule crosslinking agent for the first time. The preparation method provides in this study can avert the problem posed by the use of the toxic carcinogenic chloromethyl ether reagent in the traditional HCP resin synthesis process. The results indicated that HCP(St-DVB-VP) had a highly porous structure with a specific surface area of 761 m2 g−1. Notably, the adsorbent demonstrated excellent adsorptive properties towards both protein-bound toxins (bilirubin) and medium- and large-sized molecular toxins (PTH, IL-6) in vitro experiments simultaneously. More importantly, the obtained adsorbent showed acceptable hemocompatibility. Taken together, the low-cost and ecofriendly fabrication method, broad-spectrum adsorption performance and hemocompatibility makes the HCP(St-DVB-VP) promising for whole blood perfusion in artificial liver blood purification in clinical practice.
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Chai Y, Liu Z, Du Y, Wang L, Lu J, Zhang Q, Han W, Wang T, Yu Y, Sun L, Ou L. Hydroxyapatite reinforced inorganic-organic hybrid nanocomposite as high-performance adsorbents for bilirubin removal in vitro and in pig models. Bioact Mater 2021; 6:4772-4785. [PMID: 34095628 PMCID: PMC8144535 DOI: 10.1016/j.bioactmat.2021.05.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/15/2021] [Accepted: 05/10/2021] [Indexed: 12/20/2022] Open
Abstract
Highly efficient removal of bilirubin from whole blood directly by hemoperfusion for liver failure therapy remains a challenge in the clinical field due to the low adsorption capacity, poor mechanical strength and low biocompatibility of adsorbents. In this work, a new class of nanocomposite adsorbents was constructed through an inorganic-organic co-crosslinked nanocomposite network between vinyltriethoxysilane (VTES)-functionalized hydroxyapatite nanoparticles (V-Hap) and non-ionic styrene-divinylbenzene (PS-DVB) resins (PS-DVB/V-Hap) using suspension polymerization. Notably, our adsorbent demonstrated substantially improved mechanical performance compared to the pure polymer, with the hardness and modulus increasing by nearly 3 and 2.5 times, respectively. Moreover, due to the development of a mesoporous structure, the prepared PS-DVB/V-Hap3 exhibited an ideal adsorption capacity of 40.27 mg g-1. More importantly, the obtained adsorbent beads showed outstanding blood compatibility and biocompatibility. Furthermore, in vivo extracorporeal hemoperfusion verified the efficacy and biosafety of the adsorbent for directly removing bilirubin from whole blood in pig models, and this material could potentially prevent liver damage and improve clinical outcomes. Taken together, the results suggest that PS-DVB/V-Hap3 beads can be used in commercial adsorption columns to threat hyperbilirubinemia patients through hemoperfusion, thus replacing the existing techniques where plasma separation is initially required.
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Affiliation(s)
- Yamin Chai
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Zhuang Liu
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Yunzheng Du
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Lichun Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Jinyan Lu
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Qian Zhang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Wenyan Han
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Tingting Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Yameng Yu
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
| | - Lisha Sun
- General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Lailiang Ou
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin, 300071, China
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Rosner MH, Reis T, Husain-Syed F, Vanholder R, Hutchison C, Stenvinkel P, Blankestijn PJ, Cozzolino M, Juillard L, Kashani K, Kaushik M, Kawanishi H, Massy Z, Sirich TL, Zuo L, Ronco C. Classification of Uremic Toxins and Their Role in Kidney Failure. Clin J Am Soc Nephrol 2021; 16:1918-1928. [PMID: 34233920 PMCID: PMC8729494 DOI: 10.2215/cjn.02660221] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Advances in our understanding of uremic retention solutes, and improvements in hemodialysis membranes and other techniques designed to remove uremic retention solutes, offer opportunities to readdress the definition and classification of uremic toxins. A consensus conference was held to develop recommendations for an updated definition and classification scheme on the basis of a holistic approach that incorporates physicochemical characteristics and dialytic removal patterns of uremic retention solutes and their linkage to clinical symptoms and outcomes. The major focus is on the removal of uremic retention solutes by hemodialysis. The identification of representative biomarkers for different classes of uremic retention solutes and their correlation to clinical symptoms and outcomes may facilitate personalized and targeted dialysis prescriptions to improve quality of life, morbidity, and mortality. Recommendations for areas of future research were also formulated, aimed at improving understanding of uremic solutes and improving outcomes in patients with CKD.
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Affiliation(s)
- Mitchell H. Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, Virginia
| | - Thiago Reis
- Department of Nephrology, University of Brazil, Brasília, Brazil
- National Academy of Medicine, Rio de Janeiro, Brazil
| | - Faeq Husain-Syed
- Department of Internal Medicine II, Justus-Liebig-University Giessen, Giessen, Germany
| | - Raymond Vanholder
- Department of Internal Medicine and Pediatrics, University Hospital, Ghent, Belgium
| | - Colin Hutchison
- Faculty of Medicine, University of Queensland, Herston, Australia
- Department of Medicine, Hawke's Bay District Health Board, Hastings, New Zealand
| | - Peter Stenvinkel
- Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Peter J. Blankestijn
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mario Cozzolino
- Renal Division, Università degli Studi di Milano, Milan, Italy
| | - Laurent Juillard
- University of Lyon, Villeurbanne, France
- Hôpital E. Herriot, Lyon, France
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota
| | - Manish Kaushik
- Department of Renal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Hideki Kawanishi
- Department of Artificial Organs, Tsuchiya General Hospital, Hiroshima, Japan
| | - Ziad Massy
- INSERM U1018, Villejuif, France
- Service de Néphrologie et Dialyse, Hôpital Universitaire Ambroise Paré, Boulogne-Billancourt, France
| | - Tammy Lisa Sirich
- Nephrology Section, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
- Division of Nephrology, Stanford University School of Medicine, Stanford, California
| | - Li Zuo
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Claudio Ronco
- Department of Medicine, University of Padova, Padova, Italy
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza, Vicenza, Italy
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Yao G, Huang C, Ji F, Ren J, Zang B, Jia L. Nanobody-loaded immunosorbent for highly-specific removal of interleukin-17A from blood. J Chromatogr A 2021; 1654:462478. [PMID: 34450522 DOI: 10.1016/j.chroma.2021.462478] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/13/2021] [Accepted: 08/14/2021] [Indexed: 10/20/2022]
Abstract
Elimination of overproduced cytokines from blood can relieve immune system disorders caused by hypercytokinemia. Due to the central roles of interleukin-17A (IL-17A) plays in regulating the immunity and inflammatory responses in humans, here, a novel immunosorbent containing anti-IL-17A nanobodies (Nbs) was constructed for IL-17A removal from blood. The theoretical maximum adsorption capacity estimated from the Langmuir isotherm is up to 11.55 mg/g gel, which is almost consistent with the saturated adsorption capacity determined in dynamic adsorption. The in vitro plasma perfusion test demonstrated a remarkable adsorptive performance of the Nb-coupled sorbent since more than 75% IL-17A could be eliminated under the plasma/sorbent ratio of 1000:1. These results indicated the Nb-loaded immunosorbent can provide a simple and economic platform technology for immunoaffinity depletion of single or even multiple cytokines from plasma.
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Affiliation(s)
- Guangshuai Yao
- Liaoning Key Laboratory of Molecular Recognition and imaging, School of Bioengineering, Dalian University of Technology, No.2 Linggong Road, Dalian, Liaoning 116023, PR China
| | - Chundong Huang
- Liaoning Key Laboratory of Molecular Recognition and imaging, School of Bioengineering, Dalian University of Technology, No.2 Linggong Road, Dalian, Liaoning 116023, PR China
| | - Fangling Ji
- Liaoning Key Laboratory of Molecular Recognition and imaging, School of Bioengineering, Dalian University of Technology, No.2 Linggong Road, Dalian, Liaoning 116023, PR China
| | - Jun Ren
- Liaoning Key Laboratory of Molecular Recognition and imaging, School of Bioengineering, Dalian University of Technology, No.2 Linggong Road, Dalian, Liaoning 116023, PR China
| | - Berlin Zang
- Liaoning Key Laboratory of Molecular Recognition and imaging, School of Bioengineering, Dalian University of Technology, No.2 Linggong Road, Dalian, Liaoning 116023, PR China
| | - Lingyun Jia
- Liaoning Key Laboratory of Molecular Recognition and imaging, School of Bioengineering, Dalian University of Technology, No.2 Linggong Road, Dalian, Liaoning 116023, PR China.
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Rad IY, Lewis S, Barros MD, Kipper M, Stansbury JW. Suppression of hydrolytic degradation in labile polymer networks via integrated styrenic nanogels. Dent Mater 2021; 37:1295-1306. [PMID: 34103152 DOI: 10.1016/j.dental.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/14/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVE The objective of this study was to demonstrate an approach with potential to increase the life of dental restorative polymers in water, by maintaining their strength and toughness with varied content of inert or reactive styrenic pre-polymeric additives. It was hypothesized that addition of styrene-co-divinylbenzene nanogels to a conventional dimethacrylate resin (e.g. TEGDMA) would reduce its susceptibility towards hydrolytic degradation, while maintaining equivalent mechanical properties. METHODS Polymerization kinetics and functional group conversions were determined by Fourier transform infrared spectroscopy. Triple-detection gel permeation chromatography was used for nanogel particle characterization. A goniometer was used to measure water contact angle on experimental and control photocured polymers. Hydrolytic degradation and mass loss evaluation was performed after extended water storage of an intentionally hydrolytically degradable polymer. Resin viscosity was determined rheometrically and polymer mechanical properties were evaluated using three-point flexural testing with TEGDMA-nanogel formulations. RESULTS The polymer network with highest level of nanogel loading (50 wt%) and the highest level of internal nanogel crosslinking (50 mol%) had the lowest degree of equilibrium swelling ratio and mass loss. The flexural modulus and ultimate strength of polymerized TEGDMA and styrenic nanogel-modified TEGDMA were not statistically different (p > 0.05). SIGNIFICANCE Due to improved shielding throughout the bulk of methacrylate-based polymers, including an example with an intentionally hydrolytically labile network structure, and a dramatic decrease of water uptake while maintaining equivalent mechanical properties, styrenic nanogel additives especially in high loading levels provide an excellent alternative to eliminate the adverse effects of water and presumably salivary fluids.
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Affiliation(s)
- Ima Y Rad
- University of Colorado-Anschutz Medical Campus, Craniofacial Biology Department, Research Complex-I North, 13065 E. 17th Avenue, Aurora, CO 80045 United States of America.
| | - Steven Lewis
- University of Colorado-Anschutz Medical Campus, Craniofacial Biology Department, Research Complex-I North, 13065 E. 17th Avenue, Aurora, CO 80045 United States of America.
| | - Matthew D Barros
- University of Colorado-Anschutz Medical Campus, Craniofacial Biology Department, Research Complex-I North, 13065 E. 17th Avenue, Aurora, CO 80045 United States of America.
| | - Matt Kipper
- Colorado State University, Chemical and Biological Engineering, Suzanne and Walter Scott, Jr. Bioengineering Building, 700 Meridian Ave, Fort Collins, CO 80523 United States of America.
| | - Jeffrey W Stansbury
- University of Colorado-Anschutz Medical Campus, Craniofacial Biology Department, Research Complex-I North, 13065 E. 17th Avenue, Aurora, CO 80045 United States of America.
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Magnani S, Atti M. Uremic Toxins and Blood Purification: A Review of Current Evidence and Future Perspectives. Toxins (Basel) 2021; 13:toxins13040246. [PMID: 33808345 PMCID: PMC8066023 DOI: 10.3390/toxins13040246] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/15/2022] Open
Abstract
Accumulation of uremic toxins represents one of the major contributors to the rapid progression of chronic kidney disease (CKD), especially in patients with end-stage renal disease that are undergoing dialysis treatment. In particular, protein-bound uremic toxins (PBUTs) seem to have an important key pathophysiologic role in CKD, inducing various cardiovascular complications. The removal of uremic toxins from the blood with dialytic techniques represents a proved approach to limit the CKD-related complications. However, conventional dialysis mainly focuses on the removal of water-soluble compounds of low and middle molecular weight, whereas PBTUs are strongly protein-bound, thus not efficiently eliminated. Therefore, over the years, dialysis techniques have been adapted by improving membranes structures or using combined strategies to maximize PBTUs removal and eventually prevent CKD-related complications. Recent findings showed that adsorption-based extracorporeal techniques, in addition to conventional dialysis treatment, may effectively adsorb a significant amount of PBTUs during the course of the sessions. This review is focused on the analysis of the current state of the art for blood purification strategies in order to highlight their potentialities and limits and identify the most feasible solution to improve toxins removal effectiveness, exploring possible future strategies and applications, such as the study of a synergic approach by reducing PBTUs production and increasing their blood clearance.
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16
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Ronco C, Reis T. Continuous renal replacement therapy and extended indications. Semin Dial 2021; 34:550-560. [PMID: 33711166 DOI: 10.1111/sdi.12963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/02/2021] [Accepted: 02/08/2021] [Indexed: 01/16/2023]
Abstract
Extracorporeal blood purification (EBP) techniques provide support for critically ill patients with single or multiple organ dysfunction. Continuous renal replacement therapy (CRRT) is the modality of choice for kidney support for those patients and orchestrates the interactions between the different artificial organ support systems. Intensive care teams should be familiar with the concept of sequential extracorporeal therapy and plan on how to incorporate new treatment modalities into their daily practices. Importantly, scientific evidence should guide the decision-making process at the bedside and provide robust arguments to justify the costs of implementing new EBP treatments. In this narrative review, we explore the extended indications for CRRT as an adjunctive treatment to provide support for the heart, lung, liver, and immune system. We detail practicalities on how to run the treatments and how to tackle the most frequent complications regarding each of the therapies, whether applied alone or integrated. The physicochemical processes and technologies involved at the molecular level encompassing the interactions between the molecules, membranes, and resins are spotlighted. A clinical case will illustrate the timing for the initiation, maintenance, and discontinuation of EBP techniques.
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Affiliation(s)
- Claudio Ronco
- Department of Medicine (DIMED), University of Padova, Padova, Italy.,Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,National Academy of Medicine, Young Leadership Physicians Program, Rio de Janeiro, Brazil
| | - Thiago Reis
- Department of Nephrology, Dialysis and Transplantation, International Renal Research Institute of Vicenza (IRRIV), San Bortolo Hospital, Vicenza, Italy.,Department of Nephrology, Clínica de Doenças Renais de Brasília, Molecular Pharmacology Laboratory, University of Brasília, Brasilia, Brazil
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17
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Donati G, Angeletti A, Gasperoni L, Piscaglia F, Croci Chiocchini AL, Scrivo A, Natali T, Ullo I, Guglielmo C, Simoni P, Mancini R, Bolondi L, La Manna G. Detoxification of bilirubin and bile acids with intermittent coupled plasmafiltration and adsorption in liver failure (HERCOLE study). J Nephrol 2020; 34:77-88. [PMID: 32710265 PMCID: PMC7881965 DOI: 10.1007/s40620-020-00799-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 07/04/2020] [Indexed: 01/15/2023]
Abstract
Background CPFA is an extracorporeal treatment used in severe sepsis to remove circulating proinflammatory cytokines. Limited evidence exists on the effectiveness of bilirubin adsorption by the hydrophobic styrenic resin, the distinctive part of CPFA. The aim of this study is to validate CPFA effectiveness in liver detoxification. Methods In this prospective observational study, we enrolled patients with acute or acute-on-chronic liver failure (serum total bilirubin > 20 mg/dL or MELD Score > 20) hospitalized from June 2013 to November 2017. CPFA was performed using the Lynda (Bellco/MedTronic, Mirandola, Italy) or the Amplya (Bellco/MedTronic, Mirandola, Italy) machines. Anticoagulation was provided with unfractionated heparin or citrate. Bilirubin and bile acids reduction ratios per session (RRs) were the main parameters for hepatic detoxification. Results Twelve patients with acute (n = 3) or acute-on-chronic (n = 9) liver failure were enrolled. Alcohol was the main cause of liver disease. Thirty-one CPFA treatments of 6 h each were performed, 19 with heparin and 12 with citrate. RRs was 28.8% (range 2.2–40.5) for total bilirubin, 32.7% (range 8.3–48.9) for direct bilirubin, 29.5% (range 6.5–65.4) for indirect bilirubin and 28.9% (16.7- 59.7) for bile acids. One patient received liver transplantation and 8/9 were alive at 1 year of follow-up. Three patients (25%) died: 2 during hospitalization and 1 for a cardiac event at 4 months of follow up with restored liver function. Conclusions CPFA resulted to be effective in liver detoxification. Thus, it may be considered as a “bridge technique” both to the liver transplant and to the recovery of the basal liver function.
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Affiliation(s)
- Gabriele Donati
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Andrea Angeletti
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Lorenzo Gasperoni
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Fabio Piscaglia
- Internal Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Anna Laura Croci Chiocchini
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Anna Scrivo
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Teresa Natali
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Ines Ullo
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Chiara Guglielmo
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy
| | - Patrizia Simoni
- Laboratory of Gastroenterology, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Rita Mancini
- Metropolitan Laboratory, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Luigi Bolondi
- Internal Medicine Unit, S. Orsola Hospital, University of Bologna, Bologna, Italy
| | - Gaetano La Manna
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplantation Unit, S. Orsola Hospital, University of Bologna, Via G. Massarenti 9 (Pad. 15), 40138, Bologna, Italy.
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Shan L, Sun Y, Shan F, Li L, Xu ZP. Recent advances in heparinization of polymeric membranes for enhanced continuous blood purification. J Mater Chem B 2020; 8:878-894. [PMID: 31956883 DOI: 10.1039/c9tb02515d] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Continuous blood purification technology such as hemodiafiltration has been used worldwide for saving patients suffering from severe diseases or organ function failure, especially in the intensive care unit and emergency setting. The filters as core devices are commonly made of polymer materials as hollow fiber membranes. However, the membrane is often inductively blocked by blood clot formation due to its interactions with blood components. Heparin is the anticoagulant often used in clinical practice for anti-coagulation. Recently, heparin is also employed to modify the hollow fiber membranes either chemically or physically to improve the filtration performance. This review summarizes recent advances in methodology for surface heparinization of such hollow fiber membranes, and their filtration performance improvement. The review also provides expert opinions for further research in this rapidly expanding field.
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Affiliation(s)
- Liang Shan
- Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao 266003, China and Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, Brisbane 4072, Australia.
| | - Yunbo Sun
- Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Feng Shan
- Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao 266003, China
| | - Li Li
- Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, Brisbane 4072, Australia.
| | - Zhi Ping Xu
- Australian Institute for Bioengineering and Nanotechnology (AIBN), The University of Queensland, Brisbane 4072, Australia.
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Napp LC, Ziegeler S, Kindgen-Milles D. Rationale of Hemoadsorption during Extracorporeal Membrane Oxygenation Support. Blood Purif 2019; 48:203-214. [PMID: 31096211 PMCID: PMC6878728 DOI: 10.1159/000500015] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/29/2019] [Indexed: 12/14/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support are increasingly used for treating various forms of shock, lung failure, protected interventions and life support including resuscitation. Most patients on ECMO are affected by a systemic inflammatory response caused by the underlying disease as well as the ECMO support itself, which contributes to vasoplegia, multi-organ failure, deterioration and death. Unfortunately, effective strategies for control of inflammation and related organ failure and shock on ECMO are lacking. Recently, a new polystyrene-based device for hemoadsorption, which aims to reduce excessive levels of inflammatory molecules such as interleukins, cytokines as well as damage- and pathogen-associated molecular patterns, has become available. Here we summarize the rationale, available data and technical aspects of polystyrene-based hemoadsorption during ECMO support, and give recommendations based on existing experience.
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Affiliation(s)
- L Christian Napp
- Department of Cardiology and Angiology, Cardiac Arrest Center, Advanced Heart Failure Unit, Hannover Medical School, Hannover, Germany,
| | - Stephan Ziegeler
- Department of Anesthesiology, Operative Intensive Care Medicine, Pain Management and Emergency Medicine, Hospital Ibbenbüren, Ibbenbüren, Germany
| | - Detlef Kindgen-Milles
- Department of Anesthesiology, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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20
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Ma Y, Chen J, Li J, Han W, Chai Y, Wang T, Zhang Q, Wang L, Wang W, Wang Z, Ou L. Selective adsorption of bilirubin against albumin to alkylamine functionalized PVA microspheres. JOURNAL OF BIOMATERIALS SCIENCE-POLYMER EDITION 2019; 30:337-354. [PMID: 30486758 DOI: 10.1080/09205063.2018.1553104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adsorbents are widely used in hemoperfusion for bilirubin removal. However, their performance is often compromised by the presence of plasma proteins. In this study, the bilirubin adsorption capacity of polyvinyl alcohol microspheres (PVAm) functionalized with different amino-alkane ligands has been investigated, with the aim of gaining binding selectivity over albumin. Octylamine-functionalized PVA microspheres (PVAm-8) exhibited an excellent adsorption capacity for bilirubin (75% and 3.95 mg/mL in PBS vs 72% and 3.84 mg/mL in albumin solution) when compared to the clinical adsorbent BPR (92% and 4.84 mg/mL in PBS vs 71%, and 3.80 mg/mL in albumin solution). The bilirubin adsorption capacities of PVAm-8 were largely unaffected by the presence of albumin. Adsorption of bilirubin to PVAm-8 occurs mainly through hydrophobic effects, with adsorption consistent with the monolayer model and the pseudo-first-order model operating in both PBS and albumin solution. The effects of PVAm-8 on hemolytic activity, blood component stability and coagulant activity were negligible, indicating that PVAm-8 has good potential as a high-affinity bilirubin adsorbent for hemoperfusion applications.
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Affiliation(s)
- Yingda Ma
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Jian Chen
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Jian Li
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Wenyan Han
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Yamin Chai
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Tingting Wang
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Qian Zhang
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Lichun Wang
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Weichao Wang
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Zhexiang Wang
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
| | - Lailiang Ou
- a Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences , Nankai University , Tianjin , China
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Singh A, Mehta Y, Trehan N. Bilirubin Removal Using CytoSorb Filter in a Cardiac Surgical Patient. J Cardiothorac Vasc Anesth 2018; 33:881-883. [PMID: 30292390 DOI: 10.1053/j.jvca.2018.08.213] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Ajmer Singh
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurgaon, India
| | - Yatin Mehta
- Department of Cardiac Anaesthesia, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurgaon, India
| | - Naresh Trehan
- Department of Cardiac Surgery, Institute of Critical Care and Anesthesiology, Medanta-The Medicity, Gurgaon, India
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Mathew BT, Raji S, Dagher S, Hilal-Alnaqbi A, Mourad AHI, Al-Zuhair S, Al Ahmad M, El-Tarabily KA, Amin A. Bilirubin detoxification using different phytomaterials: characterization and in vitro studies. Int J Nanomedicine 2018; 13:2997-3010. [PMID: 29872292 PMCID: PMC5973425 DOI: 10.2147/ijn.s160968] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Activated carbon (AC) is a common adsorbent that is used in both artificial and bioartificial liver devices. METHODS Three natural materials - date pits of Phoenix dactylifera (fruit), Simmondsia chinensis (jojoba) seeds, and Scenedesmus spp. (microalgae) - were used in the present investigation as precursors for the synthesis of AC using physical activation. The chemical structures and morphology of AC were analyzed. Then, AC's bilirubin adsorption capacity and its cytotoxicity on normal liver (THLE2) and liver cancer (HepG2) cells were characterized. RESULTS Compared with the other raw materials examined, date-pit AC was highly selective and showed the most effective capacity of bilirubin adsorption, as judged by isotherm-modeling analysis. MTT in vitro analysis indicated that date-pit AC had the least effect on the viability of both THLE2 and HepG2 cells compared to jojoba seeds and microalgae. All three biomaterials under investigation were used, along with collagen and Matrigel, to grow cells in 3D culture. Fluorescent microscopy confirmed date-pit AC as the best to preserve liver cell integrity. CONCLUSION The findings of this study introduce date-pit-based AC as a novel alternative biomaterial for the removal of protein-bound toxins in bioartificial liver devices.
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Affiliation(s)
- Betty Titus Mathew
- Mechanical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Shaima Raji
- Electrical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sawsan Dagher
- Mechanical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ali Hilal-Alnaqbi
- Mechanical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
- Abu Dhabi Polytechnic, Abu Dhabi, United Arab Emirates
| | - Abdel-Hamid Ismail Mourad
- Mechanical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
- Mechanical Design Department, Faculty of Engineering, Helwan University, Helwan, Cairo, Egypt
| | - Sulaiman Al-Zuhair
- Chemical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Mahmoud Al Ahmad
- Electrical Engineering Department, College of Engineering, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Khaled Abbas El-Tarabily
- Biology Department, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Amr Amin
- Biology Department, College of Science, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Zoology/College of Science, Cairo University, Giza, Egypt
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Harm S, Schildböck C, Hartmann J. Removal of stabilizers from human serum albumin by adsorbents and dialysis used in blood purification. PLoS One 2018; 13:e0191741. [PMID: 29364955 PMCID: PMC5783404 DOI: 10.1371/journal.pone.0191741] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 01/10/2018] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Human serum albumin (HSA) is a monomeric multi-domain protein that possesses an extraordinary binding capacity. It plays an important role in storing and transporting endogenous substances, metabolites, and drugs throughout the human circulatory system. Clinically, HSA is used to treat a variety of diseases such as hypovolemia, shock, burns, hemorrhage, and trauma in critically ill patients. Pharmaceutical-grade HSA contains the stabilizers sodium caprylate and N-acetyltryptophanate to protect the protein from oxidative stress and to stabilize it for heat treatment which is applied for virus inactivation. MATERIAL AND METHODS The aim of this study was to determine if the two stabilizers can be depleted by adsorbent techniques. Several, adsorbents, some of them are in clinical use, were tested in batch and in a dynamic setup for their ability to remove the stabilizers. Furthermore, the removal of the stabilizers was tested using a pediatric high flux dialyzer. RESULTS The outcome of this study shows that activated charcoal based adsorbents are more effective in removal of N-acetylthryptophanate, whereas polystyrene based adsorbents are better for the removal of caprylate from HSA solutions. An adsorbent cartridge which contains a mix of activated charcoal and polystyrene based material could be used to remove both stabilizers effectively. After 4 hours treatment with a high flux dialyzer, N-acetyltryptophanate was totally removed whereas 20% of caprylate remained in the HSA solution.
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Affiliation(s)
- Stephan Harm
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna, Austria
- * E-mail:
| | - Claudia Schildböck
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
| | - Jens Hartmann
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
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Preparation of nano-CaCO3/polystyrene nanocomposite beads for efficient bilirubin removal. Colloids Surf B Biointerfaces 2018; 161:480-487. [DOI: 10.1016/j.colsurfb.2017.11.017] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/17/2017] [Accepted: 11/07/2017] [Indexed: 11/18/2022]
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Koertge A, Wasserkort R, Wild T, Mitzner S. Extracorporeal Hemoperfusion as a Potential Therapeutic Option for Critical Accumulation of Rivaroxaban. Blood Purif 2017; 45:126-128. [DOI: 10.1159/000484923] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 11/02/2017] [Indexed: 01/13/2023]
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Pavlenko D, Giasafaki D, Charalambopoulou G, van Geffen E, Gerritsen KGF, Steriotis T, Stamatialis D. Carbon Adsorbents With Dual Porosity for Efficient Removal of Uremic Toxins and Cytokines from Human Plasma. Sci Rep 2017; 7:14914. [PMID: 29097715 PMCID: PMC5668241 DOI: 10.1038/s41598-017-15116-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 10/20/2017] [Indexed: 11/28/2022] Open
Abstract
The number of patients with chronic kidney disease increases while the number of available donor organs stays at approximately the same level. Unavoidable accumulation of the uremic toxins and cytokines for these patients comes as the result of malfunctioning kidneys and their high levels in the blood result in high morbidity and mortality. Unfortunately, the existing methods, like hemodialysis and hemofiltration, provide only partial removal of uremic toxins and/or cytokines from patients' blood. Consequently, there is an increasing need for the development of the extracorporeal treatments which will enable removal of broad spectrum of uremic toxins that are usually removed by healthy kidneys. Therefore, in this work we developed and tested ordered mesoporous carbons as new sorbents with dual porosity (micro/meso) that provide selective and efficient removal of a broad range of uremic toxins from human plasma. The new sorbents, CMK-3 are developed by nanocasting methods and have two distinct pore domains, i.e. micropores and mesopores, therefore show high adsorption capacity towards small water soluble toxins (creatinine), protein-bound molecules (indoxyl sulfate and hippuric acid), middle molecules (β-2-microglobulin) and cytokines of different size (IL-6 and IL-8). Our results show that small amounts of CMK-3 could provide selective and complete blood purification.
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Affiliation(s)
- D Pavlenko
- (Bio)artificial organs, Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - D Giasafaki
- National Center for Scientific Research "Demokritos", Agia Paraskevi Attikis, 15341, Athens, Greece
| | - G Charalambopoulou
- National Center for Scientific Research "Demokritos", Agia Paraskevi Attikis, 15341, Athens, Greece
| | - E van Geffen
- (Bio)artificial organs, Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands
| | - K G F Gerritsen
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
| | - T Steriotis
- National Center for Scientific Research "Demokritos", Agia Paraskevi Attikis, 15341, Athens, Greece
| | - D Stamatialis
- (Bio)artificial organs, Department of Biomaterials Science and Technology, MIRA Institute for Biomedical Engineering and Technical Medicine, University of Twente, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
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Hartmann J, Harm S. Removal of bile acids by extracorporeal therapies: an in vitro study. Int J Artif Organs 2017; 41:0. [PMID: 28885663 DOI: 10.5301/ijao.5000643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2017] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Bile acids (BAs) accumulating in the circulation in patients with liver failure are considered to be responsible for pruritus, which strongly impairs quality of life of the affected patients. The aim of this study was the in vitro characterization of different BAs regarding their removability with high-flux dialysis as well as with different adsorbents, and the evaluation of their binding to plasma proteins. METHODS Dialysis experiments were conducted in pediatric circuits with human plasma. For the adsorption studies, batch tests using 10% adsorbent in spiked human plasma were carried out. The binding of BAs to plasma compounds was determined by centrifugation of spiked plasma through spin columns. Sieving coefficients were determined using an albumin filter and a high-flux dialyzer. RESULTS With high-flux dialysis, only hydrophilic BAs such as glycocholic and taurocholic acid could be removed efficiently, while all tested BAs were removed by adsorption. CONCLUSIONS In conclusion, the hydrophilicity of BAs plays a major role in their removability using extracorporeal approaches. Adsorption-based systems offer particular advantages for the removal of hydrophobic BAs.
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Affiliation(s)
- Jens Hartmann
- Center for Biomedical Technology, Danube University Krems, Krems - Austria
| | - Stephan Harm
- Center for Biomedical Technology, Danube University Krems, Krems - Austria
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A New Integrated Technique for the Supportive Treatment of Sepsis. Int J Artif Organs 2017; 40:4-8. [DOI: 10.5301/ijao.5000550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2017] [Indexed: 12/17/2022]
Abstract
Although there has been continuous, intensive research for many years in the field of sepsis treatment, currently available treatment options are limited, and there is still a lack of systems that efficiently remove endotoxins as well as mediators. Here, we discuss a newly developed, integrated technique that combines different aspects for their use in extracorporeal blood purification for the supportive treatment of liver failure and sepsis.
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Focus issue | Bioartificial organs and tissue engineering. Int J Artif Organs 2017; 40:133-135. [PMID: 28493275 DOI: 10.5301/ijao.5000599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2017] [Indexed: 12/27/2022]
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Biomimetic Principles to Develop Blood Compatible Surfaces. Int J Artif Organs 2017; 40:22-30. [DOI: 10.5301/ijao.5000559] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2017] [Indexed: 12/11/2022]
Abstract
Functionalized biomaterial surface patterns capable of resisting nonspecific adsorption while retaining their bioactivity are crucial in the advancement of biomedical technologies, but currently available biomaterials intended for use in whole blood frequently suffer from nonspecific adsorption of proteins and cells, leading to a loss of activity over time. In this review, we address two concepts for the design and modification of blood compatible biomaterial surfaces, zwitterionic modification and surface functionalization with glycans – both of which are inspired by the membrane structure of mammalian cells – and discuss their potential for biomedical applications.
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Chen J, Han W, Chen J, Zong W, Wang W, Wang Y, Cheng G, Li C, Ou L, Yu Y. High performance of a unique mesoporous polystyrene-based adsorbent for blood purification. Regen Biomater 2017; 4:31-37. [PMID: 28149527 PMCID: PMC5274706 DOI: 10.1093/rb/rbw038] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/23/2016] [Accepted: 10/24/2016] [Indexed: 12/13/2022] Open
Abstract
A multi-functional polystyrene based adsorbent (NKU-9) with a unique mesoporous and a high surface area was prepared by suspension polymerization for removal of therapeutic toxins in blood purification. The adsorbent produced had an almost equal amount of mesopore distribution in the range from 2 to 50 nm. The adsorption of serum toxins with different molecular weights were examined by in vitro adsorption assays and compared with some clinical currently used adsorbents such as HA-330, Cytosorb and BL-300 which are produced by China, America and Japan, respectively. Test results indicated that the adsorption rate for pentobarbital by NKU-9 was 81.24% which is nearly as high as HA-330 (81.44%). The latter adsorbent is currently used for acute detoxification treatment in China. To reach adsorption equilibrium, NKU-9 was faster than HA-330, which implies short treatment time. For the removal of middle molecular toxins such as β2-microglobulin (98.88%), NKU-9 performed better adsorptive selectivity than Cytosorb (92.80%). In addition, NKU-9 showed high performance for the removal of albumin-bound toxins (e.g., bilirubin), and its adsorption rate for total bilirubin (80.79%) in plasma was 8.4% higher than that of anion exchange resin BL-300 which is currently used to eliminate bilirubin in clinic. Therefore, our results indicate that the newly developed adsorbent with a wide distribution and almost equal amount of mesopores is a multifunctional adsorbent for high efficient removal of serum toxins with different molecular weights which might be an excellent blood purification adsorbent especially to treat diseases that conventional medical methods are low or not efficient.
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Affiliation(s)
- Jian Chen
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Wenyan Han
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Jie Chen
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Wenhui Zong
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Weichao Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yue Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Guanghui Cheng
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Chunran Li
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Lailiang Ou
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yaoting Yu
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
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Updating the Journal Sections for the Evolution of Research and Clinical Applications in Artificial Organs. Int J Artif Organs 2016; 39:261-4. [DOI: 10.5301/ijao.5000515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2016] [Indexed: 12/18/2022]
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Harm S, Gabor F, Hartmann J. Low-dose polymyxin: an option for therapy of Gram-negative sepsis. Innate Immun 2016; 22:274-83. [PMID: 26993088 PMCID: PMC4834512 DOI: 10.1177/1753425916639120] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 02/15/2016] [Indexed: 12/19/2022] Open
Abstract
Endotoxins are the major components of the outer membrane of most Gram-negative bacteria and are one of the main targets in inflammatory diseases. The presence of endotoxins in blood can provoke septic shock in case of pronounced immune response. Here we show in vitro inactivation of endotoxins by polymyxin B (PMB). The inflammatory activity of the LPS–PMB complex in blood was examined in vitro in freshly drawn blood samples. Plasma protein binding of PMB was determined by ultracentrifugation using membranes with different molecular cut-offs, and PMB clearance during dialysis was calculated after in vitro experiments using the AV1000S filter. The formed LPS–PMB complex has lower inflammatory activity in blood, which results in highly reduced cytokine secretion. According to in vitro measurements, the appropriate plasma level of PMB for LPS inactivation is between 100 and 200 ng/ml. Furthermore, the combination of cytokine removal by adsorbent treatment with LPS inactivation by PMB dosage leads to strong suppression of inflammatory effects in blood in an in vitro model. Inactivation of endotoxins by low-dose intravenous PMB infusion or infusion into the extracorporeal circuit during blood purification can be applied to overcome the urgent need for endotoxin elimination not only in treatment of sepsis, but also in liver failure.
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Affiliation(s)
- Stephan Harm
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Althanstraße 14, A-1090 Vienna, Austria
| | - Franz Gabor
- Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Althanstraße 14, A-1090 Vienna, Austria
| | - Jens Hartmann
- Department for Health Sciences and Biomedicine, Danube University Krems, Krems, Austria
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Dieter Falkenhagen (1942–2015): A Multifaceted Scientist. Int J Artif Organs 2015; 38:617-23. [DOI: 10.5301/ijao.5000454] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2015] [Indexed: 11/20/2022]
Abstract
Dieter Falkenhagen was born in 1942 in Dresden, Germany and died in 2015. He specialized in internal medicine and nephrology. Focusing on artificial organ research, he investigated various aspects of the efficacy and safety of hemodialysis and adsorption technologies, including biocompatibility issues related to blood versus surface interactions and the adverse effects of endotoxin contamination. He studied various mathematical models to analyze efficacy and safety, and animal models to help clarify uncertainty issues. Through his studies, adsorbents were developed, resulting in Prometheus, an artificial liver support device. Anticoagulation models, including citrate perfusion, were improved and made safer by his work. He also stepped into bioreactor research to increase efficacy of liver support devices.
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Characterization of Adsorbents for Cytokine Removal from Blood in an In Vitro Model. J Immunol Res 2015; 2015:484736. [PMID: 26770992 PMCID: PMC4685123 DOI: 10.1155/2015/484736] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/05/2015] [Accepted: 11/10/2015] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Cytokines are basic targets that have to be removed effectively in order to improve the patient's health status in treating severe inflammation, sepsis, and septic shock. Although there are different adsorbents commercially available, the success of their clinical use is limited. Here, we tested different adsorbents for their effective removal of cytokines from plasma and the resulting effect on endothelial cell activation. METHODS The three polystyrene divinylbenzene (PS-DVB) based adsorbents Amberchrom CG161c and CG300m and a clinically approved haemoperfusion adsorbent (HAC) were studied with regard to cytokine removal in human blood. To induce cytokine release from leucocytes, human blood cells were stimulated with 1 ng/ml LPS for 4 hours. Plasma was separated and adsorption experiments in a dynamic model were performed. The effect of cytokine removal on endothelial cell activation was evaluated using a HUVEC-based cell culture model. The beneficial outcome was assessed by measuring ICAM-1, E-selectin, and secreted cytokines IL-8 and IL-6. Additionally the threshold concentration for HUVEC activation by TNF-α and IL-1β was determined using this cell culture model. RESULTS CG161c showed promising results in removing the investigated cytokines. Due to its pore size the adsorbent efficiently removed the key factor TNF-α, outperforming the commercially available adsorbents. The CG161c treatment reduced cytokine secretion and expression of cell adhesion molecules by HUVEC which underlines the importance of effective removal of TNF-α in inflammatory diseases. CONCLUSION These results confirm the hypothesis that cytokine removal from the blood should approach physiological levels in order to reduce endothelial cell activation.
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