The LIFT trial: study protocol for a double-blind, randomised, placebo-controlled trial of K+-binder Lokelma for maximisation of RAAS inhibition in CKD patients with heart failure

BACKGROUND

CKD is common in heart failure (HF) and associated with morbidity and mortality, yet life-prolonging medications such as renin-angiotensin-aldosterone inhibitors (RAASi) are underused due to risk of hyperkalaemia. Sodium zirconium cyclosilicate (SZC) is a potassium-binding medication that has been shown to reduce incidence of hyperkalaemia in CKD, non-CKD, and HF populations, which we propose will support maximisation of RAASi therapy.

METHODS

We propose a 1:1 randomised, double-blind, placebo-controlled trial in which participants will receive either SZC or placebo. We will up-titrate participants' RAASi therapy while monitoring their serum potassium levels and adjusting their SZC dose if necessary. Participants with CKD and HF will be recruited from CKD and HF clinics at St George's Hospital. The total study period will be 18 months; 130 participants will be enrolled for approximately two months each following screening. Our primary outcome will be the proportion of participants who achieve maximum RAASi dose while maintaining normokalaemia. Secondary outcomes include participants reaching maximum RAASi dose without severe hyperkalaemia; time from randomisation to hyperkalaemia; time from randomisation to severe hyperkalaemia; number of RAASi dose escalations per participant; final doses of RAASi therapy; changes in quality of life score, eGFR, ACR, serum sodium, troponin T; number and duration of hospital admissions; and within-participant change in serum potassium compared to baseline.

DISCUSSION

This trial will be the first to examine the use of SZC for the maximisation of RAASi dosing in patients with advanced CKD and HF. We will assess the impact of achieving target RAASi dosing on hospital admission rates and duration of stay, with the hope that optimum RAASi treatment will translate into reduced morbidity and improved QoL. If clinical benefit is demonstrated, we hope that the joint multidisciplinary CKD-HF approach will be expanded.

TRIAL REGISTRATION

EudraCT number 2020-002946-18. Registered on 08 June 2020. Online record pending.

Hemoperfusion in diabetic coma

Hemoperfusion on ionic exchange resins in the therapy of diabetic keto-acidosis (DKA) coma is proposed. Resins used are strong anionic resins in mixed form able to release bicarbonates and to trap ketoanions and organic anions in a stoichiometric manner. A series of trials in open circuit are performed in order to search for a suitable mixture of resins and to establish the amounts of HCO3- and ketoanions respectively released or entrapped. Therefore, ten simulated hemoperfusions in closed circuit systems were performed, utilizing cartridges containing 1,700 g of mixed resin (9% HCO3- form and 91% Cl- form). The results indicate that all side effects of bicarbonate i.v. therapy of DKA coma are avoided because of the smooth HCO3- administration to the patient. Furthermore, a good removal of ketoanions and organic acids is obtained without changing the blood osmolality.

Resin hemoperfusion for unconjugated bilirubin removal

The application of an anionic macroreticular ion exchange resin, coated with a thin cross-linked albumin layer, as a hemoperfusion device for the removal of unconjugated bilirubin from the blood of hyperbilirubinemic newborn babies is reviewed. In vivo hemoperfusion runs with hyperbilirubinemic animal models - either by a choledocho-suprarenal vein shunt or by direct infusion of bilirubin into the vein - showed that a 40-ml resin column can remove some 20 mg bilirubin in 3 h. Hemoperfusion of female 8-14 kg baboons showed no significant effect of the column on blood chemistry and coagulation factors and repeated runs had no ill effects.

The use of lipid-lowering drug therapy in children and adolescents

Atherosclerosis, the condition underlying cardiovascular disease (CVD), often begins in childhood. Therefore, strategies to prevent CVD should be implemented at an early age, especially in populations at high risk for CVD. In addition to lifestyle interventions, these strategies include pharmacological treatment of dyslipidemia, a well-established risk factor for CVD in adults. Several lipid-lowering agents have been evaluated in children; however, long-term safety and efficacy data are lacking. As in adults, statins are the preferred pharmacological agents in pediatric practice due to excellent efficacy and tolerability, with few adverse safety outcomes observed to date. Nevertheless, more studies are needed to confirm the lifelong benefit of lipid-lowering therapy initiated in childhood.

Reduction of dioxins and polychlorinated biphenyls (PCBs) in human body

The accumulation of persistent lipophilic organic pollutants like dioxins and PCBs in human body is of great concern since many of these compounds may elicit adverse health effects on humans. To reduce dioxins and PCBs with long half-lives that are absorbed into the human body, we need to work actively to minimize accumulation of dioxins and PCBs taken. Lot of manner has been tested such as foods containing dietary fibers and chlorophyll, lipids (squalane etc) and anion exchange resins. Cholestyramine, a cholesterol lowering agent, was no efficacy in humans. Authors have conducted a pilot study to demonstrate the effect lowering dioxin in human bodies using colestimide. Nine patients on cdestimide for 6 months, showed mean 20% decrease respectively in both dioxin and PCB levels, and the maximum percentage decrease was approximately 40%. From a standpoint to avoid the influence on high-risk group and high-risk life stage other than next generation, the world-wide cooperation for reducing environmental chemicals is greatly appealed.

The effect of combination therapy with propylthiouracil and cholestyramine in the treatment of Graves' hyperthyroidism

OBJECTIVE

The study aims to evaluate the efficacy of combination therapy with propylthiouracil (PTU) and cholestyramine in the treatment of Graves' hyperthyroidism.

BACKGROUND

Thyroxine (T4) is metabolized mainly in the liver by conjugation to glucuronides and sulphates that enter the enterohepatic circulation. Thyrotoxic patients have an abnormal increase in thyroid hormone in their enterohepatic circulation. Previous studies on combination therapy with methimazole and cholestyramine for Graves' hyperthyroidism have shown it to be an effective adjunctive treatment. In this study, we examined the efficacy of combination therapy with PTU and cholestyramine in the treatment of Graves' hyperthyroidism.

METHODS

Thirty patients with newly diagnosed Graves' hyperthyroidism were randomly divided into two groups: group I (n = 15) received PTU 100 mg twice a day, propranolol 40 mg twice a day and cholestyramine 4 g twice a day for 4 weeks; group II (n = 15) received PTU 100 mg twice a day and propranolol 40 mg twice a day for 4 weeks. The therapeutic efficacy was determined by serum total triiodothyronine (TT3), free thyroxine (FT4) and TRAb levels at baseline, and at the end of 2 and 4 weeks during the study period.

RESULTS

There was no significant difference in baseline thyroid function parameters. At the end of 2 and 4 weeks of the study period, serum TT3 and FT4 levels of group I were significantly lower than those of group II. No significant differences in the TRAb level were found between the two groups.

CONCLUSION

Cholestyramine contributed to a more rapid and complete decline in thyroid hormone levels in patients with Graves' hyperthyroidism. It was thus proved to be an effective and well-tolerated adjunctive therapy.

[Front line of management of hyperphosphatemia in hemodialysis patients]

Management of hyperphosphatemia in hemodialysis patients is very important to prevent progress of renal hyperparathyroidism or ectopic calcification. Sevelamer hydrochloride is a Ca and Al free phosphate binder, and reduces serum phosphorus level, without any influence on serum Ca level, and Ca-P products. This compound is expected to reduce the incidence of arterial calcification, and improve the QOL (quality of life) of hemodialysis patients.

[Treatment of bone disease in chronic kidney disease and in renal transplant recipients under K/DOQI clinical practice guidelines]

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (K/DOQI) provides evidence based clinical practice guidelines developed for all phases of kidney disease and related complications, from diagnosis to monitoring and management. Bone disease sets in during the early stages of Chronic Kidney Disease (CKD). Bone disease is observed in almost patients with chronic renal failure and after renal transplantation. Hyperparathyroid (high turnover) bone disease in patients with chronic renal failure is found most frequently followed by mixed osteodystrophy, low-turn over bone disease, and osteomalasia. Ninety to one hundred percent of kidney transplant patients have histological evidence of osteodystrophy and osteopenia (reduction of bone mass) following renal transplantation. Furthermore, osteoporosis is also appeared in many renal transplant recipients. After renal transplantation, renal osteodystrophy generally improves but bone mineral density (BMD) often worsens. When renal bone disease is assessed using a combination of biochemical markers, histology and bone densitometry, early intervention and carefully effective therapies might be reduced the morbidity associated with these common problems.

Middle molecules and small-molecular-weight proteins in ESRD: properties and strategies for their removal

Molecular weight has traditionally been the parameter most commonly used to classify uremic toxins, with a value of approximately 500 Da frequently used as a demarcation point below which the molecular weights of small nitrogenous waste products fall. This toxin group, the most extensively studied from a clinical perspective, is characterized by a high degree of water solubility and the absence of protein binding. However, uremia is mediated by the retention of a plethora of other compounds having characteristics that differ significantly from those of the previously mentioned group. As opposed to the relative homogeneity of the nitrogenous metabolite class, other uremic toxins collectively are a very heterogeneous group, not only with respect to molecular weight but also other characteristics, such as protein binding and hydrophobicity. A recently proposed classification scheme by the European Uraemic Toxin Work Group subdivides the remainder of molecules into 2 categories: protein-bound solutes and middle molecules. For the latter group, the Work Group proposes a molecular weight range (500-60,000 Da) that incorporates many toxins identified since the original middle molecule hypothesis, for which the upper molecular weight limit was approximately 2,000 Da. In fact, low-molecular-weight peptides and proteins (LMWPs) comprise nearly the entire middle molecule category in the new scheme. The purpose of this article is to provide an overview of the middle molecule class of uremic toxins, with the focus on LMWPs. A brief review of LMWP metabolism under conditions of normal (and in a few cases, abnormal) renal function will be presented. The physical characteristics of several LMWPs will also be presented, including molecular weight, conformation, and charge. Specific LMWPs to be covered will include beta 2-microglobulin, complement proteins (C3a and Factor D), leptin, and proinflammatory cytokines. The article will also include a discussion of the treatment-related factors influencing dialytic removal of middle molecules. Once these factors, which include membrane characteristics, protein-membrane interactions, and solute removal mechanisms, are discussed, an overview of the different therapeutic strategies used to enhance clearance of these compounds is provided.

Role of colestipol in the treatment of hyperthyroidism

The enterohepatic circulation of thyroxine (T4) and triiodothyronine (T3) is higher in thyrotoxicosis. Bile-salt sequestrants bind iodothyronines and thereby increase their fecal excretion. We, therefore, evaluated the effect of colestipol-hydrochloride administration on clinical and biochemical indices of patients with hyperthyroidism. In a prospective, controlled trial, ninety-two adult volunteers with Graves' disease, toxic autonomous nodule or toxic multinodular goiter were randomly assigned into the following treatment protocols: Group 1, 30 mg of methimazole (MMI) and 20 g of colestipol-hydrochloride (COL) daily; Group 2, 30 mg of MMI daily; and Group 3, 15 mg of MMI 20 g of COL daily. The patients were further classified into Group A, severe hyperthyroidism (baseline levels of total T3 (TT3) > or =5 nmol/l) and Group B, mild to moderate thyrotoxicosis (baseline levels of TT-3<5 nmol/l). Crook's clinical index, serum free T4 (FT4), TT3 and thyroid stimulating hormone (TSH) levels were determined before (WO), following one week (W1) and two weeks (W2) of treatment. Serum TT3 level decreased (mean+/-SE) at W1 by 40.8+/-2.6% of WO in Group1 and by 29.2+/-2.4% in Group 2 (p<0.001), and down further to 47.8+/-3.0% at W2 in Group 1, and 40.6+/-2.8% in Group 2 (p=0.01). Serum FT4 level decreased (mean+/-SE) from WO to W1 by 31.7+/-2.7% in Group 1 and by 16.2+/-3.1% in Group 2 (p=0.005), and down to 49.1+/-2.8% of WO at W2 in Group 1 and to 38.7+/-3.5% in Group 2 (p=0.07). In sub groups B COL was not effective in reducing thyroid hormone levels nor in ameliorating the clinical status of the patients. However, in Group A3 COL lowered FT4 (p=0.001) and TT3 (p=0.05) levels as compared to group A2. At W2 the clinical hyperthyroidism score improved faster in Group A1 (p<0.001) and Group A3 (p=0.012) as compared to the control Group A2. In conclusion, COL is an effective and well tolerated adjunctive agent in the treatment of hyperthyroidism. Its main effect is in severe cases of thyrotoxicosis, and in the first phase of treatment. As adjunctive COL treatment in hyperthyroidism allows reducing MMI dosage it may decrease the rate of dose dependent MMI side effects.

[The pathophysiology and treatment of cholestatic pruritus]

Pruritus is a frequent, distressing and sometimes disabling symptom of liver and biliary tract disorders. Results of treatment are sometimes disappointing and the pathophysiology is still largely unknown. It was recently discovered that endogenous opioids contribute to the perception of itching and that opiate receptor antagonists can reduce the overstimulation of these receptors and thereby attenuate the itching. A stepwise treatment strategy focusing successively on ion exchange resins, rifampicin and opiate receptor antagonists leads to effective alleviation of itching in most patients.

Bile acid dysfunction after clam enterocystoplasty

OBJECTIVE

To determine if the bowel dysfunction that develops in approximately 12% of patients after a clam enterocystoplasty is due to disruption of the enterohepatic circulation of bile acids.

PATIENTS AND METHODS

Fourteen symptomatic patients (mean age 36 years, range 21-65) who had undergone clam enterocystoplasty were investigated by bowel frequency charts, hydrogen breath tests of expired air and the retention of radioactive 75Se-labelled homocholic acid-taurine (SeHCAT), a synthetic bile acid. Patients with abnormal results were commenced on anion-exchange resins and the symptoms evaluated 6 weeks later.

RESULTS

The interruption of bile acid circulation, as estimated by SeHCAT, occurred in most of the patients studied and was due to surgical resection of the terminal ileum. All hydrogen breath tests were normal, excluding bacterial overgrowth as a cause of diarrhoea. Bowel frequency correlated well with the percentage of SeHCAT retained. Anion-exchange resins were successful in relieving the symptoms if patients complied well with the treatment.

CONCLUSIONS

After clam enterocystoplasty, some patients have bowel dysfunction caused by the interruption of the enterohepatic circulation of bile acids. These patients can be identified using bowel frequency charts and treated by anion-exchange resins.

[Progress in the treatment of atherosclerotic vascular diseases]

The treatment of atherosclerotic vascular diseases has improved greatly. Clinical and epidemiological studies have recently revealed the following data. Changes in lifestyles is extremely effective and should be prevailed widely. Amelioration of atherosclerosis by drugs, including hypolipidemics, antihypertensives and antioxidant agents, is also confirmed. Skills and devices are much improved in PTCA and DCA which face the possibility of restenosis. Control of risk factors is also considered to be important to prevent restenosis.

[Treatment and evolution of 100 cases with staghorn lithiasis]

We reviewed 100 selected cases of staghorn stone that have been followed for at least 3 years after treatment. The results achieved by surgery (e.g., intrasinusal pyelolithotomy) and non-surgical treatment (e.g., ion exchanger) are presented. Overall, good results were achieved in 57% of the cases.

Controlled trial of nicotine polacrilex gum with supportive measures

In a placebo-controlled, double-blind, 2-year prospective study, 182 smokers were given either nicotine polacrilex gum containing 4 mg of nicotine (n = 92) or a placebo (n = 90). The number of participants abstinent at 2-year follow-up was 41 (44.6%) of 92 in the nicotine group vs 28 (31.1%) of 90 in the placebo group. Abstinence rates for daily nicotine gum users (n = 64) at 12 months and again at 24 months remained 48.4%, as compared with 26.1% and 31.9% for the daily placebo gum users (n = 69). Of participants with a high nicotine-dependence score, those allotted to the nicotine group rather than to the placebo group were 13 times more likely to be abstaining at the 2-year follow-up. Use of nicotine polacrilex gum, therefore, can substantially aid in stopping smoking, particularly among highly dependent smokers.

[Ion-exchange hemosorption in the intensive therapy of liver insufficiency in patients with obstructive jaundice]

Hemosorption on thromboresistant ion-exchange resins synthetized at D. I. Mendeleev Moscow Chemical Technological Institute (MCTI) was used in combined therapy of hepatic failure. Use was made of anion-exchange resin A-I-II MCTI, catonit C-I-II MCTI, polyampholit. Stability of hemodynamic parameters, absence of blood element disturbances, effective sampling of anionic and cationic metabolites have been observed.

Composition and structure of renal and ureteral calculi in patients under covalitin therapy

We examined the composition and texture of 53 urinary calculi from patients receiving Covalitin therapy. The texture of the infection stones and of concrements containing mainly apatite showed no changes as compared to concrements from control groups receiving no such therapy. Calcium oxalate stones more often showed a whewellite texture (Type 2) and a less frequent occurrence of weddellite (Type 4) as compared to the control groups. Surface or marginal changes indicating a possible litholysis could not be shown.

Pharmacologic treatment of calcium calculi

Selective pharmacologic therapy of calcium nephrolithiasis is highly effective in preventing new stone formation. A remission rate of greater than 80 per cent and overall reduction in individual stone formation rate of greater than 90 per cent can be obtained in patients with calcium nephrolithiasis. In patients with mild-to-moderate severity of stone disease, virtually total control of stone disease can be achieved as evidenced by remission rates of greater than 95 per cent. The need for stone removal may be dramatically reduced by an effective prophylactic program. Selective pharmacologic therapy of calcium nephrolithiasis also encompasses the advantages of overcoming the nonrenal manifestations of conditions that cause stone formation as well as averting certain side effects that may be caused by nonselective medical therapy. Despite these advantages, selective medical therapy clearly cannot provide total control of stone disease. A satisfactory response requires continued, dedicated compliance by patients to the recommended program and a commitment of the physician to provide long-term follow-up and care.

The effectiveness of a cation resin (Kayexalate) as an adsorbent of paraquat: experimental and clinical studies

The cation-exchange-resin Kayexalate has an adsorption capacity for paraquat 15 times greater than activated charcoal and 6 times greater than Adsorbin. The oral LD50 of paraquat in rats rose 2.1 times by intragastric injection of Kayexalate. In the present study, the survival rate of rats given Kayexalate or Adsorbin after paraquat administration was examined. Results of clinical studies on 22 patients are also presented.

Management of antibiotic-associated pseudomembranous colitis

The diagnosis, etiology, epidemiology, and drug therapy of antibiotic-associated pseudomembranous colitis (AAPMC) are reviewed. AAPMC is an uncommon but potentially serious adverse reaction to therapy with almost any oral or injectable antibiotic and certain antineoplastic agents that alter intestinal flora. Proliferation of Clostridium difficile and subsequent release of clostridial cytotoxins cause pseudomembranous lesions and symptoms such as watery diarrhea, cramping abdominal pain, and low-grade fever. Symptoms can appear from four days after the start of antibiotic or antineoplastic therapy to 10 weeks after therapy has been discontinued. Drug therapy of AAPMC is directed at reducing the amount of Cl. difficile in the colon and promoting normalization of intestinal flora. Mild cases of AAPMC may respond to discontinuation of the etiologic agent and replacement of fluid and electrolytes. Therapy with an anticlostridial antibiotic is indicated in severe cases; although a seven- to 10-day course of oral vancomycin hydrochloride is the most widely recognized therapy, the drug is expensive and unpalatable. Good results have been reported with oral metronidazole and with bacitracin, both of which are less expensive than vancomycin. For all of these therapies, relapse rates are 20-39%. Anion exchange resins may be useful in mild cases of AAPMC. Successful management of AAPMC depends on a complex and ill-defined interrelationship between normal intestinal flora, patient immune response, antibiotic therapy, and the infecting clostridium strain. For moderate or severe cases of AAPMC, therapy should begin with metronidazole or bacitracin and vancomycin should be reserved for refractory cases, relapses, or patients with allergies to the other agents.

Resin hemoperfusion in hepatic porphyrias

In three types of hepatic porphyrias, 32 hemoperfusions over polyhema-coated Amberlite XAD-2 resin were performed. An attack of acute intermittent porphyria subsided after a 6-h hemoperfusion. During the procedure, 13 L of plasma was completely cleared of porphyrins. In a child with variegate porphyria, the laboratory changes were slight and no clinical effect of hemoperfusion was seen. In a patient suffering from porphyria cutanea tarda resistant to standard therapy, 30 hemoperfusions were performed during a period of 10 months. The total plasma porphyrin concentration increased sharply following the start of the treatment, and preceding the fifth procedure it reached a peak of four times the initial value. Since then, the plasma porphyrin level decreased, eventually to one-half the starting value. The mean drop in porphyrin level during each perfusion was 22%. Similar changes were observed in the amount of porphyrins excreted into the urine, which, following an early rise, decreased to 25% of the initial value. However, the patient's skin vulnerability improved only slightly. There were no untoward effects of the treatment.

Pseudohypoaldosteronism in a child with Down syndrome. Long-term management of salt loss by ion exchange resin administration

At 4 weeks of age, an infant with Down syndrome developed severe dehydration and salt loss with the typical features of pseudohypoaldosteronism (PHA). Plasma renin activity, 11-deoxycorticosterone, corticosterone and aldosterone levels were all increased several-fold over the normal range for age, thus excluding an adrenal biosynthetic defect. Clinical condition, hyponatraemia and hyperkalaemia could be rapidly normalised by the ion exchange resin Resonium A administered first as enema and later orally (3 g/day). At that time, no further salt supplementation was necessary. At 18 months of age, Resonium A could be completely withdrawn with neither clinical deterioration nor electrolyte abnormalities. However at 3 1/2 years of age, plasma renin activity and aldosterone were still markedly elevated while precursor steroids were normal and the clinical condition satisfactory. No side effects were observed with the Resonium A therapy. The combination of trisomy 21 and PHA is very unusual. Similarly, the successful treatment of severe renal salt loss during infancy by sodium supplementation and concomitant potassium withdrawal via an oral ion exchange resin has not yet been described and warrants further therapeutic trials.

[Acute renal insufficiency in children]

Acute renal failure (ARF) implies a sudden decrease in glomerular filtration rate with consequent retention of nitrogen waste products, water and electrolytes normally excreted by the kidney. The causes of ARF fall into three main groups: prerenal, intrinsic, and postrenal. Prerenal or functional failure can usually be controlled by simple therapeutic measures. If unrelieved, it leads to the development of renal parenchymal damage. Early biochemical indices are useful in distinguishing prerenal from intrinsic renal failure. Potentially reversible obstruction must be searched for by ultrasonographic and radiological procedures, and rapidly relieved. Symptoms of ARF result from disturbance of physiological regulatory functions. Prerenal failure requires urgent vascular expansion and careful monitoring of fluid and electrolyte replacement. Established renal failure demands careful management of electrolyte and water overload, metabolic acidosis, anemia, hypertension, infections and nutrition. Peritoneal dialysis or hemodialysis should be prepared for whenever severe hypertension, pulmonary edema or worsening biochemistry occur. Acute renal failure has a generally good prognosis if properly treated.

Cation exchange resin preparation in recurrent calcium urolithiasis

The efficacy of the cation exchange preparation, Campanyl, was studied in animal experiments and also in patients with absorptive hypercalciuria suffering from recurrent calcium stones, both in short-term studies on several treatment groups and with long-term maintenance dosage. In a dose of 15 Gm daily, taken with the main meal, the preparation was well tolerated and no serious side effects occurred. The frequency of stone passage, compared with that in the pretreatment period, was reduced by more than half, and urinary calcium excretion was considerably reduced. Litholysis was not observed. Campanyl is considered to be especially useful in patients with hyperabsorptive hypercalciuria. Dosage should be adjusted individually according to urinary calcium concentration.

[Long-term clinical experiences with the cation exchanger UJOLYT as a metaphylactic in absorptive hypercalciuria and chronic recurring calcium oxalate lithiasis]

The UJOLYT cation exchange was checked in a clinically controlled study over a long period using 6 male test persons with chronically recidive calcium oxalate lithiasis and absorptive hypercalciuria. The PAK calcium load test proved clinically valuable in the differentiation of idiopathic hypercalciuria. The paraclinical findings revealed an average reduction of urinary calcium excretion by 40% and an increase of urinary magnesium excretion by 11.7% compared to the initial situation. The recidive frequency was clearly reduced. No serious side-effects were observed in the patients presented.

The effects of cholestyramine, colestipol, and ADR-132 on the rat prostate and dunning R-3327 adenocarcinoma

The effects of three compounds known to have hypocholesterolemic activity in several species were investigated on the rat prostate and the hormone-dependent R-3327 rat prostatic adenocarcinoma. Cholestyramine, colestipol, and ADR-132 are bile acid-sequestering anion exchange resins which were fed to separate groups of adult male Copenhagen X Fischer (F1) hybrid rats in doses of 0.25%, 1.00%, and 2.00% of diet. The results indicate that serum cholesterol levels in tumor-bearing rats and controls fed these compounds for 29 days were not reduced. The body and organ weights as well as the histological features of the prostate gland, seminal vesicles, and the R-3327 tumor were unaffected by these agents.

Preparation of a biocompatible albumin-coated ion exchange resin for bilirubin removal from the blood of jaundiced newborns

Removal of bilirubin by hemoperfusion with ion exchange resin particles is suggested to replace exchange transfusion of blood of jaundiced infants in some cases of unconjugated hyperbilirubinemia. The hemoperfusion system developed here consists of a packed bed of a macroreticular resin which is made biocompatible by a coating of a monomolecular layer of albumin. The choice of the appropriate ionic form of the resin and the proper albumin coating and crosslinking procedure assures a high bilirubin adsorption capacity and excellent blood compatibility of the resin. The albumin coated resin removes in vitro 80-90% of the bilirubin initially present in the plasma. The results encourage in vivo clinical studies.