Evaluation of an ADVanced Organ Support (ADVOS) system in a two-hit porcine model of liver failure plus endotoxemia

Al-Chalabi, Ahmed; Matevossian, Edouard; Thaden, Anne von; Schreiber, Catherine; Radermacher, Peter; Huber, Wolfgang; Garibay, Aritz Pérez Ruiz de; Kreymann, B.

doi:10.1186/s40635-017-0144-3

Cited by 12 publications

(15 citation statements)

References 45 publications

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“…Preclinical studies demonstrated high detoxification rates for protein-bound and water-soluble toxins. Removal of relevant amounts of CO 2 at blood flow rates typical for renal replacement therapies was shown in vitro [21][22][23]. A clinical case series using a prototype of the system demonstrated the ability to remove water-soluble and albumin-bound substances [24].…”

Section: ]mentioning

confidence: 99%

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Fuhrmann

Weber

Roedl

et al. 2020

Ann. Intensive Care

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Background: Prevalence of multiple organ failure (MOF) in critically ill patients is increasing and associated mortality remains high. Extracorporeal organ support is a cornerstone in the management of MOF. We report data of an advanced hemodialysis system based on albumin dialysis (ADVOS multi device) that can regulate acid-base balance in addition to the established properties of renal replacement therapy and albumin dialysis systems in critically ill patients with MOF. Methods: 34 critically ill patients with MOF received 102 ADVOS treatment sessions in the Department of Intensive Care Medicine of the University Medical Center Hamburg-Eppendorf. Markers of metabolic detoxification and acidbase regulation were collected and blood gas analyses were performed. A subgroup analyses were performed in patients with severe acidemia (pH < 7.2). Results: Median number of treatment sessions was 2 (range 1-9) per patient. Median duration of treatment was 17.5 (IQR 11-23) hours per session. Treatment with the ADVOS multi-albumin dialysis device caused a significant decrease in bilirubin levels, serum creatinine, BUN and ammonia levels. The relative elimination rate of bilirubin was concentration dependent. Furthermore, a significant improvement in blood pH, HCO 3 − and PaCO 2 , was achieved during ADVOS treatment including six patients that suffered from severe metabolic acidosis refractory to continuous renal replacement therapy. Delta pH, HCO 3 − and PaCO 2 were significantly affected by the ADVOS blood flow rate and pH settings. This improvement in the clinical course during ADVOS treatments allowed a reduction in norepinephrine during ADVOS therapy. Treatments were well tolerated. Mortality rates were 50% and 62% for 28 and 90 days, respectively. Conclusions: In this case series in patients with MOF, ADVOS was able to eliminate water-soluble and albuminbound substances. Furthermore, the device corrected severe metabolic and respiratory acid-base disequilibrium. No major adverse events associated with the ADVOS treatments were observed.

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Section: ]mentioning

confidence: 99%

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Fuhrmann

Weber

Roedl

et al. 2020

Ann. Intensive Care

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“…The free portion of toxins is then removed by a filtration process. The acidified and the alkalinized albumin dialysates finally join each other so that a physiological pH is generated before passage in the dialysate compartment of the haemodialyzers [29].…”

Section: Discussionmentioning

confidence: 99%

Effect of Ionic Strength, pH and Chemical Displacers on the Percentage Protein Binding of Protein-Bound Uremic Toxins

et al. 2018

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Background and Objectives: While trying to optimize the dialysis clearances of protein-bound uremic toxins (PBUTs), their percentage protein binding (% PB) is an important parameter. We evaluated the effects of ionic strength, pH change and chemical displacers on the dissociation of PBUTs from albumin in vitro. Methods: PBUTs, such as 3-Carboxy-4-methyl-5-propyl-2-furan-propanoic acid (CMPF), p-cresylsulfate (PCS), indoxyl sulfate (IS) and indole-3-acetic acid (IAA), were spiked with human serum albumin (HSA) solution prepared with different Nacl concentrations and pH values or in the presence of a series of chemical displacers. Ultrafiltration was performed to separate the free and bound fractions, and the % PB of each PBUT was calculated. Results: For all 4 compounds, their % PB decreased with increasing ionic strength, while only slight changes occurred when the pH of the test solution increased from pH 6.0 to pH 8.5; PCS, IS and 3-IAA were relatively easily dissociated from albumin by drug displacement, while CMPF was released from HSA by all studied drugs with difficulty; the PB % for CMPF, PCS, IS and 3-IAA decreased most remarkably in the presence of free fatty acids, such as oleic acid (41.73% for CMPF, 29.9% for PCS, 23.22% for IS, and 20.34% for 3-IAA) and linoleic acid (43.12% for CMPF, 16.65% for PCS, 29.99% for IS, and 16.29% for 3-IAA). Conclusion: The protein binding of PBUTs can be decreased by higher ionic strength, increased pH and the presence of some chemical displacers, including free fatty acids. Effective dialytic removal of PBUTs may be achieved by applying these methods jointly to blood-purification techniques.

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“…A modified device called advanced organ support (ADVOS) was first presented in 2013, which included a dialysate circuit containing standard dialysate with a 2-4% albumin concentration, an extracorporeal blood circuit, and a third and last circuit where the albumin dialysate was separated into two parts. Each part would undergo a PH and temperature change before reaching the cation and anion filters, resulting in dialysates that have albumin that is free of toxins [49,50]. This is accomplished by adding and removing acid or base.…”

Section: Other Devicesmentioning

confidence: 99%

Liver Assist Devices for Liver Failure

Mandal¹,

Garlapati²,

Tiongson³

et al. 2021

Liver Pathology

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Historically, mortality rates for liver failure have been high, regardless of the type. With new advancements in liver transplantation (LTx), 1-year survival rates have improved up to 95% in most recent estimates. While some patients may live past the critical period, the majority of patients do not survive the interval period for awaiting LTx or liver regeneration. The function of the liver to detoxify and correct several biochemical parameters has been achieved to some extent through artificial liver support technology, although constant innovations are still being developed for the most optimal liver support device. The complex function of the liver makes it challenging since it does not only detoxify toxic by-products but also participates in numerous other synthetic and metabolic functions of the body. Liver support systems are divided into an artificial liver assist device (ALD) and a bioartificial liver assist device (BLD). ALDs include molecular adsorbent recirculating system (MARS), Prometheus, single-pass albumin dialysis, and selective plasma filtration therapy. These devices work as a blood purification system of the liver. On the other hand, BLD has hepatic cell lines incorporated in its equipment, which aims to function as a complex biological liver system providing support to its biochemical processes. Several clinical and randomized trials have conflicting results on the survival of the patients with acute liver failure (ALF), and the ideal liver support system still seems a far-off goal.

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Evaluation of an ADVanced Organ Support (ADVOS) system in a two-hit porcine model of liver failure plus endotoxemia

Cited by 12 publications

References 45 publications

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Advanced organ support (ADVOS) in the critically ill: first clinical experience in patients with multiple organ failure

Effect of Ionic Strength, pH and Chemical Displacers on the Percentage Protein Binding of Protein-Bound Uremic Toxins

Liver Assist Devices for Liver Failure

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