The Next Step from High-Flux Dialysis: Application of Sorbent Technology

Winchester, James F.; Ronco, Claudio; Brady, James A.; Cowgill, Larry D; Salsberg, Jamie A.; Yousha, Eric; Choquette, Mike; Albright, Robert L.; Clemmer, J; Davankov, V. A.; Tsyurupa, M. P.; Павлова, Л. А.; Pavlov, Mikhail; Cohen, Gerald; Hörl, Walter H.; Gotch, Frank A.; Levin, Nathan W.

doi:10.1159/000046989

Cited by 37 publications

(16 citation statements)

References 28 publications

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“…This is impractical, even at risk for hemodynamically unstable patients, such as septic shock. Meanwhile, it has been reported that the adsorptive resin was capable of signifi cantly removing middle molecular weight substances including various cytokines [22] . Ronco et al [23] developed and reported the continuous plasma fi ltration adsorption, a combination of plasma fi ltration and adsorption by resin.…”

Section: Discussionmentioning

confidence: 99%

Cytokine Adsorptive Property of Various Adsorbents in Immunoadsorption Columns and a Newly Developed Adsorbent: An in vitro Study

et al. 2004

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Background/Aims: Cytokines play important roles in the pathophysiology of systemic inflammatory response syndrome (SIRS) and sepsis. Therefore, some effective measures to remove cytokines from the bloodstream could be effective in the treatment of SIRS and sepsis. The aim of this study was to evaluate the cytokine adsorptive property of various adsorbents for the purpose of the development of new selective cytokine adsorption columns. Methods: The cytokine adsorptive property of adsorbent in a CF-X column, which consists of cellulose beads cross-linked with hexamethylene-di-isocyanate, was compared with those of various adsorbents in currently available immunoadsorption columns, such as Immusorba TR^®, Immusorba PH^®, Selesorb^®, and Lixelle^®, in vitro batchwise test using patients’ plasma. A newly developed adsorbent, MPCF-X, which was modified by coating the surface of the adsorbent in CF-X with 2-methacryloyloxyethyl phosphorylcholine (MPC), was also tested for its cytokine adsorptive property. Results: The adsorbent in CF-Xshowed a significantly higher adsorption rate for TNF-α, interleukin (IL)-6 and IL-10 compared with other adsorbents (p < 0.05). Adsorbent in Lixelle^® showed good affinity to TNF-α and IL-8. Especially, the adsorbent in CF-X almost completely removed TNF-α, whereas it also had considerable affinity to normal IgG. MPCF-X showed decreased affinity to IgG with considerable adsorptive properties to cytokines. Conclusion: Selective cytokine adsorption columns could be developed with improvement of currently available adsorbents. Such a new selective cytokine adsorption column could be clinically applied for the treatment of SIRS/sepsis.

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Section: Discussionmentioning

confidence: 99%

Cytokine Adsorptive Property of Various Adsorbents in Immunoadsorption Columns and a Newly Developed Adsorbent: An in vitro Study

et al. 2004

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“…Continuous venovenous hemofiltration (CVVH) with dialysis or continuous hemodiafiltration (CHDF) was first used for the treatment of hyper-cytokinemia in 1993 [46], and many of the subsequent efforts focused on this approach to improve outcomes in sepsis [46][47][48][49][50][51]. However, randomized controlled trials (RCTs) were unable to demonstrate clear outcome benefits with dialysis in patients with sepsis [52,53], and the inability to remove middle molecular weight toxins led to the need for supplementary hemoadsorption therapy [50,54,55].…”

Section: History Of Cytokine Adsorption Therapymentioning

confidence: 99%

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

et al. 2018

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Cytokines play a critical role in coordinating and amplifying a host immune response to infection. The normal pattern of localized and systemic release of proinflammatory and anti-inflammatory cytokines varies on the basis of the disease process. A dysregulated cytokine response can lead to a hyper-inflammatory condition called a cytokine storm. This is believed to contribute to the pathophysiology of sepsis and septic shock, a condition carrying high morbidity and mortality in critically ill patients. Extracorporeal cytokine hemoadsorption is an emerging technology utilized in the treatment of dysregulated inflammatory states such as sepsis, although there is a paucity of clinical evidence supporting its outcomes benefits. We assess the peer-reviewed literature relating to cytokine hemoadsorption in the context of sepsis and suggest areas of future research incorporating this novel technology.

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“…The adsorptive resins used in the studies [36] described here (BetaSorb™ and CytoSorb™, RenalTech, New York, N.Y., USA), are capable of removing lowmolecular-weight protein toxins from blood, such as ß 2 -microglobulin, leptin, retinol-binding protein, complement factor D, IL-18 and angiogenin [37], as well as the proinflammatory cytokines TNF-·, IL-1ß, IL-6, IL-10 and TNF-· [38][39][40].…”

Section: Rationale For Sorbents In Arf and Esrdmentioning

confidence: 99%

Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

et al. 2004

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Renal replacement therapy in acute renal failure (ARF) and chronic renal failure (end-stage renal disease; ESRD) has been based on the use of modifications of dialysis (continuous arteriovenous hemofiltration and hemodiafiltration) to remove middle-molecular-weight toxins, consisting of low-molecular-weight proteins and peptides (LMWP) and cytokines involved in inflammation. High-flux dialyzers are not efficient at removing LMWP, and for this reason, sorbents have been studied to augment or replace dialysis. Removal of LMWP such as β₂-microglobulin, leptin, complement factor D, angiogenin and cytokines such as interleukin (IL)-1, IL-6, IL-10, IL-18 and tumor necrosis factor-α has been established in animal models of sepsis and in ESRD patients using sorbents. Sorbent devices added to hemodialysis, or the use of such devices alone in inflammatory states, including sepsis, ARF, cardiopulmonary bypass, pre-explantation of donor organs and ESRD, are being studied.

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The Next Step from High-Flux Dialysis: Application of Sorbent Technology

Cited by 37 publications

References 28 publications

Cytokine Adsorptive Property of Various Adsorbents in Immunoadsorption Columns and a Newly Developed Adsorbent: An in vitro Study

Cytokine Adsorptive Property of Various Adsorbents in Immunoadsorption Columns and a Newly Developed Adsorbent: An in vitro Study

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

Sorbents in Acute Renal Failure and End-Stage Renal Disease: Middle Molecule and Cytokine Removal

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