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Novokhodko A, Hao S, Ahmad S, Gao D. Non-Cell-Based Extracorporeal Artificial Liver Systems: Historic Perspectives, Approaches and Mechanisms, Current Applications, and Challenges. Artif Organs 2024. [PMID: 39737603 DOI: 10.1111/aor.14931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2024] [Revised: 11/03/2024] [Accepted: 12/09/2024] [Indexed: 01/01/2025]
Abstract
BACKGROUND Liver disease is a growing burden. Transplant organs are scarce. Extracorporeal liver support systems (ELSS) are a bridge to transplantation for eligible patients. For transplant-ineligible patients the objective becomes liver recovery. METHODS We review seven decades of non-cell-based ELSS research in humans. Where possible, we emphasize randomized controlled trials (RCTs). When RCTs are not available, we describe the available human clinical data. RESULTS There are three broad cell-free approaches to remove protein-bound toxins (PBTs) and treat liver failure. The first is a dialysate binder suspension. A material that binds the PBT (the binder) is added to the dialysate. Binders include albumin, charcoal, and polystyrene sulfonate sodium. The unbound fraction of the PBT crosses the dialyzer membrane along a chemical gradient and binds to the binder. The second approach is using grains of sorbent fixed in a plastic housing to remove PBTs. Toxin-laden blood or plasma flows directly through the column. Toxins are removed by binding to the sorbent. The third approach is exchanging toxin-laden blood, or fractions of blood, for a healthy donor blood product. Most systems lack widespread acceptance, but plasma exchange (PE) is recommended in many guidelines. The large donor plasma requirement of PE creates demand for systems to complement or replace it. CONCLUSIONS Now that PE has become recommended in some, but not all, jurisdictions, we discuss the importance of reporting precise PE protocols and dose. Our work provides an overview of promising new systems and lessons from old technologies to enable ELSS improvement.
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Affiliation(s)
- Alexander Novokhodko
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Shaohang Hao
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
| | - Suhail Ahmad
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Dayong Gao
- Department of Mechanical Engineering, University of Washington, Seattle, Washington, USA
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2
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Du Y, Chen M, Wang B, Chai Y, Wang L, Li N, Zhang Y, Liu Z, Guo C, Jiang X, Ma B, Wang Z, Tian Z, Ou L. TiO 2/Polystyrene Nanocomposite Antibacterial Material as a Hemoperfusion Adsorbent for Efficient Bilirubin Removal and Prevention of Bacterial Infection. ACS Biomater Sci Eng 2024; 10:1494-1506. [PMID: 38414275 DOI: 10.1021/acsbiomaterials.3c01854] [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] [Indexed: 02/29/2024]
Abstract
The use of hemoperfusion adsorbents for the removal of bilirubin in patients with liver failure has become a critical treatment. However, the insufficient clearance of bilirubin and the possibility of bacterial infection during hemoperfusion limit the application. In this work, we designed a novel antibacterial bilirubin adsorbent (PSVT) through the suspension polymerization reaction between double-bond functionalized TiO2 nanoparticles and styrene. PSVT showed an excellent bilirubin adsorption ability and antibacterial performance, ensuring efficient clearance of bilirubin in liver failure patients during hemoperfusion and preventing bacterial infection. The experimental results indicated that TiO2 was uniformly dispersed in the microspheres, which improved the mesoporous structure and increased the specific surface area. Composite adsorbent PSVT showed an exceptional bilirubin adsorption capacity, with the maximum adsorption capacity reaching 24.3 mg/g. In addition, the introduction of TiO2 endowed PSVT with excellent antibacterial ability; the ultimate antibacterial rates against Escherichia coli and Staphylococcus aureus reached 97.31 and 96.47%, respectively. In summary, PSVT served as a novel antibacterial bilirubin adsorbent with excellent bilirubin clearance capacity and antibacterial performance, providing excellent application prospects for treating liver failure patients.
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Affiliation(s)
- Yunzheng Du
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Mengya Chen
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Biao Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yamin Chai
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
- General Hospital Tianjin Medical University, Tianjin 300052, China
| | - Lichun Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
- School of Environmental Science and Engineering, Huazhong University of Science and Technology, Wuhan 430074, P. R. China
| | - Nan Li
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Yanjia Zhang
- 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
| | - Chen Guo
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Xinbang Jiang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Boya Ma
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Zimeng Wang
- Key Laboratory of Bioactive Materials, Ministry of Education, College of Life Sciences, Nankai University, Tianjin 300071, China
| | - Ziying Tian
- 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
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Li W, Chen Y, Li D, Meng X, Liu Z, Liu Y, Fan H. Hemoadsorption in acute respiratory distress syndrome patients requiring venovenous extracorporeal membrane oxygenation: a systematic review. Respir Res 2024; 25:27. [PMID: 38217010 PMCID: PMC10785465 DOI: 10.1186/s12931-024-02675-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Venovenous extracorporeal membrane oxygenation (VV ECMO) has been widely used for severe acute respiratory distress syndrome (ARDS) in recent years. However, the role of hemoadsorption in ARDS patients requiring VV ECMO is unclear. METHODS Therefore, we conducted a systematic review to describe the effect of hemoadsorption on outcomes of ARDS patients requiring VV ECMO and elucidate the risk factors for adverse outcomes. We conducted and reported a systematic literature review based on the principles derived from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The systematic review searched Embase, CINHAL, and Pubmed databases for studies on ARDS patients receiving hemoadsorption and VV ECMO. The demographic data, clinical data and biological data of the patients were collected. RESULTS We ultimately included a total of 8 articles including 189 patients. We characterized the population both clinically and biologically. Our review showed most studies described reductions in inflammatory markers and fluid resuscitation drug dosage in ARDS patients with Coronavirus disease 2019 (COVID-19) or sepsis after hemoadsorption. CONCLUSION Because most of the studies have the characteristics of high heterogeneity, we could only draw very cautious conclusions that hemoadsorption therapy may enhance hemodynamic stability in ARDS patients with COVID-19 or sepsis receiving VV ECMO support. However, our results do not allow us to draw conclusions that hemoadsorption could reduce inflammation and mortality. Prospective randomized controlled studies with a larger sample size are needed in the future to verify the role of hemoadsorption in ARDS patients requiring VV ECMO.
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Affiliation(s)
- Wenli Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yuansen Chen
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Duo Li
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Xiangyan Meng
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Ziquan Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China
| | - Yanqing Liu
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
| | - Haojun Fan
- Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
- Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
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4
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Zhou W, Hu W, Zhan Q, Zhang M, Liu X, Hussain W, Yu H, Wang S, Zhou L. Novel hemoperfusion adsorbents based on collagen for efficient bilirubin removal - A thought from yellow skin of patients with hyperbilirubinemia. Int J Biol Macromol 2023; 253:127321. [PMID: 37820900 DOI: 10.1016/j.ijbiomac.2023.127321] [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: 08/02/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Hemoperfusion is a well-developed method for removing bilirubin from patients with hyperbilirubinemia. The performance of adsorbents is crucial during the process. However, most adsorbents used for bilirubin removal are not suitable for clinical applications, because they either have poor adsorption performance or limited biocompatibility. Patients with hyperbilirubinemia usually have distinctive yellow skin, indicating that collagen, a primary component of the skin, may be an effective material for absorbing bilirubin from the blood. Based on this idea, we designed and synthesized collagen (Col) and collagen-polyethyleneimine (Col-PEI) microspheres and employed them as hemoperfusion adsorbents for bilirubin removal. The microspheres have an efficient adsorption rate, higher bilirubin adsorption capacity, and competitive adsorption of bilirubin in the bilirubin/bovine serum albumin (BSA) solution. The maximum adsorption capacities of Col and Col-PEI microspheres for bilirubin are 150.2 mg/g and 258.4 mg/g, respectively, which are higher than those of most traditional polymer microspheres. Additionally, the microspheres exhibit excellent blood compatibility originating from collagen. Our study provides a new collagen-based strategy for the hemoperfusion treatment of hyperbilirubinemia.
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Affiliation(s)
- Wan Zhou
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wenbin Hu
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Qiancheng Zhan
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Minjun Zhang
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Xinjie Liu
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Wajid Hussain
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Huibin Yu
- Department of Pharmacy, Renmin Hospital, Hubei University of Medicine, Shiyan 442099, China
| | - Shenqi Wang
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Lei Zhou
- College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
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Szigetváry CE, Turan C, Kovács EH, Kói T, Engh MA, Hegyi P, Csukly G, Ruszkai Z, Molnár Z. Hemoadsorption as Adjuvant Therapy in Acute Respiratory Distress Syndrome (ARDS): A Systematic Review and Meta-Analysis. Biomedicines 2023; 11:3068. [PMID: 38002070 PMCID: PMC10669540 DOI: 10.3390/biomedicines11113068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/07/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) is often a consequence of a dysregulated immune response; therefore, immunomodulation by extracorporeal cytokine removal has been increasingly used as an adjuvant therapy, but convincing data are still missing. The aim of this study was to investigate the effects of adjunctive hemoadsorption (HA) on clinical and laboratory outcomes in patients with ARDS. METHODS We performed a systematic literature search in PubMed, Embase, CENTRAL, Scopus, and Web of Science (PROSPERO: CRD42022292176). The population was patients receiving HA therapy for ARDS. The primary outcome was the change in PaO2/FiO2 before and after HA therapy. Secondary outcomes included the before and after values for C-reactive protein (CRP), lactate, interleukin-6 (IL-6), and norepinephrine (NE) doses. RESULTS We included 26 publications, with 243 patients (198 undergoing HA therapy and 45 controls). There was a significant improvement in PaO2/FiO2 ratio following HA therapy (MD = 68.93 [95%-CI: 28.79 to 109.06] mmHg, p = 0.005) and a reduction in CRP levels (MD = -45.02 [95%-CI: -82.64; -7.39] mg/dL, p = 0.026) and NE dose (MD = -0.24 [95%-CI: -0.44 to -0.04] μg/kg/min, p = 0.028). CONCLUSIONS Based on our findings, HA resulted in a significant improvement in oxygenation and a reduction in NE dose and CRP levels in patients treated with ARDS. Properly designed RCTs are still needed.
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Affiliation(s)
- Csenge Erzsébet Szigetváry
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Caner Turan
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Emőke Henrietta Kovács
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
| | - Tamás Kói
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Stochastics, Institute of Mathematics, Budapest University of Technology and Economics, 1111 Budapest, Hungary
| | - Marie Anne Engh
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Péter Hegyi
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
- Institute of Pancreatic Diseases, Semmelweis University, 1083 Budapest, Hungary
| | - Gábor Csukly
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Psychiatry and Psychotherapy, Semmelweis University, 1085 Budapest, Hungary
| | - Zoltán Ruszkai
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Department of Anaesthesiology and Intensive Therapy, Pest County Flór Ferenc Hospital, 2143 Kistarcsa, Hungary
| | - Zsolt Molnár
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, 1085 Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, 1085 Budapest, Hungary
- Department of Anesthesiology and Intensive Therapy, Poznan University, 60-806 Poznan, Poland
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6
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Gao Q, Chen J, Zhao C, Li J, Song A, Zhang Z, Lin X, Dong S, Xin M, Hou J, Han M, Li X, Yang X, Jin Y, Zhang Y. Combination of Plasma Exchange and Adsorption Versus Plasma Exchange in Pediatric Acute Liver Failure: A Multicenter Cohort Study. J Pediatr Gastroenterol Nutr 2023; 76:710-715. [PMID: 36913704 DOI: 10.1097/mpg.0000000000003759] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
OBJECTIVES This study aimed to compare the efficacy of double plasma molecular adsorption system (DPMAS) with half-dose plasma exchange (PE) to that of full-dose PE in pediatric acute liver failure (PALF). METHODS This multicenter, retrospective cohort study was conducted in 13 pediatric intensive care units in Shandong Province, China. DPMAS+PE and single PE therapies were performed in 28 and 50 cases, respectively. The patients' clinical information and biochemical data were obtained from the patients' medical records. RESULTS The severity of illness did not differ between the 2 groups. At 72 hours after treatment, comparing with PE group, the rates of decline of Pediatric model for End-stage Liver Disease and Pediatric Sequential Organ Failure Assessment scores as well as total bilirubin blood ammonia and interleukin-6 were significantly higher, while the short-term effective rate (75.0% vs 44.0%, P = 0.008) was significantly higher in the DPMAS+PE group. The volume of plasma consumption (26.5 vs 51.0 mL/kg, P = 0.000) and the rate of adverse events (3.6% vs 24.0%, P = 0.026) were lower in the DPMAS+PE group than in the PE group, respectively. However, there was no statistical difference in the 28-day mortality between the 2 groups (21.4% vs 40.0%, P > 0.05). CONCLUSIONS For PALF patients, both DPMAS + half-dose PE and full-dose PE could improve the liver function, while DPMAS + half-dose PE could significantly reduce plasma consumption without obvious adverse effects in contrast with full-dose PE. Thus, DPMAS + half-dose PE may be a suitable alternative method for PALF in the context of the increasingly tight blood supply situation.
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Affiliation(s)
- Qian Gao
- From the Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jie Chen
- the Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
| | - Chun Zhao
- From the Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Jing Li
- the Department of Pediatric Intensive Care Unit, Critical Care Medicine Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
| | - Aiqin Song
- the Department of Pediatric Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zhaohua Zhang
- the Department of Pediatric Intensive Care Unit, The Second Hospital of Shandong University, Jinan, Shandong, China
| | - Xia Lin
- the Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Shengying Dong
- the Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Meiyun Xin
- the Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Jining Medical Hospital, Jining, Shandong, China
| | - Jian Hou
- the Department of Pediatric Intensive Care Unit, Zibo Maternal and Child Health Care Hospital, Zibo, Shandong, China
| | - Mingying Han
- the Department of Pediatric Intensive Care Unit, Linyi People's Hospital, Linyi, Shandong, China
| | - Xiaomei Li
- the Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
| | - Xinli Yang
- the Department of Pediatrics, Taian City Central Hospital, Taian, Shandong, China
| | - Youpeng Jin
- From the Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
- the Department of Pediatric Intensive Care Unit, Shandong Provincial Hospital, Shandong University, Jinan, Shandong, China
- the Department of Pediatric Intensive Care Unit, Critical Care Medicine Center, Women and Children's Hospital, Qingdao University, Qingdao, Shandong, China
- the Department of Pediatric Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
- the Department of Pediatric Intensive Care Unit, The Second Hospital of Shandong University, Jinan, Shandong, China
- the Department of Pediatric Intensive Care Unit, Children's Hospital Affiliated to Shandong University, Jinan, Shandong, China
- the Department of Pediatric Intensive Care Unit, Liaocheng People's Hospital, Liaocheng, Shandong, China
- the Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Jining Medical Hospital, Jining, Shandong, China
- the Department of Pediatric Intensive Care Unit, Zibo Maternal and Child Health Care Hospital, Zibo, Shandong, China
- the Department of Pediatric Intensive Care Unit, Linyi People's Hospital, Linyi, Shandong, China
- the Department of Pediatric Intensive Care Unit, The Affiliated Hospital of Binzhou Medical University, Binzhou, Shandong, China
- the Department of Pediatrics, Taian City Central Hospital, Taian, Shandong, China
- the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Yucai Zhang
- the Department of Critical Care Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China
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Wei F, Qi F, Li Y, Dou W, Zeng T, Wang J, Yao Z, Zhang L, Tang Z. Amino-rich nanofiber membrane with favorable hemocompatibility for highly efficient removal of bilirubin from plasma. Sep Purif Technol 2023. [DOI: 10.1016/j.seppur.2023.123648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
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8
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Lesbekov T, Nurmykhametova Z, Kaliyev R, Kuanyshbek A, Faizov L, Bekishev B, Jabayeva N, Samalavicius R, Pya Y. Hemadsorption in patients requiring V-A ECMO support: Comparison of Cytosorb versus Jafron HA330. Artif Organs 2023; 47:721-730. [PMID: 36398369 DOI: 10.1111/aor.14457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 10/13/2022] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND ECMO support is associated with the development of a systemic hyper-inflammatory response, which may become quite significant and extreme in some cases. We hypothesize that Cytosorb or Jafron therapy may benefit patients on V-A ECMO in terms of levels of inflammatory markers such as IL-6, complications, and overall outcomes. METHODS We conducted a retrospective study of prospectively collected data in a single tertiary care center between January 2021 and April 2022. At the time of the analysis of this article, 20 patients on V-A ECMO had cytokine adsorption while on ECMO support: Cytosorb group (n = 10), Jafron group (n = 10). In 10 ECMO-supported patients cytokine adsorption was not used, this group served as a control group, which may be quite significant in some cases. Evaluation of the level of inflammatory markers (IL-1, 6, 8; CRP, Leukocyte, Lactate, PCT, NT-proBNP, TNF-α) was performed. RESULTS There was statistically significant longer CPB time, aortic cross-clamp time and ICU stay in cytokine adsorption groups than in the control group, but there were no differences between subgroups with different types of haemoadsorption used. Moreover, in the control group mortality rate was higher than in the cytokine adsorption groups (60% vs. 20%, p = 0.02). All patients had an elevation of inflammatory markers in the perioperative and immediate postoperative periods. After 72 h of intensive care, blood inflammation markers had a tendency to decline. CONCLUSION At the time of writing, hemadsorption in patients requiring V-A ECMO support represents a good therapeutic effect. This effect is permanent for the whole period of extracorporeal cytokine hemadsorption application for both CytoSorb and Jafron HA330 devices.
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Affiliation(s)
- Timur Lesbekov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | - Rymbay Kaliyev
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Aidyn Kuanyshbek
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Linar Faizov
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Bolat Bekishev
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | - Nilufar Jabayeva
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
| | | | - Yuriy Pya
- National Research Center for Cardiac Surgery, Nur-Sultan, Kazakhstan
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9
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Wang Y, Wei R, Zhao W, Zhao C. Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy. Macromol Biosci 2023; 23:e2200567. [PMID: 36786125 DOI: 10.1002/mabi.202200567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 02/02/2023] [Indexed: 02/15/2023]
Abstract
Hyperbilirubinemia, presenting as jaundice, is a life-threatening critical illness in newborn babies and acute severe hepatic failure patients. Over the past few decades, extracorporeal hemoadsorption by adsorbent therapy has been widely applied in the treatment of hyperbilirubinemia. The capability of hemoadsorption depends on the adsorbents. Most of the clinically used bilirubin adsorbents are made up of styrene/divinylbenzene copolymer and quaternary ammonium salt, which usually have poor biocompatibility and weak mechanical strength. To overcome the drawbacks of commercial polymer adsorbents, advanced synthetic and natural polymers with/without nanomaterials have been designed, and novel adsorbent fabrication technologies have also been developed. In this review, the adsorption mechanism of bilirubin adsorbents has been summarized, which is the basic criterion in adsorbent development. Furthermore, the preparation method, adsorption mechanism, relative merits and practicability of the emerging bilirubin adsorbents have been evaluated. Based on the existing studies, this work highlights the future direction of the efforts on how to design and develop bilirubin adsorbents with good overall clinical performance. Perhaps this study can change traditional perspectives and propose new strategies for bilirubin clearance from the aspects of pathogenic mechanisms, metabolic pathways, and material-based innovation.
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Affiliation(s)
- Yilin Wang
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.,Med-X Center for Materials, Sichuan University, Chengdu, 610041, China
| | - Ran Wei
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.,Med-X Center for Materials, Sichuan University, Chengdu, 610041, China
| | - Weifeng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.,Med-X Center for Materials, Sichuan University, Chengdu, 610041, China
| | - Changsheng Zhao
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China.,Med-X Center for Materials, Sichuan University, Chengdu, 610041, China
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10
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Sorption of bile salts from aqueous solutions by MCM-41 silica with chemically immobilized steroid groups. APPLIED NANOSCIENCE 2022. [DOI: 10.1007/s13204-022-02677-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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11
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Bao C, Zhang X, Shen J, Li C, Zhang J, Feng X. Freezing-triggered gelation of quaternized chitosan reinforced with microfibrillated cellulose for highly efficient removal of bilirubin. J Mater Chem B 2022; 10:8650-8663. [PMID: 36218039 DOI: 10.1039/d2tb01407f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The highly efficient removal of bilirubin from blood by hemoperfusion for liver failure therapy remains a challenge in the clinical field due to the low adsorption capacity and poor hemocompatibility of currently used carbon-based adsorbents. Polysaccharide-based cryogels seem to be promising candidates for hemoperfusion adsorbents owing to their inherited excellent hemocompatibility. However, the weak mechanical strength and relatively low adsorption capacity of polysaccharide-based cryogels limited their application in bilirubin adsorption. In this work, we presented a freezing-triggered strategy to fabricate QCS/MFC cryogels, which were formed by quaternized chitosan (QCS) crosslinked with divinylsulfonyl methane (BVSM) and reinforced with microfibrillated cellulose (MFC). Ice crystal exclusions triggered the chemical crosslinking to generate the cryogels with dense pore walls. The obtained QCS/MFC cryogels were characterized by FTIR, SEM, stress-strain test, and hemocompatibility assay, which exhibited interconnected macroporous structures, excellent shape-recovery and mechanical performance, and outstanding blood compatibility. Due to the quaternary ammonium functionalization of chitosan, the QCS/MFC showed a high adsorption capacity of 250 mg g-1 and a short adsorption equilibrium time of 3 h. More importantly, the QCS/MFC still exhibited high adsorption efficiency (over 49.7%) in the presence of 40 g L-1 albumin. Furthermore, the QCS/MFC could also maintain high dynamic adsorption efficiency in self-made hemoperfusion devices. This facile approach provides a new avenue to develop high-performance hemoperfusion adsorbents for bilirubin removal, showing great promise for the translational therapy of hyperbilirubinemia.
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Affiliation(s)
- Chunxiu Bao
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650092, China.
| | - Xufeng Zhang
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650092, China.
| | - Jing Shen
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650092, China.
| | - Changjing Li
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650092, China.
| | - Jinmeng Zhang
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650092, China.
| | - Xiyun Feng
- College of Chemistry and Chemical Engineering, Yunnan Normal University, Kunming 650092, China.
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12
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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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13
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Gao Q, Xin XW, Zhao C, Wang YJ, Wang W, Yin Y, Wang XR, Jin YP. Efficacy of HA330-II column hemoadsorption in Epstein-Barr virus-associated hemophagocytic lymphohistiocytosis combined with liver failure: A case report. World J Hematol 2022; 9:6-12. [DOI: 10.5315/wjh.v9.i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/09/2021] [Accepted: 02/13/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hemophagocytic lymphohistiocytosis (HLH) is a severe and potentially deadly condition associated with extensive inflammation and immune activation. Cytokine adsorption may serve as a supportive treatment that can stabilize organ function in affected patients by reducing their circulating cytokines levels. To date, no descriptions of clinical experiences associated with the use of HA330-II column hemoadsorption for the treatment of children affected by HLH have been published.
CASE SUMMARY We describe the case of an 11-year-old child with Epstein-Barr virus-associated HLH complicated by liver failure. She underwent HA330-II column hemoadsorption and chemotherapy and exhibited reductions in levels of inflammatory cytokines, including interleukin (IL), IL-6, IL-8, IL-10, and interferon-γ. The patient’s condition and laboratory parameters gradually improved with treatment.
CONCLUSION Hemoadsorption may play an important role in cytokine storm elimination in children with HLH combined with liver failure and consequent multiple organ failure.
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Affiliation(s)
- Qian Gao
- Pediatric Intensive Care Unit, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
| | - Xiao-Wei Xin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Chun Zhao
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yu-Juan Wang
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Wei Wang
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Yi Yin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - Xiao-Ru Wang
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
| | - You-Peng Jin
- Pediatric Intensive Care Unit, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250021, Shandong Province, China
- Pediatric Intensive Care Unit, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, Shandong Province, China
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14
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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: 1.0] [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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15
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Krenn CG, Steltzer H. [Hemoadsorption for blood purification-incomparability of clinically available procedures]. Med Klin Intensivmed Notfmed 2021; 116:449-453. [PMID: 32583037 PMCID: PMC8159789 DOI: 10.1007/s00063-020-00702-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/24/2020] [Accepted: 05/19/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND In the field of intensive care medicine, but also increasingly in cardiac surgery, the use of adsorptive blood purification technologies for the treatment of hyperinflammatory conditions is becoming progressively more important. In addition to the CytoSorb concept, which is more and more clinically accepted and currently the most frequently used method, other companies-particularly from China-have recently entered the market with similar concepts. OBJECTIVES Given this, the aim of this article is to analyze the different aspects of the various hemoadsorption products offered on the market today and to take a critical look at the available evidence. METHODS Technical features, application-specific characteristics, and the existing evidence of the adsorption technologies CytoSorb® (CytoSorbentsTM Inc., Monmouth Junction, NJ, USA), Jafron® HA series (Jafron Biomedical Co., Guangdong, China), and Biosky® MG series (Biosun® Medical Technology Co., Foshan City, Guangdong Province, China) were analyzed. The purely substance-specific methods for endotoxin elimination only (Toraymyxin®, Alteco®) were not considered. RESULTS A comprehensive analysis of these criteria reveals that there are considerable differences between the various available technologies in terms of materials used, adsorption characteristics, application, and available data on safety and clinical experience. Furthermore, it becomes clear that not only the efficacy of blood purification technologies should be considered in terms of an effect-price-performance ratio, but that in particular the safety of the individual technologies is of crucial importance. DISCUSSION Among the technologies analyzed, CytoSorb currently represents the most investigated and clinically established procedure. Furthermore, it should be noted that clinical results, but particularly safety-relevant aspects, are not transferable between the products due to technically different procedures.
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Affiliation(s)
- C G Krenn
- Klinik für Anästhesie, Allgemeine Intensivmedizin und Schmerztherapie, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
| | - H Steltzer
- Abteilung für Anästhesiologie und Intensivmedizin, Traumazentrum Wien, Standort Meidling, Meidling, Österreich
- Lehrstuhl für Intensivmedizin, Sigmund Freud Privatuniversität Wien, Wien, Österreich
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16
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KOCAYİĞİT H, ÖZMEN SÜNER K, TOMAK Y, DEMİR G, KOCAYİĞİT İ, YAYLACI S, AYDEMİR Y, KÖROĞLU M, KARABAY O, ÖZTÜRK MH, ERDEM AF. Characteristics and outcomes of critically ill patients with covid-19 in Sakarya, Turkey: a single centre cohort study. Turk J Med Sci 2021; 51:440-447. [PMID: 33185365 PMCID: PMC8203134 DOI: 10.3906/sag-2005-57] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 11/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background/aim Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first reported in Turkey on March 10, 2020 and the number of the patients are increasing day by day. Coronavirus disease 2019 (Covid-19) has high mortality rates in intensive care units (ICUs). We aimed to describe the demographic characteristics, comorbidities, treatment protocols, and clinical outcomes among the critically ill patients admitted to the ICU of our hospital. Materials and methods This cohort study included 103 consecutive patients who had laboratory confirmed Covid-19 and admitted to ICU of Sakarya University Training and Research Hospital between March 19 and April 13, 2020. The final date of the follow-up was April 18. Results The mean age of the patients was 69.6 ± 14.1 years. Most of the patients had increased CRP (99%), serum ferritin (73.8%), d-dimer (82.5%), and hs-troponin levels (38.8%). 34 patients (33%) had lymphocytopenia, 24 patients (23.3%) had thrombocytopenia. 63 patients (61.2%) developed acute respiratory distress syndrome (ARDS), 31 patients (30.1%) had acute kidney injury, and 52 patients (50.5%) had multiple organ dysfunction syndrome (MODS) during follow-up. Sixty-two patients (60.2%) received mechanical ventilation. As of April 18, of the 103 patients, 52 (50.5%) had died, 30 (29.1%) had been discharged from the ICU, 21 (20.4%) were still in the ICU. Conclusions Covid-19 has high mortality rates in ICU. Patients with elevated procalcitonin, hs-troponin, d-dimer, and CRP levels and lower platelet count at admission have higher mortality.
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Affiliation(s)
- Havva KOCAYİĞİT
- Department of Anaesthesiology and Reanimation, Sakarya University Education and Research Hospital, SakaryaTurkey
| | - Kezban ÖZMEN SÜNER
- Department of Intensive Care, Sakarya University Education and Research Hospital, SakaryaTurkey
| | - Yakup TOMAK
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Gürkan DEMİR
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - İbrahim KOCAYİĞİT
- Department of Cardiology, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Selçuk YAYLACI
- Department of Internal Medicine, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Yusuf AYDEMİR
- Department of Pulmonary Diseases, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Mehmet KÖROĞLU
- Department of Medical Microbiology, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Oğuz KARABAY
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Mehmet Halil ÖZTÜRK
- Department of Radiology, Faculty of Medicine, Sakarya University, SakaryaTurkey
| | - Ali Fuat ERDEM
- Department of Anaesthesiology and Reanimation, Faculty of Medicine, Sakarya University, SakaryaTurkey
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17
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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: 0.5] [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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18
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Godi I, Lorenzin A, De Rosa S, Golino G, Knust M, Gaspar A, Sandini A, Fiorin F, de Cal M, Navalesi P, Ronco C. Vancomycin Adsorption During in vitro Model of Hemoperfusion with HA380 Cartridge. Nephron Clin Pract 2021; 145:157-163. [PMID: 33567447 DOI: 10.1159/000513122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION A critical point for using blood purification during sepsis may be the potential interaction with antimicrobial therapy, the mainstay of sepsis treatment. The aim of our study was to investigate the vancomycin removal during hemoperfusion (HP) using HA380 cartridge. METHODS This is an experimental study, in which 500 mL of solution was circulated in a closed-circuit (blood flow of 250 mL/min) simulating HP ran using HA380. Vancomycin was added to reach a through concentration or a very high concentration to evaluate the removal ratio (RR) during 120 min of HP. Comparison between blood-crystalloid solution and balanced solution was performed by using Kruskal-Wallis test. The kinetics of vancomycin removal and the adsorption isotherm were evaluated. RESULTS We found a complete removal of vancomycin at baseline through concentration of 23.0 ± 7.4 mg/L. Using extremely high concentration (baseline 777.0 ± 62.2 mg/L), RR was 90.1 ± 0.6% at 5 min and 99.2 ± 0.6% at 120 min. No difference in terms of RR was found between blood-crystalloid mixture and balanced solution. The kinetics of the vancomycin reduction followed an exponential decay. Repeated boluses (total amount of 2,000 mg) resulted in cumulative adsorption of 1,919.4 mg with RR of 96.6 ± 1.4%, regardless of the amount injected (100 vs. 500 mg). Vancomycin adsorption onto HA380 followed the Langmuir isotherm model. CONCLUSIONS A considerable amount of vancomycin was rapidly removed during in vitro HP with HA380. Clinical studies are needed to determine whether this may lead to underdosing. Drug therapeutic monitoring is highly recommended when using HA380 for blood purification in patients receiving vancomycin.
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Affiliation(s)
- Ilaria Godi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy, .,International renal Research Institute of Vicenza, Vicenza, Italy,
| | - Anna Lorenzin
- International renal Research Institute of Vicenza, Vicenza, Italy
| | - Silvia De Rosa
- International renal Research Institute of Vicenza, Vicenza, Italy.,Department of Anesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy
| | - Gianlorenzo Golino
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy.,International renal Research Institute of Vicenza, Vicenza, Italy
| | - Maira Knust
- International renal Research Institute of Vicenza, Vicenza, Italy
| | - Ana Gaspar
- International renal Research Institute of Vicenza, Vicenza, Italy
| | - Alessandra Sandini
- Department of Transfusional Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Fiorin
- Department of Transfusional Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Massimo de Cal
- International renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Navalesi
- Department of Medicine - DIMED, Section of Anesthesiology and Intensive Care, University of Padova, Padova, Italy
| | - Claudio Ronco
- International renal Research Institute of Vicenza, Vicenza, Italy.,Department of Nephrology, Dialysis and Transplantation, San Bortolo Hospital, Vicenza, Italy.,Department of Medicine - DIMED, University of Padova, Padova, Italy
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19
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Liu Y, Peng X, Hu Z, Yu M, Fu J, Huang Y. Fabrication of a novel nitrogen-containing porous carbon adsorbent for protein-bound uremic toxins removal. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 121:111879. [PMID: 33579500 DOI: 10.1016/j.msec.2021.111879] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 12/15/2020] [Accepted: 01/08/2021] [Indexed: 12/20/2022]
Abstract
Protein-bound uremic toxins (PBUTs), the presence of which in the blood is an important risk factor for the progression of chronic kidney disease (CKD), have not been cleared efficiently via traditional hemodialysis methods until now. In this study, biosafe and efficient nitrogen-containing porous carbon adsorbent (NPCA) beads for the clearance of PBUTs were prepared from porous acrylonitrile/divinylbenzene cross-linked copolymer beads followed by pyrolysis. The resulting NPCA beads were characterized via SEM, XPS and nitrogen adsorption/desorption tests. The results demonstrated that the NPCA beads possessed a mesoporous/microporous hierarchical structure with rich nitrogen functional groups on their surfaces and realized efficient PBUTs adsorption in human plasma. More importantly, the efficacy of PBUTs removal was substantially higher than those of commercial adsorbents that are commonly used in clinical uremia treatments. The NPCA beads also exhibited satisfactory removal efficacy towards middle-molecular-weight uremic toxins. The PBUTs removal mechanism of the NPCA beads is ascribed to effective competition between nitrogen-containing NPCA and proteins for PBUT binding. According to hemocompatibility assays, the NPCA beads possessed satisfactory in vitro hemocompatibility. This nitrogen-containing porous carbon adsorbent is an attractive and promising material for blood purification applications in the treatment of clinical uremia.
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Affiliation(s)
- Yunhong Liu
- College of Chemical Engineering and Materials Science, Quanzhou Normal University, Quanzhou 362000, China
| | - Xinyan Peng
- College of Chemical Engineering and Materials Science, Quanzhou Normal University, Quanzhou 362000, China.
| | - Zhudong Hu
- School of Materials Science and Energy Engineering, Foshan University, Foshan 528000, China
| | - Mingguang Yu
- School of Materials Science and Energy Engineering, Foshan University, Foshan 528000, China
| | - Jijun Fu
- School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, China
| | - Yugang Huang
- School of Pharmaceutical Sciences, Guangzhou Medical University, Guangzhou 511436, China
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20
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Huang S, Zheng J, Zhang Y, Zheng J, Zhuang Z, Yang Q, Wang F, Chen G, Huang S, Ouyang G. Polydopamine decorated ordered mesoporous carbon for efficient removal of bilirubin under albumin-rich conditions. J Mater Chem B 2019; 8:290-297. [PMID: 31803882 DOI: 10.1039/c9tb02147g] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Excess bilirubin in the body will lead to serious health problems; however, its efficient removal remains a challenge in the clinical field because the available sorbent materials still suffer from serious performance issues, performance declining in a high-content albumin environment. Herein, we prepared a novel polydopamine (PDA) decorated ordered mesoporous carbon (OMC) material for the efficient removal of bilirubin in albumin-rich conditions. OMC was used as the supporting material due to its high specific surface area and its good affinity to hydrophobic analytes. PDA was then decorated on the OMC material through a facile self-assembly process to form a surface-imprinted layer. The obtained PDA-coated OMC material (OMC@PDA) exhibited excellent adsorption performance towards bilirubin in albumin-free conditions, in which its theoretical maximum adsorption amount was calculated to be 513.54 mg g-1. The imprinted PDA layer, for which the association constant towards bilirubin reached 4.51 × 104 M-1, endowed OMC@PDA with a competitive affinity compared to albumin. Therefore the materials showed good adsorption capacity and efficiency even in an albumin-rich environment (the adsorption equilibrated at 122.7 mg g-1 in 30 min). In addition, the good biocompatibility of OMC@PDA was demonstrated by hemolysis assay and protein fouling evaluation, which indicated the feasibility of applying this material in clinical situations.
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Affiliation(s)
- Shuyao Huang
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Jiating Zheng
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Yimin Zhang
- Nephrology Department, Sun Yat-sen University Sixth Affiliated Hospital, Guangzhou, Guangdong 510000, China
| | - Juan Zheng
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Zena Zhuang
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Qian Yang
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Fuxin Wang
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Guosheng Chen
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China.
| | - Siming Huang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics, Sun Yat-sen Memorial Hospital, Guangzhou, Guangdong 510120, China
| | - Gangfeng Ouyang
- KLGHEI of Environment and Energy Chemistry, School of Chemistry, Sun Yat-sen University, Guangzhou, Guangdong 510275, China. and Guangdong Provincial Key Laboratory of Emergency Test for Dangerous Chemicals, Guangdong Institute of Analysis (China National Analytical Center Guangzhou), Guangzhou 510070, China
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21
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Li Q, Yang J, Cai N, Zhang J, Xu T, Zhao W, Guo H, Zhu Y, Zhang L. Hemocompatible hemoadsorbent for effective removal of protein-bound toxin in serum. J Colloid Interface Sci 2019; 555:145-156. [PMID: 31377640 DOI: 10.1016/j.jcis.2019.07.045] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/13/2019] [Accepted: 07/16/2019] [Indexed: 12/27/2022]
Abstract
Resin hemoperfusion is a life-saving treatment for drug intoxication or hepatic failure of patients. However, current resin adsorbents exhibit a limited hemocompatibility or low adsorption efficiency, representing a major roadblock to successful clinical applications. In this work, we developed a hemocompatible and effective hemoadsorbent based on polystyrene resin (H103) microparticles encapsulated in anti-biofouling zwitterionic poly(carboxybetaine) (PCB) hydrogels. Apart from a strong mechanical stability, this PCB-based adsorbent (PCB-H103) exhibited excellent hemocompatibility (hemolysis ratio was ∼0.64%), which was attributed to the anti-biofouling property of PCB hydrogel. In addition, it can efficiently adsorb both small and middle molecular weight molecules in phosphate-buffered saline, and the efficiencies were significantly higher than poly(ethylene glycol) methacrylate-based and poly(2-hydroxyethyl methacrylate)-based adsorbent counterparts, indicating the favorable permeability of PCB hydrogel coating. More importantly, PCB-H103 could effectively remove protein-bound toxins including phenol red and bilirubin in bovine serum albumin solution or even in 100% fetal bovine serum (FBS). In 100% FBS, the adsorption capacity of PCB-H103 towards bilirubin was 8.3 times higher than that of pristine clinical-scale resin beads. Findings in this work may provide a new strategy for the development of modern resin hemoperfusion technology.
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Affiliation(s)
- Qingsi Li
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Jing Yang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Nana Cai
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Jiamin Zhang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Tong Xu
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Weiqiang Zhao
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Hongshuang Guo
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Yingnan Zhu
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China
| | - Lei Zhang
- Department of Biochemical Engineering, School of Chemical Engineering and Technology, Tianjin University, Tianjin 300072, PR China; Frontier Science Center for Synthetic Biology and Key Laboratory of Systems Bioengineering (MOE), School of Chemical Engineering and Technology, Tianjin University, Tianjin 300350, PR China; Qingdao Institute for Marine Technology of Tianjin University, Qingdao 266235, PR China; Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin University, Tianjin 300072, PR China.
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22
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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: 1.6] [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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