Acute removal of common sepsis mediators does not explain the effects of extracorporeal blood purification in experimental sepsis

Peng, Zhi; Wang, Hong Zhi; Carter, Melinda J.; DiLeo, Morgan V.; Bishop, Jeffery V.; Zhou, Fei; Wen, Xiaoru; Rimmelé, Thomas; Singbartl, Kai; Federspiel, William J.; Clermont, Gilles; Kellum, John A.

doi:10.1038/ki.2011.320

Cited by 76 publications

(75 citation statements)

References 35 publications

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“…A more recent rat model of sepsis utilizing cecal ligation and puncture exposed experimental animals to 3 different amounts of hemoadsorption beads (0.75, 1.6, and 3 mg) and one sham treatment. Although the selected sample size was too small to compare survival benefits, rats in the treatment groups had trends indicating improved renal and hepatic function compared to the sham group [100,101].…”

Section: Literature Evidence For 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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Section: Literature Evidence For Cytokine Adsorption Therapymentioning

confidence: 99%

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

et al. 2018

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“…First, they may decrease cytokine concentrations under a "toxic threshold" in order to limit the local deleterious effects of cytokines [5]. Other authors have hypothesized that because of a restored concentration gradient, the decrease in cytokine blood concentrations could promote leukocyte chemotaxis toward infected tissue where cytokine concentrations are higher [11]. Another target of the blood purification techniques is the inhibition of the immunoinflammatory cascade trigger.…”

Section: Pathophysiology Of Immune Response In Sepsis: From Pathophysmentioning

confidence: 99%

Extracorporeal Blood Purification Therapies for Sepsis

2019

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Extracorporeal blood purification is proposed as an adjuvant therapy for sepsis, aiming at controlling the associated dysregulation of the immune system, which is known to induce organ dysfunctions. Different therapies have been developed to address certain steps of the immune dysregulation. Most of the available blood purification devices focus on a single target, such as the endotoxin that triggers the immune cascade, or the cytokine storm that causes organ damages. However, the highly adsorptive membrane named oXiris® is a unique 4-in-1 device that combines cytokine and endotoxin removal properties, renal replacement function, and antithrombogenic properties. More recently, promising treatments that focus on the pathogen itself or the immune cells have been developed and are currently under investigation. In this review, we aim to summarize, according to their target, the different extracorporeal blood purification techniques that are already available for use. We will also briefly introduce the most recent techniques that are still under development. Because of its unique ability to remove both endotoxins and cytokines, we will particularly discuss the highly adsorptive preheparinized oXiris® membrane. We will present its properties, advantages, pitfalls, as well as therapeutic perspectives based on experimental and clinical data. Video Journal Club “Cappuccino with Claudio Ronco” at https://www.karger.com/Journal/ArticleNews/223997?sponsor=52

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“…Similarly, WBC counts in healthy blood fell to 34% versus 82% of baseline with HA and sham device, respectively (N = 5). Experimental details and additional results are published [57,58].…”

Section: Wbc Capture Modelmentioning

confidence: 99%

Modeling and Hemofiltration Treatment of Acute Inflammation

et al. 2016

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Abstract:The body responds to endotoxins by triggering the acute inflammatory response system to eliminate the threat posed by gram-negative bacteria (endotoxin) and restore health. However, an uncontrolled inflammatory response can lead to tissue damage, organ failure, and ultimately death; this is clinically known as sepsis. Mathematical models of acute inflammatory disease have the potential to guide treatment decisions in critically ill patients. In this work, an 8-state (8-D) differential equation model of the acute inflammatory response system to endotoxin challenge was developed. Endotoxin challenges at 3 and 12 mg/kg were administered to rats, and dynamic cytokine data for interleukin (IL)-6, tumor necrosis factor (TNF), and IL-10 were obtained and used to calibrate the model. Evaluation of competing model structures was performed by analyzing model predictions at 3, 6, and 12 mg/kg endotoxin challenges with respect to experimental data from rats. Subsequently, a model predictive control (MPC) algorithm was synthesized to control a hemoadsorption (HA) device, a blood purification treatment for acute inflammation. A particle filter (PF) algorithm was implemented to estimate the full state vector of the endotoxemic rat based on time series cytokine measurements. Treatment simulations show that: (i) the apparent primary mechanism of HA efficacy is white blood cell (WBC) capture, with cytokine capture a secondary benefit; and (ii) differential

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Acute removal of common sepsis mediators does not explain the effects of extracorporeal blood purification in experimental sepsis

Cited by 76 publications

References 35 publications

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review

Extracorporeal Blood Purification Therapies for Sepsis

Modeling and Hemofiltration Treatment of Acute Inflammation

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