Coupled Plasma Filtration Adsorption Application for Liver and Thyroid Toxins

Donati, Gabriele; Capelli, Irene; Chiocchini, Anna Laura Croci; Natali, Nadia; Scrivo, Anna; Manna, Gaetano La

doi:10.1159/000468909

Cited by 6 publications

(8 citation statements)

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“…Three 10-hour CPFA treatments reduced creatinine kinase and myoglobin and improved overall renal function [32]. The application of CPFA in removing toxins and protein-bound bilirubin has also been reported in cases of hyperbilirubinemia due to acute liver failure [33], severe intra-abdominal infections [34], and transplantation rejection.…”

Section: Resultsmentioning

confidence: 99%

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Army¹,

Violetta²

2022

J. Med. Chem. Sci.

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The Corona-19 virus disease continues to cause an increasing number of deaths, mainly due to acute respiratory disorders. The high pandemic mortality and morbidity prompted clinicians to seek suitable adjunctive therapeutic methods to eliminate high cytokine levels effectively. This study aimed to review the combined plasma filtration adsorption (CPFA) technology and its potential efficacy in treating critically ill Covid-19. CPFA combines plasma separation, adsorption, and hemofiltration techniques that meet the need to remove substances such as cytokines. Findings from the report suggest an immune dysregulation known as cytokine storm syndrome plays a role in severe and critically ill Covid-19 patients. Extracorporeal blood purification targets cytokine elimination and is preferred as a bridging strategy to improve survival. Combined adsorption plasma filtration (CPFA) can remove various substances, including cytokines, without depleting physiologically essential proteins. CPFA can be considered and assessed in clinical trials to treat critically ill Covid-19 patients. Paired Plasma Filtration Adsorption (PPFA) can be viewed as a potentially effective therapy in treating Covid-19 patients in critical condition.

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Section: Resultsmentioning

confidence: 99%

Untitled

Army¹,

Violetta²

2022

J. Med. Chem. Sci.

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“…A case of CPFA application during thyreotoxicosis to achieve free triiodothyronine (FT3) and free thyroxin (FT4) adsorption was also reported by our group [23]. Two CPFA sessions were carried out with 8 L of plasma detoxificated for each CPFA session.…”

Section: Emerging Additional Indications For Cpfamentioning

confidence: 87%

“…Our group [23] carried out successfully 2 CPFA treatments, 6-h length, in a patient with acute liver failure with jaundice and encephalopathy. The bilirubin reduction rate per each session was 41%.…”

Section: Cpfa and Liver Dysfunctionmentioning

confidence: 99%

“…A future approach might be the CPFA use also in case of exogenous poisoning: in case of poisons with high protein binding (e.g., amiodarone [23]) the resin competes with albumin for binding and removes the protein-poison complexes [32]. Previously, Berning et al [33] also observed the effectiveness of plasma perfusion with resins in the elimination of toxic substances: after the separation Blood Purif 2018;46:228-238 DOI: 10.1159/000490234 from blood, plasma was perfused on the resin adsorber.…”

Section: Future Of Cpfa and Evolutionmentioning

confidence: 99%

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Coupled Plasma Filtration Adsorption: A Multipurpose Extracorporeal Detoxification Therapy

Manna¹,

Donati²

2018

Blood Purif

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Coupled plasma filtration adsorption (CPFA) is a detoxification system that combines a plasma adsorption circuit with a continuous renal replacement therapy. The circuit consists of a plasma filter, a resin/adsorbent cartridge and a haemofilter. It differs from many other types of extracorporeal therapies in that the upper part of the circuit can be considered a “closed loop”. In this manner, the plasma separated by the plasma filter passes through an adsorbent cartridge containing a resin with high affinity to many cytokines, mediators and toxins/poisons. After passing through the cartridge, the purified plasma is returned to the patient. The second part of the circuit, the haemofilter, can then be used to remove small toxins that are not adsorbed by the resin or to modulate the patient hematic volume. Although more complex, the use of a plasma-separation step prior to the passage through the resin cartridge offers advantages over adsorption by haemoperfusion. The plasma passes through the resin cartridge with a lower velocity than the blood flow, and this allows better contact time for the toxins with the resin, and more thorough penetration into the resin pores. The adsorption of many toxins is highly dependent on a factor expressed as linear velocity. In addition, the plasma does not contain cells or a very limited number of platelets, allowing less potential activation upon contact with the resin. Although the technique was originally developed for the treatment of sepsis and septic shock, there are many additional applications where there can be an advantage of having access to larger molecular weight toxins (compared to haemofiltration) and avoiding the loss of important physiologic substances such as albumin. Some of these new applications, in patients with or without acute kidney injury, include liver failure, rhabdomyolysis, severe autoimmune exacerbations and poisonings. In this article, we discuss some of the basic principles involved in sorbent technology, and how these may contribute to treatment efficacy, review the actual experiences with CPFA and finally discuss the results of recent human studies and their implications. Video Journal Club “Cappuccino with Claudio Ronco” at http://www.karger.com/?doi=490234.

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“…In view of the key role of the kidney in multiorgan failure, descriptive and useful case series are reported, indicating novel possible applications of coupled plasma filtration adsorption for toxin removal during the course in liver failure or in serious medical emergencies, such as thyrotoxicosis [12] .…”

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confidence: 99%