Extracorporeal Blood Purification Therapies for Sepsis

Abstract

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

Potential effect of blood purification therapy in reducing cytokine storm as a late complication of critically ill COVID-19

“…On Feb 19, he experienced sudden death and was successfully resuscitated, after which continuous renal replacement therapy (CRRT) was initiated. It was performed with the oXiris® hemofilter (Baxter, Meyzieu, France), a modified AN69 surface treated membrane with adsorption capacity [9]. The hemofilter was changed every 12-24 h for 6 days, and his lab tests were improved (lymphocyte 0.43 × 10 9 /l, CRP 154.9 mg/l, IL-6 78.22 pg/ml) ( Fig.…”

Sepsis 2019: What Surgeons Need to Know

“…Beta-blockade, in particular with esmolol, has demonstrated promise in several randomized controlled trials, including demonstrating a reduction in morality from sepsis [58]. Extracorporeal blood purification strategies are currently under investigation, as are industry-sponsored adsorptive membranes, as adjuvant therapy for sepsis [59]. Similarly, therapeutic plasma exchange has been investigated for similar reasons with some promising data [60].…”

Multiscale Biofluidic and Nanobiotechnology Approaches for Treating Sepsis in Extracorporeal Circuits

“…As we overviewed above, there are many technical challenges that researchers in interdisciplinary fields ranging from medicine and biology to nanotechnology, polymer sciences, and complex fluid dynamics, could work together to revolutionize the current extracorporeal therapeutic strategies. Besides removing pathogenic materials from blood, elimination of activated leukocytes may have positive impacts on therapeutic efficacy 59 ; however, more fundamental and clinical evaluations are required to follow because the detailed primary mechanisms and their consequences governing sepsis progression remain largely unknown 16 . It is also important to note that once proving their therapeutic efficiency in RCTs, it would be worth exploring whether the extracorporeal therapeutic scenario could not only help decrease the mortality of septic patients but also improve the post-therapeutic life quality because about half of the survivors of sepsis suffer from the post-sepsis syndrome 60 .…”

“…Efforts first dedicated to removing infectious reagents in whole blood of septic patients were developed by modifying the conventional extracorporeal blood treatment devices, such as hemofiltration devices. The inner surface of the fiber bundles of the device was functionalized with synthetic proteins 16 or antibiotics 17 that were known to capture a range of Gram-negative pathogens or lipopolysaccharides (LPS) ( Figure 1A). The fibers of Toraymyxin® and oXiris®, for example, are functionalized with polymyxin B (antibiotics) and polyethyleneimine (PEI) (positively charged mo-lecule), respectively, which are known to bind Gramnegative bacteria and LPS (negatively charged moiety).…”