In-Vitro Myoglobin Clearance by a Novel Sorbent System

Abstract

Rhabdomyolysis may lead to acute kidney injury following deposition of myoglobin in renal tubules. Although high-flux dialysis membranes may remove a substantial amount of myoglobin from plasma, this may still not be sufficient to prevent renal damage. We tested a new polymer sorbent, X-Sorb, in vitro to determine its potential to clear myoglobin from solutions. Normal saline or human serum in which myoglobin was dissolved was perfused by a peristaltic pump through a column packed with the sorbent. After a 4-hour perfusion, the myoglobin level in normal saline fell from 200,000 ng/ml to virtually undetectable (<780 ng/ml). Perfusion through the sorbent was then found to lower concentrations of dissolved myoglobin in 3 different 110-ml samples of human serum consistently by > 90% over 4 hours. X-Sorb appears to be an effective sorbent for myoglobin and warrants a trial in vivo to determine whether it is equally effective and safe.

Hemoadsorption Improves Survival of Rats Exposed to an Acutely Lethal Dose of Aflatoxin B1

“…The reduced scale device used in this study is based on the 300 mL CytoSorb ® adsorber, a CE-Mark certified device approved for use as an extracorporeal cytokine adsorber. The indications for use have been expanded to include the adsorption of myoglobin 19 and bilirubin 20 . The device has been shown to adsorb a number of small lipophilic molecules from blood in vitro including amitriptyline, diazepam, digoxin, quetiapine, and rivaroxaban 21 as well as aflatoxin and T-2 toxin 16 , which prompted this investigation.…”

Hemoadsorption Treatment of Patients with Acute Infective Endocarditis during Surgery with Cardiopulmonary Bypass - A Case Series

“…As circulating proinflammatory mediators like IL-6 and IL-8 play a central role in the development of SIRS and sepsis, the application of hemoadsorption devices represents a potential interesting interventional tool to avoid detrimental cross-talk between mediators, DAMPS and PAMPS with the immune system. CytoSorb has been shown to effectively remove hydrophobic molecules from 5 kDa up to approximately 55 kDa such as cytokines, chemokines, myoglobin and various other substances ( 7 , 8 ). Moreover, cytokine reduction by means of CytoSorb application was reported for critically ill and cardiac surgery patients, as supported by a number of published preclinical and clinical data ( 4 , 9 , 10 ).…”

Hypothermic Cardiac Arrest With Full Neurologic Recovery After Approximately Nine Hours of Cardiopulmonary Resuscitation: Management and Possible Complications

“…For instance, acute renal failure is frequently observed after prolonged cardiac arrest. 2,13 In our case, in addition to continuous renal replacement therapy, a hemofiltration filter was incorporated into the extracorporeal membrane oxygenation circuit 14 to enhance the clearance of myoglobin 15 and the inflammatory cytokines released after reperfusion. Overall, postresuscitation treatment is challenging for critical care providers because of pathophysiologic alterations related to therapeutic choices (such as weaning from extracorporeal membrane oxygenation and mechanical ventilation) and the complexities related to neurologic monitoring in the unconscious patient.…”