Leukocyte capture and modulation of cell-mediated immunity during human sepsis: an ex vivo study

Rimmelé, Thomas; Kaynar, A. Murat; McLaughlin, Joseph N.; Bishop, Jeffery V.; Fedorchak, Morgan V.; Chuasuwan, Anan; Peng, Zhiyong; Singbartl, Kai; Frederick, Daniel R.; Zhu, Lin; Carter, Melinda; Federspiel, William J.; Zeevi, Adriana; Kellum, John A.

doi:10.1186/cc12587

Cited by 42 publications

(49 citation statements)

References 42 publications

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“…Extracorporeal blood purification could therefore be an additional asset for clinicians, as its principle is to mitigate this pro-and anti-inflammatory overflow. Several theories exist to explain the value of blood purification in sepsis, including the "cytokine peak hypothesis" [16], the "threshold immunomodulation theory" [17], the "cytokinetic model" [18] and the modulation of immune cells themselves [19].…”

Section: Discussionmentioning

confidence: 99%

oXiris® Use in Septic Shock: Experience of Two French Centres

et al. 2019

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Background: Sepsis is a dysregulated host response to an infection and can result in organ dysfunctions and death. Extracorporeal blood purification techniques aim to improve the prognosis of these patients by modulating the unbalanced immune response. This study reports our experience with the use of the oXiris® membrane for septic shock patients requiring continuous renal replacement therapy (CRRT). Summary: Thirty-one patients were diagnosed with septic shock and underwent CRRT with the oXiris® membrane between 2014 and 2019. We compared the observed hospital mortality with that predicted by the Simplified Acute Physiology Score II (SAPS II). Change in the Sequential Organ Failure Assessment (SOFA) score and of the main clinical and biological parameters over time were analyzed. Hospital mortality was lower than predicted for the most severe patients (60 vs. 91% for the [74–87] SAPS II quartile and 70 vs. 98% for the [87–163] SAPS II quartile, p < 0.02). There was no significant improvement in the SOFA score from 0h to 48 h. An 88% relative decrease in norepinephrine infusion was observed (median at 0 h was 1.69 [0.52–2.45] µg/kg/min; at 48 h it was 0.20 [0.09–1.14] µg/kg/min, p = 0.002). Lactataemia and pH were significantly improved over time. Patients with intra-abdominal sepsis as well as those with Gram-negative bacilli (GNB) infections seemed to benefit the most from the therapy. Key Messages: CRRT with the oXiris® haemofilter resulted in higher observed survival than predicted by a severity score (SAPS II) for the most severe patients. Haemodynamic status and lactataemia appeared to improve, especially in intra-abdominal sepsis and GNB infections.

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Section: Discussionmentioning

confidence: 99%

oXiris® Use in Septic Shock: Experience of Two French Centres

et al. 2019

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“…Interestingly, it has been suggested that hemoadsorption devices such as CytoSorb ® could also adsorb leukocytes (mainly activated monocytes and neutrophils) in addition to their designated targets (cytokines and/or endotoxins), and thus modulate the immune response at a cellular level [14]. Furthermore, Srisawat et al [81] have suggested that polymyxin B could also act at the cellular level of the immune modulation, by improving the expression of the monocyte human leukocyte antigen at the surface of leukocytes in septic ICU patients.…”

Section: Patientsmentioning

confidence: 99%

“…The objective is therefore to remove pathogens or PAMPs such as endotoxins before they activate leukocytes [12]. Finally, the modulation of the immune process may directly involve the leukocytes, either through their direct removal or through an immune cell reprograming (modulation of surface markers expression, improvement of antigen-presenting capability, or adjustment of apoptosis) [13,14].…”

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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“…Although many extracorporeal blood-purification techniques have demonstrated efficacy in clearing these molecular targets from plasma, clinical studies have reported limited success in using molecularly targeted blood purification (159). However, it has also been proposed that blood-purification therapy should be used for a broader spectrum of targets, including microbial pathogens and host immune cells (161).…”

Section: Extracorporeal Blood Purification For Sepsis Therapymentioning

confidence: 98%

“…Similarly, extracorporeal blood-purification platforms aimed at immune-cell removal have been developed mainly using affinity-based approaches that employ sorbent polymer (163) or synthetic biomimetic membrane (164). Rimmelé et al (161) have shown that leukocytes together with cytokines can be adsorbed onto CytoSorb (CytoSorbents, Monmouth Junction, NJ), a type of polystyrene divinylbenzene copolymer bead.…”

Section: Extracorporeal Blood Purification For Sepsis Therapymentioning

confidence: 99%

Large-Volume Microfluidic Cell Sorting for Biomedical Applications

Warkiani

Wu²,

Tay

et al. 2015

Annu. Rev. Biomed. Eng.

102

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Microfluidic cell-separation technologies have been studied for almost two decades, but the limited throughput has restricted their impact and range of application. Recent advances in microfluidics enable high-throughput cell sorting and separation, and this has led to various novel diagnostic and therapeutic applications that previously had been impossible to implement using microfluidics technologies. In this review, we focus on recent progress made in engineering large-volume microfluidic cell-sorting methods and the new applications enabled by them.

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Leukocyte capture and modulation of cell-mediated immunity during human sepsis: an ex vivo study

Cited by 42 publications

References 42 publications

oXiris® Use in Septic Shock: Experience of Two French Centres

oXiris® Use in Septic Shock: Experience of Two French Centres

Extracorporeal Blood Purification Therapies for Sepsis

Large-Volume Microfluidic Cell Sorting for Biomedical Applications

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