Techniques of Extracorporeal Cytokine Removal: A Systematic Review of the Literature on Animal Experimental Studies

Atan, Rafidah; Crosbie, David; Bellomo, Rinaldo

doi:10.5301/ijao.5000128

Cited by 22 publications

(21 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We had earlier published two systematic reviews on the same topic focusing on ex-vivo cytokine removal and cytokine removal in animal studies respectively. 53,54 The findings of the human studies reported here are broadly consistent with the findings of these two previous systematic reviews.…”

Section: Relation To Previous Literaturesupporting

confidence: 90%

Techniques of extracorporeal cytokine removal: a systematic review of human studies

2013

Self Cite

View full text Add to dashboard Cite

Background and aims: Hypercytokinemia is believed to be harmful and reducing cytokine levels is considered beneficial. Extracorporeal blood purification (EBP) techniques have been studied for the purpose of cytokine reduction. We aimed to study the efficacy of various EBP techniques for cytokine removal as defined by technical measures. Method: We conducted a systematic search for human clinical trials which focused on technical measures of cytokine removal by EBP techniques. We identified 41 articles and analyzed cytokine removal according to clearance (CL), sieving coefficient (SC), ultrafiltrate (UF) concentration and percentage removed. Results: We identified the following techniques for cytokine removal: standard hemofiltration, high volume hemofiltration (HVHF), high cut-off (HCO) hemofiltration, plasma filtration techniques, and adsorption techniques, ultrafiltration (UF) techniques relating to cardiopulmonary bypass (CPB), extracorporeal liver support systems and hybrid techniques including combined plasma filtration adsorption. Standard filtration techniques and UF techniques during CPB were generally poor at removing cytokines (median CL for interleukin 6 [IL-6]: 1.09 mL/min, TNF-alpha 0.74 mL/min). High cut-off techniques consistently offered moderate cytokine removal (median CL for IL-6: 26.5 mL/min, interleukin 1 receptor antagonist [IL-1RA]: 40.2 mL/ min). Plasma filtration and extracorporeal liver support appear promising but data are few. Only one paper studied combined plasma filtration and adsorption and found low rates of removal. The clinical significance of the cytokine removal achieved with more efficacious techniques is unknown. Conclusion: Human clinical trials indicate that high cut-off hemofiltration techniques, and perhaps plasma filtration and extracorporeal liver support techniques are likely more efficient in removing cytokines than standard techniques.

show abstract

Section: Relation To Previous Literaturesupporting

confidence: 90%

Techniques of extracorporeal cytokine removal: a systematic review of human studies

2013

Self Cite

View full text Add to dashboard Cite

show abstract

“…Enhanced cytokine depletion with high cutoff filters has been reported in a number of studies in vitro and in vivo [20,21,22]. It has been proposed that the concurrent removal of multiple mediators from the circulation can contribute to restoring immune homeostasis by eliminating the peaks of cytokine blood concentrations in the early phase of sepsis (peak concentration hypothesis) [23], by effecting the depletion of cytokines due to re-equilibration of blood and tissue cytokine levels (threshold immunomodulation hypothesis) [24], by inducing increased lymphatic flow and a displacement of mediators to the blood compartment (mediator delivery hypothesis) [25], or by directly acting on inflammatory cells, such as monocytes or neutrophils (cytokinetic model) [26].…”

Section: Discussionmentioning

confidence: 99%

Clearance of Selected Plasma Cytokines with Continuous Veno-Venous Hemodialysis Using Ultraflux EMiC2 versus Ultraflux AV1000S

Eichhorn

Hartmann²,

Harm³

et al. 2017

Blood Purif

View full text Add to dashboard Cite

Background: High cutoff hemofilters might support the restoration of immune homeostasis in systemic inflammation by depleting inflammatory mediators from the circulation. Methods: Interleukin (IL)-6, IL-8, IL-10, and tumor necrosis factor-alpha depletion was assessed in 30 sepsis patients with acute renal failure using continuous veno-venous hemodialysis with high cutoff versus standard filters (CVVHD-HCO vs. CVVHD-STD) over 48 h. Results: The transfer of IL-6 and IL-8 was significantly higher for CVVHD-HCO, as shown by increased IL-6 and IL-8 effluent concentrations. The mean plasma cytokine concentrations decreased over time for all cytokines without detectable differences for the treatment modalities. No transfer of albumin was observed for either of the filters. C-reactive protein remained stable over time and did not differ between CVVHD-HCO and CVVHD-STD, while procalcitonin decreased significantly over 48 h for both treatment modalities. Conclusion: CVVHD-HCO achieved enhanced removal of IL-6 and IL-8 as compared to CVVHD-STD, without differentially reducing plasma cytokine levels.

show abstract

“…Several extracorporeal filtering techniques have been used to remove these cytokines [12, 13]. Continuous veno-venous hemofiltration (CVVH) is one of the emerging techniques that has been studied for this purpose [14–17].…”

Section: Introductionmentioning

confidence: 99%

The effects of early high-volume hemofiltration on prolonged cardiac arrest in rats with reperfusion by cardiopulmonary bypass: a randomized controlled animal study

Shinozaki

Lampe

Kim

et al. 2016

ICMx

View full text Add to dashboard Cite

BackgroundIt is not yet clear whether hemofiltration can reduce blood cytokine levels sufficiently to benefit patients who suffer prolonged cardiac arrest (CA) treated with cardiopulmonary bypass (CPB). We sought to assess effects of high-volume and standard volume continuous veno-venous hemofiltration (CVVH) on blood cytokine levels and survival in a rat model of prolonged CA treated with CPB.MethodsSprague-Dawley male rats were subjected to 12 min of asphyxia to induce CA. CPB was initiated for resuscitation of animals and maintained for 30 min. Twenty-four rats were randomly assigned into three groups: without CVVH treatment (sham); standard volume CVVH at a filtration rate of 35–45 mL/kg/h; and high-volume hemofiltration (HVHF, 105–135 mL/kg/h). Hemofiltration was started simultaneously with CPB and maintained for 6 h. Plasma TNFα and IL-6 levels were measured at baseline, 0.5, 1, 2, 3, and 6 h after reperfusion. Survival time, neurological deficit score, and hemodynamic status were assessed.ResultsAll animals survived over 6 h and died within 24 h. There were no significant differences in survival time (log-rank test, sham vs. CVVH; p = 0.49, sham vs. HVHF; p = 0.33) or neurological deficit scores (ANOVA, p = 0.14) between the groups. There were no significant differences in blood cytokine levels between the groups. Mean blood pressure in sham group animals increased to 1.5-fold higher than baseline levels at 30 min. HVHF significantly reduced blood pressure to 0.7-fold of sham group (p < 0.01).ConclusionsThere was no improvement in mortality, neurological dysfunction, TNFα, or IL-6 levels in rats after prolonged CA with CPB on either hemofiltration group when compared to the sham group.Electronic supplementary materialThe online version of this article (doi:10.1186/s40635-016-0101-6) contains supplementary material, which is available to authorized users.

show abstract

Techniques of Extracorporeal Cytokine Removal: A Systematic Review of the Literature on Animal Experimental Studies

Abstract: Experimental animal studies indicate that HVHF (especially with HCO filters) and plasmafiltration have the potential to achieve appreciable IL-6 and IL-10 clearances. However, only PF can remove TNF-alpha reliably.

Cited by 22 publications

References 26 publications

Techniques of extracorporeal cytokine removal: a systematic review of human studies

Techniques of extracorporeal cytokine removal: a systematic review of human studies

Clearance of Selected Plasma Cytokines with Continuous Veno-Venous Hemodialysis Using Ultraflux EMiC2 versus Ultraflux AV1000S

The effects of early high-volume hemofiltration on prolonged cardiac arrest in rats with reperfusion by cardiopulmonary bypass: a randomized controlled animal study

Contact Info

Product

Resources

About