Pub Date : 2002-06-01DOI: 10.1046/J.1526-0968.2002.00431.X
S. Oda, H. Hirasawa, H. Shiga, K. Nakanishi, K. Matsuda, Masataka Nakamura
Continuous hemofiltration and continuous hemodiafiltration (CHF/CHDF) were developed as continuous renal replacement therapy for patients with severe conditons and has come to be widely performed mainly in critical care, taking the place of intermittent hemodialysis. The membrane pore size of a hemofilter used for CHF/CHDF allows passage of substances ranging from 30,000 to 50,000 Da, and the method for solute removal in CHF/CHDF employs the principle of convection, which is advantageous for removing middle- to high-molecular-weight substances. As apheresis therapy to remove pathogenic substances in blood, CHF/CHDF is therefore being investigated for its possible effect on various morbid conditions. It has recently been found that CHF/CHDF removes humoral mediators including cytokines, particularly in severe systemic inflammatory response syndromes such as septic shock and severe acute pancreatitis. CHF/CHDF is thus beginning to be performed for the prevention and treatment of organ dysfunction secondary to septic shock, trauma, or acute pancreatitis. CHF/CHDF is also efficacious as artificial liver support in preventing adverse effects caused by plasma exchange (PE) and for continuous removal of hepatic coma-inducing substances. CHF/CHDF is effective for various morbid conditions not only as renal replacement therapy, but also as apheresis therapy and is expected to be applied more widely in critical care in the future.
{"title":"Continuous hemofiltration/hemodiafiltration in critical care.","authors":"S. Oda, H. Hirasawa, H. Shiga, K. Nakanishi, K. Matsuda, Masataka Nakamura","doi":"10.1046/J.1526-0968.2002.00431.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00431.X","url":null,"abstract":"Continuous hemofiltration and continuous hemodiafiltration (CHF/CHDF) were developed as continuous renal replacement therapy for patients with severe conditons and has come to be widely performed mainly in critical care, taking the place of intermittent hemodialysis. The membrane pore size of a hemofilter used for CHF/CHDF allows passage of substances ranging from 30,000 to 50,000 Da, and the method for solute removal in CHF/CHDF employs the principle of convection, which is advantageous for removing middle- to high-molecular-weight substances. As apheresis therapy to remove pathogenic substances in blood, CHF/CHDF is therefore being investigated for its possible effect on various morbid conditions. It has recently been found that CHF/CHDF removes humoral mediators including cytokines, particularly in severe systemic inflammatory response syndromes such as septic shock and severe acute pancreatitis. CHF/CHDF is thus beginning to be performed for the prevention and treatment of organ dysfunction secondary to septic shock, trauma, or acute pancreatitis. CHF/CHDF is also efficacious as artificial liver support in preventing adverse effects caused by plasma exchange (PE) and for continuous removal of hepatic coma-inducing substances. CHF/CHDF is effective for various morbid conditions not only as renal replacement therapy, but also as apheresis therapy and is expected to be applied more widely in critical care in the future.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75713224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1046/J.1526-0968.2002.00416.X
Hiromichi Suzuki, H. Nemoto, H. Nakamoto, H. Okada, S. Sugahara, Y. Kanno, K. Moriwaki
The aim of this study was first, to evaluate the effects of continuous hemodiafiltration (CHDF) alone or combined with CHDF and polymyxin-B immobilized fiber (PMX) on survival rates of patients with sepsis and acute renal failure, and second, to evaluate the changes in plasma levels of inflammatory cytokines before and after treatment with CHDF and PMX and CHDF alone in these patients. Forty-eight patients with septic shock and acute renal failure were enrolled in this study. The survival rate of all patients at 28 days was 25% for those with CHDF and 75% for those with PMX and CHDF treatment. Combination treatment produced a significant reduction of plasma levels of endotoxin and interleukin-6 compared to the basal values and to the treatment with CHDF alone. From these data, it is suggested that the combined therapy with PMX and CHDF is effective in improvement of survival rate of patients with septic shock and acute renal failure.
{"title":"Continuous hemodiafiltration with polymyxin-B immobilized fiber is effective in patients with sepsis syndrome and acute renal failure.","authors":"Hiromichi Suzuki, H. Nemoto, H. Nakamoto, H. Okada, S. Sugahara, Y. Kanno, K. Moriwaki","doi":"10.1046/J.1526-0968.2002.00416.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00416.X","url":null,"abstract":"The aim of this study was first, to evaluate the effects of continuous hemodiafiltration (CHDF) alone or combined with CHDF and polymyxin-B immobilized fiber (PMX) on survival rates of patients with sepsis and acute renal failure, and second, to evaluate the changes in plasma levels of inflammatory cytokines before and after treatment with CHDF and PMX and CHDF alone in these patients. Forty-eight patients with septic shock and acute renal failure were enrolled in this study. The survival rate of all patients at 28 days was 25% for those with CHDF and 75% for those with PMX and CHDF treatment. Combination treatment produced a significant reduction of plasma levels of endotoxin and interleukin-6 compared to the basal values and to the treatment with CHDF alone. From these data, it is suggested that the combined therapy with PMX and CHDF is effective in improvement of survival rate of patients with septic shock and acute renal failure.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74687501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1046/J.1526-0968.2002.00407.X
R. Tullis, R. Duffin, M. Zech, J. Ambrus
We tested an affinity hemodialysis technique designed to efficiently remove HIV and toxic viral proteins from blood. Miniature polyethersulfone hollow-fiber dialysis cartridges (200-500 nm pore) were packed with anti-HIV antibodies covalently coupled to agarose beads and sealed inside the cartridge. Cell culture fluids, plasma, or infected blood (7-15 ml) containing HIV-1 were circulated over the cartridge at 0.7-10 ml/min and the rate of removal of HIV measured by PCR and p24 ELISA. The technique removed up to 98% of HIV-1 particles from cell culture supernatants. Affinity hemodialysis also efficiently captured cultured HIV from human blood plasma (90%) and native HIV from infected blood (83% to 100%). Viral capture followed first-order kinetics (t(1/2) = 2.8 h). Variations in antibody type, matrix linkage (protein G versus direct coupling), bead pore size, and temperature of operation (25-37 degrees C) had only small effects. Although some binding was nonspecific, direct binding to the immobilized antibodies appeared to be the predominant mechanism.
{"title":"Affinity hemodialysis for antiviral therapy. I. Removal of HIV-1 from cell culture supernatants, plasma, and blood.","authors":"R. Tullis, R. Duffin, M. Zech, J. Ambrus","doi":"10.1046/J.1526-0968.2002.00407.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00407.X","url":null,"abstract":"We tested an affinity hemodialysis technique designed to efficiently remove HIV and toxic viral proteins from blood. Miniature polyethersulfone hollow-fiber dialysis cartridges (200-500 nm pore) were packed with anti-HIV antibodies covalently coupled to agarose beads and sealed inside the cartridge. Cell culture fluids, plasma, or infected blood (7-15 ml) containing HIV-1 were circulated over the cartridge at 0.7-10 ml/min and the rate of removal of HIV measured by PCR and p24 ELISA. The technique removed up to 98% of HIV-1 particles from cell culture supernatants. Affinity hemodialysis also efficiently captured cultured HIV from human blood plasma (90%) and native HIV from infected blood (83% to 100%). Viral capture followed first-order kinetics (t(1/2) = 2.8 h). Variations in antibody type, matrix linkage (protein G versus direct coupling), bead pore size, and temperature of operation (25-37 degrees C) had only small effects. Although some binding was nonspecific, direct binding to the immobilized antibodies appeared to be the predominant mechanism.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79638453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1046/J.1526-0968.2002.00430.X
T. Ikeda
This paper concerns the results of endotoxin hemoadsorption therapy using a PMX column in patients with perforative peritonitis complicated by multiple organ failure. The subjects were 31 patients aged 68 +/- 12 years. When systolic arterial pressure decreased to less than 90 mm Hg, endotoxin hemoadsorption was initiated and continued for 2 h. At the completion of endotoxin hemoadsorption, systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were significantly increased. Platelet count decreased to less than 50,000/mm(3) in 30% of patients. As for cytokines and vascular endothelial cell function markers, interleukin-6 and plasminogen activator inhibitor-1 significantly decreased. These results suggest favorable effects of endotoxin hemoadsorption on the hemodynamic and pathophysiological conditions in patients with septic shock although attention should be given to the decrease in platelet count.
本文报道采用PMX柱对穿孔性腹膜炎合并多器官功能衰竭患者进行内毒素血液吸附治疗的结果。研究对象为31例患者，年龄68±12岁。当收缩压降至90 mm Hg以下时，开始内毒素血液吸附并持续2小时。内毒素血液吸附完成后，收缩压、舒张压和平均动脉压均显著升高。30%的患者血小板计数低于50,000/mm(3)。细胞因子和血管内皮细胞功能标志物中，白细胞介素-6和纤溶酶原激活物抑制剂-1显著降低。这些结果提示内毒素血液吸附对脓毒性休克患者的血流动力学和病理生理状况有良好的影响，但应注意血小板计数的减少。
{"title":"Hemoadsorption in critical care.","authors":"T. Ikeda","doi":"10.1046/J.1526-0968.2002.00430.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00430.X","url":null,"abstract":"This paper concerns the results of endotoxin hemoadsorption therapy using a PMX column in patients with perforative peritonitis complicated by multiple organ failure. The subjects were 31 patients aged 68 +/- 12 years. When systolic arterial pressure decreased to less than 90 mm Hg, endotoxin hemoadsorption was initiated and continued for 2 h. At the completion of endotoxin hemoadsorption, systolic arterial pressure, diastolic arterial pressure, and mean arterial pressure were significantly increased. Platelet count decreased to less than 50,000/mm(3) in 30% of patients. As for cytokines and vascular endothelial cell function markers, interleukin-6 and plasminogen activator inhibitor-1 significantly decreased. These results suggest favorable effects of endotoxin hemoadsorption on the hemodynamic and pathophysiological conditions in patients with septic shock although attention should be given to the decrease in platelet count.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90333473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1046/J.1526-0968.2002.00435.X
T. Moriguchi, H. Hirasawa, S. Oda, H. Shiga, K. Nakanishi, K. Matsuda, Masataka Nakamura, K. Yokohari, Takeshi Hirano, Y. Hirayama, Eizo Watanabe
It has been accepted widely that excessive humoral mediators play important roles in the pathogenesis of organ failure in patients with severe acute pancreatitis (SAP) and that infection of the pancreas due to bacterial translocation (BT) is the most frequent cause of death in SAP. On the other hand, it has been reported that continuous hemodiafiltration (CHDF) removes humoral mediators on hypercytokinemic patients such as those with systemic inflammatory response syndrome. Furthermore, several clinical studies have demonstrated that selective digestive decontamination (SDD) effectively eliminates aerobic Gram-negative bacteria from the intestinal tract and reduces the incidence of septic complications in SAP. Herein we report a case of SAP who was treated successfully with intensive care including CHDF and SDD. Thus, this case report suggests that CHDF aimed at removing causative humoral mediators and SDD for the prevention of BT are useful new tools for the management of SAP.
{"title":"A patient with severe acute pancreatitis successfully treated with a new critical care procedure.","authors":"T. Moriguchi, H. Hirasawa, S. Oda, H. Shiga, K. Nakanishi, K. Matsuda, Masataka Nakamura, K. Yokohari, Takeshi Hirano, Y. Hirayama, Eizo Watanabe","doi":"10.1046/J.1526-0968.2002.00435.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00435.X","url":null,"abstract":"It has been accepted widely that excessive humoral mediators play important roles in the pathogenesis of organ failure in patients with severe acute pancreatitis (SAP) and that infection of the pancreas due to bacterial translocation (BT) is the most frequent cause of death in SAP. On the other hand, it has been reported that continuous hemodiafiltration (CHDF) removes humoral mediators on hypercytokinemic patients such as those with systemic inflammatory response syndrome. Furthermore, several clinical studies have demonstrated that selective digestive decontamination (SDD) effectively eliminates aerobic Gram-negative bacteria from the intestinal tract and reduces the incidence of septic complications in SAP. Herein we report a case of SAP who was treated successfully with intensive care including CHDF and SDD. Thus, this case report suggests that CHDF aimed at removing causative humoral mediators and SDD for the prevention of BT are useful new tools for the management of SAP.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76031943","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-06-01DOI: 10.1046/J.1526-0968.2002.00432.X
H. Kawanishi
On-line products of substitution fluid permits virtually unlimited fluid volume exchange during continuous hemodiafiltration (CHDF) to critical care. In on-line hemodiafiltration (HDF), endotoxin free dialysate obtained using pyrogen cut filters is infused into the blood circuit, and HDF is automatically performed using the closed-loop balancing system of the dialysis machine. On-line CHDF is the application of this on-line HDF to continuous renal replacement therapy in the critical care field. We performed on-line CHDF on 376 acute renal failure patients during a 5 year period, and the mean survival rate was 62.5%. We concluded that the on-line CHDF system is safe and effective at maintaining acute renal failure patients.
{"title":"On-line hemodiafiltration in critical care.","authors":"H. Kawanishi","doi":"10.1046/J.1526-0968.2002.00432.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00432.X","url":null,"abstract":"On-line products of substitution fluid permits virtually unlimited fluid volume exchange during continuous hemodiafiltration (CHDF) to critical care. In on-line hemodiafiltration (HDF), endotoxin free dialysate obtained using pyrogen cut filters is infused into the blood circuit, and HDF is automatically performed using the closed-loop balancing system of the dialysis machine. On-line CHDF is the application of this on-line HDF to continuous renal replacement therapy in the critical care field. We performed on-line CHDF on 376 acute renal failure patients during a 5 year period, and the mean survival rate was 62.5%. We concluded that the on-line CHDF system is safe and effective at maintaining acute renal failure patients.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80508747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-04-01DOI: 10.1046/J.1526-0968.2002.00366.X
C. Otto, H. Geiss, E. Laubach, P. Schwandt
Direct adsorption of lipoproteins (DALI) apheresis has been shown to reduce effectively low-density lipoprotein (LDL) cholesterol and lipoprotein (a) concentrations. However, the effects on nontraditional risk indicators such as hemorheology and LDL subtypes have not been investigated so far. Five patients (2 women, 3 men, age 53 +/- 8 years) with coronary artery disease and severe LDL hypercholesterolemia regularly treated with other LDL apheresis devices entered the study and were then treated with DALI for the first time. Hemorheological and lipoprotein parameters were measured before and immediately after the initial DALI apheresis as well as before the fourth DALI apheresis. Compared to baseline (before the first DALI apheresis), the following parameters were significantly improved (p < 0.05) after the first DALI apheresis: LDL cholesterol (69 +/- 28 versus 208 +/- 82 mg/dl) and cholesterol in each LDL subfraction as well as plasma viscosity (1.23 +/- 0.04 versus 1.37 +/- 0.06 mPa), C-reactive protein, native blood viscosity, red cell aggregation, and red cell deformability. When parameters before the fourth DALI apheresis were compared to baseline, LDL cholesterol was still lower, and red cell deformability was still improved while cholesterol in each subfraction showed a statistical trend to lower concentrations (0.08 < p < 0.14). In conclusion, DALI apheresis not only reduces LDL cholesterol but also induced a significant reduction of cholesterol in all LDL subfractions and improved various hemorheological parameters.
直接吸附脂蛋白(DALI)分离已被证明可以有效降低低密度脂蛋白(LDL)胆固醇和脂蛋白(a)浓度。然而，对血液流变学和低密度脂蛋白亚型等非传统风险指标的影响迄今尚未研究。5例冠心病患者(2女，3男，年龄53±8岁)定期接受其他低密度脂蛋白分离装置治疗的严重低密度脂蛋白高胆固醇血症患者进入研究，然后首次接受DALI治疗。在首次DALI分离前后和第四次DALI分离前分别测量血液流变学和脂蛋白参数。与基线(第一次DALI单采前)相比，第一次DALI单采后，以下参数显着改善(p < 0.05): LDL胆固醇(69 +/- 28 vs 208 +/- 82 mg/dl)和每个LDL亚段中的胆固醇以及血浆粘度(1.23 +/- 0.04 vs 1.37 +/- 0.06 mPa)， c反应蛋白，天然血液粘度，红细胞聚集和红细胞变形性。第四次DALI分离前的参数与基线比较，LDL胆固醇仍较低，红细胞变形能力仍有所改善，各亚组胆固醇浓度均有降低的统计学趋势(0.08 < p < 0.14)。综上所述，DALI分离不仅可以降低LDL胆固醇，还可以诱导所有LDL亚组分的胆固醇显著降低，并改善各种血液流变学参数。
{"title":"Effects of direct adsorption of lipoproteins apheresis on lipoproteins, low-density lipoprotein subtypes, and hemorheology in hypercholesterolemic patients with coronary artery disease.","authors":"C. Otto, H. Geiss, E. Laubach, P. Schwandt","doi":"10.1046/J.1526-0968.2002.00366.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00366.X","url":null,"abstract":"Direct adsorption of lipoproteins (DALI) apheresis has been shown to reduce effectively low-density lipoprotein (LDL) cholesterol and lipoprotein (a) concentrations. However, the effects on nontraditional risk indicators such as hemorheology and LDL subtypes have not been investigated so far. Five patients (2 women, 3 men, age 53 +/- 8 years) with coronary artery disease and severe LDL hypercholesterolemia regularly treated with other LDL apheresis devices entered the study and were then treated with DALI for the first time. Hemorheological and lipoprotein parameters were measured before and immediately after the initial DALI apheresis as well as before the fourth DALI apheresis. Compared to baseline (before the first DALI apheresis), the following parameters were significantly improved (p < 0.05) after the first DALI apheresis: LDL cholesterol (69 +/- 28 versus 208 +/- 82 mg/dl) and cholesterol in each LDL subfraction as well as plasma viscosity (1.23 +/- 0.04 versus 1.37 +/- 0.06 mPa), C-reactive protein, native blood viscosity, red cell aggregation, and red cell deformability. When parameters before the fourth DALI apheresis were compared to baseline, LDL cholesterol was still lower, and red cell deformability was still improved while cholesterol in each subfraction showed a statistical trend to lower concentrations (0.08 < p < 0.14). In conclusion, DALI apheresis not only reduces LDL cholesterol but also induced a significant reduction of cholesterol in all LDL subfractions and improved various hemorheological parameters.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81363997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-04-01DOI: 10.1046/J.1526-0968.2002.00412.X
K. Tsuchida, Y. Takemoto, K. Sugimura, R. Yoshimura, K. Yamamoto, T. Nakatani
We previously reported that Lixelle, which was used for beta2-microglobulin (BMG) adsorption columns, could adsorb not only BMG but also inflammatory cytokines. We became interested in the application of Lixelle for patients with endotoxinemia and researched its ability to adsorb microorganism components in vitro using lipopolysaccharide (LPS) (Escherichia coli B8), endotoxin (ET) contaminated water. The initial concentrations of each water solution were LPS (ET 29,135 EU/L) and contaminated water (ET 3,523 EU/L) whole blood solution was LPS (ET 1,197.6 EU/L). Each 2.5 ml of the stock solution and adjusted diluted solutions contained 0.5 ml of Lixelle beads. After shaking at 37 degrees C for 2 h, ET in the solutions was determined using the endotoxin specific-limulus amebocyte lysate method. The results revealed that even though ET concentrations in LPS and contaminated water incubated in water solution and in whole blood were high, the samples containing Lixelle beads showed significant decreases. Thus, Lixelle beads can adsorb not only BMG but also microorganism components such as LPS and ET. These findings together with the ability of Lixelle to adsorb ET show the possibility of the application for treatment of endotoxinemia.
我们之前报道了用于β -微球蛋白(BMG)吸附柱的Lixelle不仅可以吸附BMG，还可以吸附炎症细胞因子。我们对Lixelle在内毒素血症患者中的应用产生了兴趣，并研究了Lixelle在体外利用脂多糖(LPS)(大肠杆菌B8)、内毒素(ET)污染的水中吸附微生物成分的能力。各水溶液初始浓度为LPS (ET 29,135 EU/L)，污染水(ET 3,523 EU/L)全血溶液为LPS (ET 1,197.6 EU/L)。每2.5 ml的原液和调整后的稀释溶液含有0.5 ml的Lixelle微珠。37℃振荡2小时后，采用内毒素特异性鲎试剂溶栓法测定溶液中的ET。结果显示，尽管脂多糖和污染水在水溶液中孵育和全血中的ET浓度很高，但含有Lixelle珠的样品中ET浓度明显降低。因此，Lixelle微球不仅可以吸附BMG，还可以吸附微生物成分，如LPS和ET。这些发现与Lixelle吸附ET的能力一起显示了应用于内毒素血症治疗的可能性。
{"title":"Adsorption of endotoxin by beta2-microglobulin adsorbent column (Lixelle): the new approach for endotoxinemia.","authors":"K. Tsuchida, Y. Takemoto, K. Sugimura, R. Yoshimura, K. Yamamoto, T. Nakatani","doi":"10.1046/J.1526-0968.2002.00412.X","DOIUrl":"https://doi.org/10.1046/J.1526-0968.2002.00412.X","url":null,"abstract":"We previously reported that Lixelle, which was used for beta2-microglobulin (BMG) adsorption columns, could adsorb not only BMG but also inflammatory cytokines. We became interested in the application of Lixelle for patients with endotoxinemia and researched its ability to adsorb microorganism components in vitro using lipopolysaccharide (LPS) (Escherichia coli B8), endotoxin (ET) contaminated water. The initial concentrations of each water solution were LPS (ET 29,135 EU/L) and contaminated water (ET 3,523 EU/L) whole blood solution was LPS (ET 1,197.6 EU/L). Each 2.5 ml of the stock solution and adjusted diluted solutions contained 0.5 ml of Lixelle beads. After shaking at 37 degrees C for 2 h, ET in the solutions was determined using the endotoxin specific-limulus amebocyte lysate method. The results revealed that even though ET concentrations in LPS and contaminated water incubated in water solution and in whole blood were high, the samples containing Lixelle beads showed significant decreases. Thus, Lixelle beads can adsorb not only BMG but also microorganism components such as LPS and ET. These findings together with the ability of Lixelle to adsorb ET show the possibility of the application for treatment of endotoxinemia.","PeriodicalId":79755,"journal":{"name":"Therapeutic apheresis : official journal of the International Society for Apheresis and the Japanese Society for Apheresis","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2002-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74798782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-04-01DOI: 10.1046/J.1526-0968.2002.00362.X
E. Kfoury Baz, Abdel Razzak A Mikati, N. Kanj
Hemophagocytic lymphohistiocytosis (HLH) is characterized by fever, cytopenia, splenomegaly, and lymphohistiocytic proliferation with hemophagocytosis. Sporadic, familial, and reactive HLH varieties exist. The latter, also termed the reactive hemophagocytic syndrome (RHS), has been associated with a variety of infectious and noninfectious etiologies. Activation of monocytes in RHS is due to stimulation by high levels of activating cytokines. RHS has not been associated previously with thrombotic thrombocytopenic purpura (TTP). TTP is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal impairment, and fever. We report on a 33 year old male patient with a classic picture of TTP who initially responded to therapeutic plasma exchange but then became refractory to treatment and developed RHS. It is likely that a specific pathophysiology involving the activation of neutrophils during TPE is present for the development of cytokine-induced hemophagocytosis during TTP treatment. The consequent development of RHS possibly caused early TTP relapse.
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Pub Date : 2002-04-01DOI: 10.1046/J.1526-0968.2002.00351.X
H. Yokoyama, M. Shimizu, T. Wada, K. Yoshimoto, Y. Iwata, Kazuaki Shimizu, N. Sakai, K. Furuichi, Y. Hisada, H. Takakuwa, Ken‐ichi Kobayashi
A considerable permeability factor (or factors) derived from circulating T cells has a crucial role in proteinuria of nephrotic syndrome (NS). We attempted to remove pathogenic T cells through lymphocytapheresis (LCAP) in 6 patients with primary NS, 2 patients with minimal change nephrotic syndrome (MCNS), 2 patients with focal segmental glomerulosclerosis (FSGS), 1 patient with membranous nephropathy (MN), and 1 patient with MN and FSGS using Cellsorba (Asahi Medical Co., Osaka, Japan). LCAP was performed 2 times in 2 consecutive weeks and was followed with corticosteroid therapy with or without cyclosporine A in 5 patients. Two patients with MCNS, 1 with FSGS, and 1 with MN and FSGS showed a dramatic decrease of proteinuria (-30% and -94%) in their urine protein/creatinine ratio. Three out of 4 patients had a complete or partial remission (proteinuria <1g/day) within 8 weeks following immunosuppressive therapy. During the LCAP, T cells, especially activated T cells, decreased significantly in the response group. The other 2 patients, 1 with FSGS and 1 with MN, however, had no response to LCAP and following immunosuppressive therapy or low-density lipoprotein apheresis and suffered from end-stage renal failure or death by pneumonia. These results suggested that LCAP might have a beneficial effect on the treatment of NS, especially MCNS and in some patients with FSGS, despite varying responses to LCAP and concomitant immunosuppressive therapy.
来自循环T细胞的大量通透性因子(或多个因子)在肾病综合征蛋白尿(NS)中起着至关重要的作用。我们使用Cellsorba (Asahi Medical Co.， Osaka, Japan)对6例原发性NS患者、2例微小改变肾病综合征(MCNS)患者、2例局灶节段性肾小球硬化(FSGS)患者、1例膜性肾病(MN)患者和1例MN合并FSGS患者进行了淋巴细胞穿刺(LCAP)去除致病性T细胞的尝试。5例患者连续2周进行2次LCAP，随后给予皮质类固醇治疗(含或不含环孢素A)。2例MCNS患者，1例FSGS患者，1例MN和FSGS患者尿蛋白/肌酐比值显著降低(-30%和-94%)。4例患者中有3例在免疫抑制治疗后8周内完全或部分缓解(蛋白尿<1g/天)。在LCAP期间，反应组的T细胞，尤其是活化T细胞明显减少。然而，另外2例患者，1例FSGS和1例MN，对LCAP没有反应，在免疫抑制治疗或低密度脂蛋白分离后，出现终末期肾功能衰竭或死于肺炎。这些结果表明，LCAP可能对NS，特别是MCNS和一些FSGS患者的治疗有有益的作用，尽管LCAP和伴随的免疫抑制治疗的反应不同。
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