Department of Internal Medicine, Center for Extracorporeal Organ Support (CEOS), University of Rostock, Rostock, Germany,
Department of Internal Medicine, Section Nephrology, University Medicine Rostock, Rostock, Germany,
Blood Purif. 2021;50(1):119-128. doi: 10.1159/000508810. Epub 2020 Jul 2.
Liver failure is characterized by compromised hepatic detoxification, protein synthesis, and metabolic derangements leading to an accumulation of a broad spectrum of water-soluble and lipophilic toxins as well as immune system mediators. Exploring complex detoxification mechanisms to therapeutically target those components, this article will focus on similarities, differences, and potential synergies in the mechanism of albumin dialysis and hemoperfusion.
An in vitro two-compartment model for the comparison of liver support techniques was used to compare MARS albumin dialysis modified with novel charcoal adsorbents to CytoSorb hemoperfusion with added hemodialysis for effects on marker molecule removal.
MARS and CytoSorb performed similar in the removal of water-soluble toxins. Ammonia removal was increased using CytoSorb. CytoSorb lead to a statistically significant reduction of albumin-bound toxins, total bilirubin and subfractions. Bile acid removal was comparable. MARS demonstrated no removal of cytokines interleukin (IL)-6 and tumor necrosis factor-alpha (TNF-α), whereas CytoSorb allowed for near complete removal. Notably, CytoSorb displayed 50% of lipophilic substance and cytokine removal during the first hour of treatment.
Compared to MARS, CytoSorb hemoperfusion leads to an initially fast removal of cytokines, TNF-α and IL-6, as well as reduction of albumin-bound toxins such as indirect bilirubin and bile acids in our model. The initial removal is also associated with removal of albumin.
肝功能衰竭的特点是肝脏解毒、蛋白质合成和代谢紊乱，导致广泛的水溶性和脂溶性毒素以及免疫系统介质的积累。为了探索复杂的解毒机制，以治疗这些成分，本文将重点介绍白蛋白透析和血液灌流的机制中的相似性、差异和潜在协同作用。
使用体外双室模型比较了改良后的白蛋白透析（MARS）和添加血液透析的新型活性炭吸附剂CytoSorb 血液灌流，以比较两种肝支持技术对标记分子清除的影响。
MARS 和 CytoSorb 在去除水溶性毒素方面表现相似。CytoSorb 可增加氨的清除。CytoSorb 可显著降低白蛋白结合毒素、总胆红素和亚组分。胆汁酸清除率相当。MARS 未显示出对细胞因子白细胞介素 (IL)-6 和肿瘤坏死因子-α (TNF-α) 的清除作用，而 CytoSorb 则允许几乎完全清除。值得注意的是，CytoSorb 在治疗的第一个小时内去除了 50%的脂溶性物质和细胞因子。
与 MARS 相比，CytoSorb 血液灌流在我们的模型中导致细胞因子 TNF-α和 IL-6 的初始快速清除，以及间接胆红素和胆汁酸等白蛋白结合毒素的减少。初始清除也与白蛋白的清除有关。
