Elimination of Uremic Toxins by Functionalized Graphene-Based Composite Beads for Direct Hemoperfusion

Nanocellulose/Graphene Oxide Composite Beads as a Novel Hemoperfusion Adsorbent for Efficient Removal of Bilirubin Plasma

Conventional hemoperfusion adsorbents suffer from inefficiency and poor biocompatibility. Cellulose, a natural polysaccharide with biocompatible, biodegradable, and nontoxic properties, was combined with graphene oxide (GO) to fabricate composite beads (TGO) for blood purification. GO synthesized via a modified Hummers method was complexed with 2,2,6,6-tetramethylpiperidine-1-oxyl (TEMPO)-oxidized cellulose nanofibrils (TOCNs). Increasing GO content (2-20 wt %) enhanced TGO's specific surface area (256.4-289.0 m2 g-1) while retaining an ∼10 nm pore size. TGO demonstrated exceptional adsorption capacities: bilirubin (418.4 mg g-1), creatinine (23.5 mg g-1), uric acid (146.6 mg g-1), and Cu2+ (171.9 mg g-1). The beads exhibited excellent hemocompatibility (hemolysis rate <5%) and prolonged recalcification time (585 ± 5.2 s). Notably, TGO restored blood bilirubin levels to normal within 30 min, highlighting its potential for blood purification.

Nanomaterials for targeted therapy of kidney diseases: Strategies and advances

The treatment and management of kidney diseases pose a significant global burden. Due to the presence of blood circulation barriers and glomerular filtration barriers, drug therapy for kidney diseases faces challenges such as poor renal targeting, short half-life, and severe systemic side effects, severely hindering therapeutic progress. Therefore, the research and development of kidney-targeted therapeutic agents is of great clinical significance. In recent years, the application of nanotechnology in the field of nephrology has shown potential for revolutionizing the diagnosis and treatment of kidney diseases. Carefully designed nanomaterials can exhibit optimal biological characteristics, influencing various aspects such as circulation, retention, targeting, and excretion. Rationally designing and modifying nanomaterials based on the anatomical structure and pathophysiological environment of the kidney to achieve highly specific kidney-targeted nanomaterials or nanodrug delivery systems is both feasible and promising. Based on the targeted therapy of kidney diseases, this review discusses the advantages and limitations of current nanomedicine in the targeted therapy of kidney diseases, and summarizes the application and challenges of current renal active/passive targeting strategies, in order to further promote the development of kidney-targeted nanomedicine through a preliminary summary of previous studies and future prospects.

Covalent organic frameworks as superior adsorbents for the removal of toxic substances

Developing new materials capable of the safe and efficient removal of toxic substances has become a research hotspot in the field of materials science, as these toxic substances pose a serious threat to human health, both directly and indirectly. Covalent organic frameworks (COFs), as an emerging class of crystalline porous materials, have advantages such as large specific surface area, tunable pore size, designable structure, and good biocompatibility, which have been proven to be a superior adsorbent design platform for toxic substances capture. This review will summarize the synthesis methods of COFs and the properties and characteristics of typical toxicants, discuss the design strategies of COF-based adsorbents for the removal of toxic substances, and highlight the recent advancements in COF-based adsorbents as robust candidates for the efficient removal of various types of toxicants, such as animal toxins, microbial toxins, phytotoxins, environmental toxins, etc. The adsorption performance and related mechanisms of COF-based adsorbents for different types of toxic substances will be discussed. The complex host-guest interactions mainly include electrostatic, π-π interactions, hydrogen bonding, hydrophobic interactions, and molecular sieving effects. In addition, the adsorption performance of various COF-based adsorbents will be compared, and strategies such as reasonable adjustment of pore size, introduction of functionalities, and preparation of composite materials can effectively improve the adsorption efficiency of toxins. Finally, we also point out the challenges and future development directions that COFs may face in the field of toxicant removal. It is expected that this review will provide valuable insights into the application of COF-based adsorbents in the removal of toxicants and the development of new materials.

Loading Self-Assembly Siliceous Zeolites for Affordable Next-Generation Wearable Artificial Kidney Technology

The global demand for dialysis among patients with end-stage kidney disease has surpassed the capacity of public healthcare, a trend that has intensified. While wearable artificial kidney (WAK) technology is seen as a crucial solution to address this demand, there is an urgent need for both efficient and renewable toxin-adsorbent materials to overcome the long-standing technological challenges in terms of cost, device size, and sustainability. In this study, we employed screening experiments for adsorbent materials, multimodal characterization, and Monte Carlo adsorption simulations to identify a synthetic self-assembly silicalite-1 zeolite that exhibits highly ordered crystal arrays along the [010] face (b-axis) direction, demonstrating exceptional adsorption capabilities for small molecular toxins such as creatinine and urea associated with uremia. Moreover, this metal-free, cost-effective, easily synthesized, and highly efficient toxin adsorbent could be regenerated through calcination without compromising the performance. The simulated toxin adsorption experiments and comprehensive biocompatibility verification position it as an auxiliary adsorbent to reduce dialysate dosages in WAK devices as well as a potential adsorbent for small-molecule toxins in dialysis. This work is poised to propel the development of next-generation WAK devices by providing siliceous adsorbent solutions for small-molecule toxins.

Cellulose acetate/metal-organic framework composite beads with macroporous adsorption channels as a novel hemoadsorbent for effective virus capture

Due to their rapid spread, high variability, and drug-resistant strains, new viral infections are continuously emerging. A lack of effective antiviral drugs and vaccines, resulting in disease and death, has significant socioeconomic consequences. Hemoperfusion can effectively adsorb and remove toxins from the blood, thus purifying the blood and serving as an acute treatment. Therefore, the aim of this study was to construct adsorbents to selectively remove viruses from the blood to quickly treat pathogen infection. We reported on new metal-organic framework (MOF)-polymer beads based on MIL-53(Al) and cellulose acetate (CNC), which were prepared by a one-step phase inversion method and applied as a viral hemo-adsorbent for the first time. The characterization results demonstrated that MIL-53(Al) was well dispersed in the CNC matrix. The adsorption results demonstrated that the capture efficiency of the human immunodeficiency virus (HIV) could exceed 99.93%, and the corresponding infectious titer decreased by approximately 103 times in clinical application. Moreover, CNC/MIL-53 exhibited low hemolysis ratios and good anticoagulant properties. Furthermore, molecular dynamics simulations revealed that the interplay of hydrogen bonding was the governing physisorption mechanism. Overall, CNC/MIL-53 could serve as a new type of hemoperfusion adsorbent for virus removal from blood and provide a new treatment pathway to mitigate epidemics.

Computer-aided nanodrug discovery: recent progress and future prospects

Nanodrugs, which utilise nanomaterials in disease prevention and therapy, have attracted considerable interest since their initial conceptualisation in the 1990s. Substantial efforts have been made to develop nanodrugs for overcoming the limitations of conventional drugs, such as low targeting efficacy, high dosage and toxicity, and potential drug resistance. Despite the significant progress that has been made in nanodrug discovery, the precise design or screening of nanomaterials with desired biomedical functions prior to experimentation remains a significant challenge. This is particularly the case with regard to personalised precision nanodrugs, which require the simultaneous optimisation of the structures, compositions, and surface functionalities of nanodrugs. The development of powerful computer clusters and algorithms has made it possible to overcome this challenge through in silico methods, which provide a comprehensive understanding of the medical functions of nanodrugs in relation to their physicochemical properties. In addition, machine learning techniques have been widely employed in nanodrug research, significantly accelerating the understanding of bio-nano interactions and the development of nanodrugs. This review will present a summary of the computational advances in nanodrug discovery, focusing on the understanding of how the key interfacial interactions, namely, surface adsorption, supramolecular recognition, surface catalysis, and chemical conversion, affect the therapeutic efficacy of nanodrugs. Furthermore, this review will discuss the challenges and opportunities in computer-aided nanodrug discovery, with particular emphasis on the integrated "computation + machine learning + experimentation" strategy that can potentially accelerate the discovery of precision nanodrugs.

[Application of Modified Polyether Sulfone Microspheres in Hyperbilirubinemia]

Objective

To design and prepare a high efficiency bilirubin adsorbent with good mechanical properties and biocompatibility.

Methods

In this study, quaternary ammonium pyridine was designed and synthesized, and then modified polyether sulfone microspheres, or PES/p(4-VP-co-N-VP)@6 microspheres, were prepared by phase conversion and electrostatic spraying. The morphology of the polymer components and the microspheres were studied by means of nuclear magnetic resonance (NMR) spectroscopy and scanning electron microscopy. The basic properties of the microspheres and their bilirubin adsorption efficiency were tested, and the adsorption mechanism was further explored. Blood cell counts and the clotting time of the microspheres were also measured.

Results

The diameter of the modified polyether sulfone microspheres prepared in the study was approximately 700-800 μm. Compared with the original PES microspheres, the surface and internal structure of PES/p(4-VP-co-N-VP)@6 microspheres did not change significantly, and they also had a loose porous structure, with some micropores scattered around in addition to irregular large pores. Compared with the control group, the bilirubin removal effect of the modified microspheres was (94.91±0.73)% after static adsorption in bilirubin PBS buffer solution for 180 min, with the difference being statistically significant (P<0.0001). According to the findings for the clotting time, the activated partial thromboplastin time (APTT) of the blank plasma group, the control PES group, and the modified PES microsphere group were (27.57±1.25) s, (28.47±0.45) s, and (30.4±0.872) s, respectively, and the difference between the experimental group and the other two groups was statistically significant (P<0.01, P<0.05). There was no significant change in red blood cell and white blood cell counts.

Conclusion

The microspheres prepared in the study have high efficiency in bilirubin adsorption, excellent mechanical properties and thermal stability, and good blood biocompatibility, and are expected to be used in the clinical treatment of patients with liver failure.

An Evolutionary Review of Hemoperfusion Adsorbents: Materials, Preparation, Functionalization, and Outlook

Accumulation of pathogenic factors in the blood may cause irreversible damage and may even be life-threatening. Hemoperfusion is an effective technique for eliminating pathogenic factors, which is widely used in the treatment of various diseases including liver failure, renal failure, sepsis, and others. Hemoperfusion adsorbents are crucial in this process as they specifically bind and remove the target pathogenic factors. This review describes the development of hemoperfusion adsorbents, detailing the different properties exhibited by inorganic materials, organic polymers, and new materials. Advances in natural and synthetic polymers and novel materials manufacturing techniques have driven the expansion of hemoperfusion adsorbents in clinical applications. Stimuli-responsive (smart responsive) adsorbents with controllable molecular binding properties have many promising and environmentally friendly biomedical applications. Knowledge gaps, future research directions, and prospects for hemoperfusion adsorbents are discussed.

Uremic toxins mediate kidney diseases: the role of aryl hydrocarbon receptor

Aryl hydrocarbon receptor (AhR) was originally identified as an environmental sensor that responds to pollutants. Subsequent research has revealed that AhR recognizes multiple exogenous and endogenous molecules, including uremic toxins retained in the body due to the decline in renal function. Therefore, AhR is also considered to be a uremic toxin receptor. As a ligand-activated transcriptional factor, the activation of AhR is involved in cell differentiation and senescence, lipid metabolism and fibrogenesis. The accumulation of uremic toxins in the body is hazardous to all tissues and organs. The identification of the endogenous uremic toxin receptor opens the door to investigating the precise role and molecular mechanism of tissue and organ damage induced by uremic toxins. This review focuses on summarizing recent findings on the role of AhR activation induced by uremic toxins in chronic kidney disease, diabetic nephropathy and acute kidney injury. Furthermore, potential clinical approaches to mitigate the effects of uremic toxins are explored herein, such as enhancing uremic toxin clearance through dialysis, reducing uremic toxin production through dietary interventions or microbial manipulation, and manipulating metabolic pathways induced by uremic toxins through controlling AhR signaling. This information may also shed light on the mechanism of uremic toxin-induced injury to other organs, and provide insights into clinical approaches to manipulate the accumulated uremic toxins.

Reusable Zwitterionic Porous Organic Polymers for Bilirubin Removal in Serum

Herein, we report a straightforward strategy to construct reusable, hemocompatible, and highly efficient bilirubin adsorbents by installing zwitterionic modules into a porous organic polymer (POP) for hemoperfusion application. Three types of zwitterions with different amounts are used to evaluate their impacts on the characteristics of POPs, including carboxybetaine methacrylate (CB), sulfobetaine methacrylate (SB), and 2-methacryloyloxyethyl phosphorylcholine (MPC). Results show that zwitterions can improve hemocompatibility, hydrophilicity, and bilirubin uptake of the POP. Among all zwitterionic POPs, POP-CB-40% exhibits the best bilirubin uptake, ∼46.5 times enhancement compared with the non-zwitterionic POP in 100% serum. This enhancement can be attributed to the improved hydrophilicity and protein resistance ability in biological solutions. More importantly, the reusability test shows that POP-CB-40% maintains ∼99% of bilirubin uptake capacity at fifth recycling in 100% serum. Findings in this work provide a guideline for the design of biocompatible and efficient POP-based bilirubin adsorbents for hemoperfusion therapy.

Protein/Polysaccharide Composite toward Multi-in-One Toxin Removal in Blood with Self-Anticoagulation and Biocompatibility

Biocompatible adsorbents play an essential role in hemoperfusion. Nevertheless, there are no hemoperfusion adsorbents that can simultaneously remove small and medium toxins, including bilirubin, urea, phosphor, heavy metals, and antibiotics. This bottleneck significantly impedes the miniaturization and portability of hemoperfusion materials and devices. Herein, a biocompatible protein-polysaccharide complex is reported that exhibits "multi-in-one" removal efficacy for liver and kidney metabolism wastes, toxic metal ions, and antibiotics. Through electrostatic interactions and polysaccharide-mediated coacervation, adsorbents can be prepared by simply mixing lysozyme (LZ) and sodium alginate (SA) together in seconds. The LZ/SA absorbent presented high adsorption capacities for bilirubin, urea, and Hg2+ of up to 468, 331, and 497 mg g-1 , respectively, and the excellent anti-protein adsorption endowed LZ/SA with a record-high adsorption capacity for bilirubin in the interference of serum albumin to simulate the physiological environment. The LZ/SA adsorbent also has effective adsorption capacity for heavy metals (Pb2+ , Cu2+ , Cr3+ , and Cd2+ ) and multiple antibiotics (terramycin, tetracycline, enrofloxacin, norfloxacin, roxithromycin, erythromycin, sulfapyrimidine, and sulfamethoxazole). Various adsorption functional groups exposed on the adsorbent surface significantly contribute to the excellent adsorption capacity. This fully bio-derived protein/alginate-based hemoperfusion adsorbent has great application prospects in the treatment of blood-related diseases.

Performant removal of creatinine using few-layer-graphene/alginate beads as a kidney filter

Reduction of renal function, such as creatinine adsorption is one of the most common and dangerous diseases. Dedicated to this issue, developing high-performance, sustainable, and bio-compatible adsorbing materials is still challenging. Herein, barium alginate (BA) and BA containing few-layer graphene (FLG/BA) beads were synthesized in water from sodium alginate, also acting as bio-surfactant in in-situ exfoliation of graphite to FLG. The physicochemical characteristics of the beads demonstrated an excess of barium chloride used as a cross-linker. The efficiency and sorption capacity (Q_e) of creatinine removal increase with processing duration reaching 82.1, 99.5 %, and 68.4, 82.9 mg·g^-1 for BA and FLG/BA, respectively. The thermodynamic parameters detect the enthalpy change (ΔH°) of about -24.29 and -36.11 kJ·mol^-1 and the entropy change (ΔS°) of around -69.24 and -79.46 kJ·mol^-1 for BA and FLG/BA, respectively. During the reusability test, the removal efficiency decreases from the optimal first cycle to 69.1 and to 88.3 % in the sixth cycle for BA and FLG/BA, revealing superior stability of FLG/BA. The MD calculations confirm a higher adsorption capacity of FLG/BA composite compared to BA alone, clearly confirming a strong structure-property relation.

Synthesis of an IRMOF-1@SiO2 Core-Shell and Amino-Functionalization with APTES for the Adsorption of Urea and Creatinine Using a Fixed-Bed Column Study

Kidney dysfunction is a clinical disease that disables the kidneys to remove the waste products and uremic toxins from the circulation and may lead to fatal kidney failure. Hemodialysis is advantageous in this circumstance since it prevents the accumulation of waste products in the body and facilitates the removal of uremic toxins. However, hemodialysis cannot entirely remove some uremic toxins, such as urea and creatinine. In this paper, a high-performance fixed-bed column for urea and creatinine removal was offered. As a result, a MOF layer was built on SiO₂, which was then amino-functionalized using APTES. Numerous assays were used to characterize the final adsorbent. The adsorption of urea and creatinine was evaluated in batch and continuous conditions. Thus, it was demonstrated that the adsorption behavior of A(0.2)-IRMOF-1@SiO₂ followed the Langmuir isotherm, and it exhibited the maximum adsorption capacity. The batch experiment determined that urea and creatinine had an adsorption capacity of 1325.73 and 625.00 mg·g^-1, respectively. The adsorption capacity was increased, which was due to the presence of amino groups (APTES) on the MOF surface. The continuous operation was evaluated using the A(0.2)-IRMOF-1@SiO₂ fixed-bed column. Thomas and Nelson's models were examined to achieve a better understanding of the adsorption behaviors. The A(0.2)-IRMOF-1@SiO₂ fixed-bed column successfully removed 92.57% of urea and 80.47% of creatinine. The separation factor for urea in comparison to creatinine was 2.40 in the A(0.2)-IRMOF-1@SiO₂ fixed-bed column.

MOFs-alginate/polyacrylic acid/poly (ethylene imine) heparin-mimicking beads as a novel hemoadsorbent for bilirubin removal in vitro and vivo models

Metal-organic frameworks (MOFs) have a potential application in blood purification, but their microcrystalline nature has hampered their industrial application. Here, novel MOFs-polymer beads based on UiO, sodium alginate, polyacrylic acid, and poly (ethylene imine) were prepared and applied as a whole blood hemoadsorbent for the first time. The amidation among polymers immobilized UiO66-NH₂ into the network of the optimal product (SAP-3), and the NH₂ of UiO66-NH₂ significantly increased the removal rate (70 % within 5 min) of SAP-3 on bilirubin. The adsorption of SAP-3 on bilirubin mainly obeyed the pseudo-second-order kinetic, Langmuir isotherm and Thomas models with a maximum adsorption capacity (q_m) of 63.97 mg·g^-1. Experimental and density functional theory simulation results show that bilirubin was mainly adsorbed by UiO66-NH₂via electrostatic force, hydrogen bonding, and π-π interactions. Notably, the adsorption in vivo show that the total bilirubin removal rate in the whole blood of the rabbit model was up to 42 % after 1 h of adsorption. Given its excellent stability, cytotoxicity, and hemocompatibility, SAP-3 has a great potential in hemoperfusion therapy. This study proposes an effective strategy for settling the powder property of MOFs and could provide experimental and theoretical references for application of MOFs in blood purification.

Bilirubin Removal by Polymeric Adsorbents for Hyperbilirubinemia Therapy

Hyperbilirubinemia, presenting as jaundice, is a life-threatening critical illness in newborn babies and acute severe hepatic failure patients. Over the past few decades, extracorporeal hemoadsorption by adsorbent therapy has been widely applied in the treatment of hyperbilirubinemia. The capability of hemoadsorption depends on the adsorbents. Most of the clinically used bilirubin adsorbents are made up of styrene/divinylbenzene copolymer and quaternary ammonium salt, which usually have poor biocompatibility and weak mechanical strength. To overcome the drawbacks of commercial polymer adsorbents, advanced synthetic and natural polymers with/without nanomaterials have been designed, and novel adsorbent fabrication technologies have also been developed. In this review, the adsorption mechanism of bilirubin adsorbents has been summarized, which is the basic criterion in adsorbent development. Furthermore, the preparation method, adsorption mechanism, relative merits and practicability of the emerging bilirubin adsorbents have been evaluated. Based on the existing studies, this work highlights the future direction of the efforts on how to design and develop bilirubin adsorbents with good overall clinical performance. Perhaps this study can change traditional perspectives and propose new strategies for bilirubin clearance from the aspects of pathogenic mechanisms, metabolic pathways, and material-based innovation.

Microfluidic electrospray generation of porous magnetic Janus reduced graphene oxide/carbon composite microspheres for versatile adsorption

HYPOTHESIS

Graphene-based microparticles materials are broadly utilized in all sorts of fields owing to their outstanding properties. Despite great progress, the present graphene microparticles still face challenges in the aspects of size uniformity, motion flexibility, and tailorable surface chemistry, which limit their application in some specific fields, such as versatile adsorption. Hence, the development of novel graphene microparticles with the aforementioned characteristics is urgently required.

EXPERIMENTS

We presented a simple microfluidic electrospray strategy to generate magnetic Janus reduced graphene oxide/carbon (rGO/C) composite microspheres with a variety of unique features. Specifically, the microfluidic electrospray method endowed the obtaiend microspheres with sufficient size uniformity as well as magnetic responsive motion ability. Additionally, magnetic-mediated surface assembly of phase transition lysozyme (PTL) nanofilm on the microspheres rendered the deposited area hydrophilic while non-deposited area hydrophobic.

FINDINGS

Such magnetic Janus rGO/C composite microspheres with regionalized wettability characteristics not only showed prominent performance in adsorbing organic liquids with high adsorption capacity and remarkable reusability but also displayed satisfying biocompatibility for the efficient uptake of bilirubin. More encouragingly, the microspheres could serve as adsorbents in a simulative hemoperfusion setup, which further demonstrated the clinical application potential of the magnetic Janus rGO/C microspheres. Thus, we anticipate that the obtained magnetic Janus rGO/C composite microspheres could show multifunctional properties toward water treatment and blood molecule cleaning.

Fabrication of 2D nanosheet sorbents through metastable emulsion droplets and subsequent two-step grafting polymerization for efficient blood lead removal in vitro

Hemoperfusion is a powerful and yet simple method for lead poisoning treatment, but creation of safe and effective sorbents with excellent selectivity remains a real challenge. To address this, we here construct 2D nanosheet sorbents (BM-SH) through metastable emulsion droplets and subsequent two-step grafting polymerization for efficient blood lead removal in vitro. Metastable emulsion droplets endow typical nanosized sheet-like structure (thickness of 30 nm) and relatively round shape. The consecutive two grafting processes using hydroxyethyl methacrylate (HEMA) and L-cysteine monomer (D-SH) provide BM-SH with a high density of accessible binding sites towards lead ions (Pb²⁺). A high adsorption capacity of 390.5 mg g^-1 and quick capture 97.35 % of Pb²⁺ within initial 10 min are obtained, surpassing most of the reported sorbents for lead removal. Besides, adsorption distribution coefficient (K_d) of BM-SH among four coexisting metal ions achieved 7792 mL g^-1, showing outstanding selectivity toward Pb²⁺. Importantly, a possible adsorption mechanism is recognized as coordination with carboxyl, sulfydryl and imino groups from L-cysteine, and mercapto ligand as the key chelating agent may be the reason for high Pb²⁺ affinity. And what's more, BM-SH displays good hemocompatibility and high efficiency of blood lead removal rate (above 86 % in vitro).

Polymyxin B engineered polystyrene-divinylbenzene microspheres for the adsorption of bilirubin and endotoxin

Hemoperfusion is an important strategy for liver disease treatment. Polystyrene-divinylbenzene (PS-DVB) microspheres are widely applied as absorbents in hemoperfusion to efficiently remove the important toxin bilirubin. However, as another common toxin, endotoxin will remain during this process and cause endotoxemia. Therefore, simultaneous removal of both bilirubin and endotoxin is highly desirable. In the present study, we engineered PS-DVB microspheres with polymyxin B sulfate (PMB) to meet this goal. After modification, the novel PMB-engineered (P-PMB) microspheres displayed excellent biocompatibility and hemocompatibility. Notably, compared to PS-DVB microspheres, P-PMB microspheres exhibited markedly stronger detoxification of both bilirubin and endotoxin, increasing by 17.03% and 42.57%, respectively. Overall, we believe that the novel P-PMB microspheres have considerable potential for liver disease treatment in clinical practice.

A new adsorbent for hemoperfusion was successfully prepared by grafting polymyxin B (PMB) on the surface of polystyrene divinylbenzene (PS-DVB) microspheres. It showed good biocompatibility and could adsorb both bilirubin and endotoxin.