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Schmieszek J, Fuehner T, Renger I, Welte T, Menne J, Fuge J, Van't Klooster MP, Paul A, Siegert A, Borchina DN, Falk CS, Kielstein JT. Effect of a biomimetic pathogen adsorbing device on inflammatory biomarkers in COVID-19 patients. Ther Apher Dial 2024; 28:802-809. [PMID: 38736311 DOI: 10.1111/1744-9987.14137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 04/03/2024] [Accepted: 04/22/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION The Seraph 100 Microbind Affinity blood filter eliminate bacteria, viruses, fungi and toxins from blood stream. METHODS This is a prospective multicenter observational biomarker trial in PCR-positive SARS-CoV-2 patients with acute respiratory failure. Biomarkers were sequentially tested at three time points. RESULTS Forty-two patients with SARS-CoV-2 detected by PCR with acute respiratory failure were included. When receiving hemoperfusion treatment, 27 (64%) patients were on mechanical ventilation, 41 (98%) patients were treated in the ICU. The 3-month survival was 52%. After one hemoperfusion treatment cycle, D-dimer (p = 0.014), hemoglobin (p = 0.003) and LDH (p = 0.001) concentrations were significantly reduced 4 days after treatment. From the multiplex assay IL-1b, CXCL8/ IL-8, IL-10, IL-13, IL-15, CCL11/Eotaxin, G-CSF, and CXCL10/IP-10 were significantly reduced 1 h after treatment, however not 4 days later. CONCLUSION Hemoperfusion with Seraph 100 Microbind Affinity Filter in patients with severe COVID-19 can transiently reduce several inflammatory biomarkers in the blood.
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Affiliation(s)
- Jan Schmieszek
- Department of Respiratory, Sleep and Intensive Care Medicine, Siloah Hospital, Hannover, Germany
| | - Thomas Fuehner
- Department of Respiratory, Sleep and Intensive Care Medicine, Siloah Hospital, Hannover, Germany
- Department of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Isabelle Renger
- Department of Respiratory, Sleep and Intensive Care Medicine, Siloah Hospital, Hannover, Germany
| | - Tobias Welte
- Department of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Jan Menne
- Department of Nephrology, Angiology, and Rheumatology, Siloah Hospital, Hannover, Germany
| | - Jan Fuge
- Department of Respiratory Medicine and German Centre for Lung Research (DZL/BREATH), Hannover Medical School, Hannover, Germany
| | - Maria P Van't Klooster
- Department of Respiratory, Sleep and Intensive Care Medicine, Siloah Hospital, Hannover, Germany
| | - Andrea Paul
- Department of Respiratory, Sleep and Intensive Care Medicine, Siloah Hospital, Hannover, Germany
| | - Alina Siegert
- Department of Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Dan-Nicolae Borchina
- Department of Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Christine S Falk
- Institute of Transplant Immunology, Hannover Medical School, Hannover, Germany
| | - Jan T Kielstein
- Department of Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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Conner TL, Vir P, Laing ED, Stewart IJ, Mitre E, Pratt KP. The Seraph 100 ® Microbind Affinity Blood Filter Does Not Alter Levels of Circulating or Mucosal Antibodies in Critical COVID-19 Patients. Antibodies (Basel) 2024; 13:65. [PMID: 39189236 PMCID: PMC11348046 DOI: 10.3390/antib13030065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 07/13/2024] [Accepted: 08/01/2024] [Indexed: 08/28/2024] Open
Abstract
PURIFY-OBS-1 is an observational study evaluating the safety and efficacy of Seraph 100® Microbind Affinity Blood Filter (Seraph 100) use for COVID-19 patients with respiratory failure admitted to the intensive care unit (ICU). The Seraph 100 is a hemoperfusion device containing heparin-coated beads that can bind to, and reduce levels of, some circulating pathogens and inflammatory molecules. This study evaluated whether treatment with the Seraph 100 affected circulating and mucosal antibody levels in critically ill COVID-19 subjects. SARS-CoV-2 anti-spike and anti-nucleocapsid IgG and IgA levels in serum were evaluated at enrollment and on days 1, 4, 7, and 28 after Seraph 100 application, while anti-spike and nucleocapsid IgG, IgA, and secretory IgA levels in tracheal aspirates were evaluated at enrollment and on days 1, 2, 3, 7, and 28. Serum samples were also collected from the pre- and post-filter lines at 1 and 4 h following Seraph 100 application to evaluate the direct impact of the filter on circulating antibody levels. Treatment with the Seraph 100 did not alter the levels of circulating or mucosal antibodies in critically ill COVID-19 subjects admitted to the ICU.
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Affiliation(s)
- Tonia L. Conner
- Department of Microbiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (T.L.C.); (E.D.L.)
| | - Pooja Vir
- The Henry Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD 20814, USA;
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
| | - Eric D. Laing
- Department of Microbiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (T.L.C.); (E.D.L.)
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
| | - Edward Mitre
- Department of Microbiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA; (T.L.C.); (E.D.L.)
| | - Kathleen P. Pratt
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA;
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3
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Seffer MT, Kielstein JT. [Extracorporeal removal of pathogens using a biomimetic adsorber-A new treatment strategy for the intensive care unit : Seraph® 100 Microbind® Affinity Blood Filter and its fields of application]. Med Klin Intensivmed Notfmed 2024:10.1007/s00063-024-01153-9. [PMID: 38981926 DOI: 10.1007/s00063-024-01153-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 03/31/2024] [Accepted: 05/15/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND In 2019 the World Health Organization (WHO) listed antimicrobial resistance among the top 10 threats to global health. The Seraph® 100 Microbind® Affinity blood filter (Seraph® 100) has been in use since 2019 to eliminate pathogens from the bloodstream in addition to anti-infective pharmacotherapy. It is the first device used to rapidly and efficiently reduce the number of circulating bacteria and viruses. OBJECTIVE After a background on the concept of extracorporeal pathogen removal in general, this review summarizes the preclinical and clinical data on the Seraph® 100 Affinity Blood Filter. The clinical effect of this treatment and potential therapeutic options are described. METHODS Structured PubMed review including references published up to February 2024. RESULTS Case reports, uncontrolled observational studies and data from registries show widespread clinical use of the Seraph® 100 ranging from difficult to treat bacterial (super) infections to viral infections. The treatment can be done as stand-alone hemoperfusion or in combination with all forms of kidney replacement therapy as well as in extracorporeal membrane oxygenation. CONCLUSION The use of the Seraph® 100 varies in terms of duration, concomitant therapy and clinical settings. Due to the absence of prospective controlled trials the clinical effect cannot be properly evaluated.
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Affiliation(s)
- Malin-Theres Seffer
- Helmholtz Centre for Infection Research, Microbial Proteomics, Braunschweig, Deutschland
- Medizinische Klinik V Nephrologie | Rheumatologie | Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland
| | - Jan T Kielstein
- Medizinische Klinik V Nephrologie | Rheumatologie | Blutreinigungsverfahren, Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126, Braunschweig, Deutschland.
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4
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Kielstein JT. [Hemoperfusion and plasmapheresis in the intensive care unit]. WIENER KLINISCHES MAGAZIN : BEILAGE ZUR WIENER KLINISCHEN WOCHENSCHRIFT 2023; 26:1-6. [PMID: 37359739 PMCID: PMC9975843 DOI: 10.1007/s00740-023-00486-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
In addition to kidney replacement procedures, several other extracorporeal procedures are employed in the intensive care unit. Hemoperfusion with activated charcoal was the predominant treatment used for removal of toxins from the 1970s until the millennium. Nowadays, this treatment does no longer play a clinically meaningful role as even strongly protein-bound toxins can be removed by effective dialysis procedures in case poisoning. The concept of a cytokine adsorber was introduced 10 years ago, which is directed towards withstanding the cytokine storm. Despite negative data from prospective randomized controlled studies, its use is steadily increasing in Germany. A totally different treatment concept is the biomimetic pathogen adsorber, which removes bacteria, viruses and fungi from the bloodstream by binding to immobilized heparin. Whether this rapid reduction of the pathogen load translates into an improvement of clinically relevant endpoints is unclear, as prospective randomized controlled studies are lacking. For the early hours of septic shock a very old procedure, plasmapheresis, has recently regained interest. The results of two large randomized controlled studies in this setting from Europe and Canada will become available in 2025/2026. The rationale to use plasma exchange in early sepsis is that this procedure not only removes cytokines but also replenishes reduced levels of protective factors, such as angiopoietin‑1, a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS-13) and protein C, if fresh plasma is used as exchange fluid. All afore mentioned procedures do not only have a different mode of action but are also used at seperate time points of bloodstream infections and/or sepsis.
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Affiliation(s)
- Jan T. Kielstein
- Medizinische Klinik V (Nephrologie | Rheumatologie | Blutreinigungsverfahren), Städtisches Klinikum Braunschweig, Salzdahlumer Str. 90, 38126 Braunschweig, Deutschland
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Jarvas G, Szerenyi D, Jankovics H, Vonderviszt F, Tovari J, Takacs L, Foldes F, Somogyi B, Jakab F, Guttman A. Microbead-based extracorporeal immuno-affinity virus capture: a feasibility study to address the SARS-CoV-2 pandemic. Mikrochim Acta 2023; 190:95. [PMID: 36808576 PMCID: PMC9937867 DOI: 10.1007/s00604-023-05671-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 01/22/2023] [Indexed: 02/20/2023]
Abstract
In this paper, we report on the utilization of micro-technology based tools to fight viral infections. Inspired by various hemoperfusion and immune-affinity capture systems, a blood virus depletion device has been developed that offers highly efficient capture and removal of the targeted virus from the circulation, thus decreasing virus load. Single-domain antibodies against the Wuhan (VHH-72) virus strain produced by recombinant DNA technology were immobilized on the surface of glass micro-beads, which were then utilized as stationary phase. For feasibility testing, the virus suspension was flown through the prototype immune-affinity device that captured the viruses and the filtered media left the column. The feasibility test of the proposed technology was performed in a Biosafety Level 4 classified laboratory using the Wuhan SARS-CoV-2 strain. The laboratory scale device actually captured 120,000 virus particles from the culture media circulation proving the feasibility of the suggested technology. This performance has an estimated capture ability of 15 million virus particles by using the therapeutic size column design, representing three times over-engineering with the assumption of 5 million genomic virus copies in an average viremic patient. Our results suggested that this new therapeutic virus capture device could significantly lower virus load thus preventing the development of more severe COVID-19 cases and consequently reducing mortality rate.
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Affiliation(s)
- Gabor Jarvas
- Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Dora Szerenyi
- Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Hajnalka Jankovics
- Bio-Nanosystems Laboratory, Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Ferenc Vonderviszt
- Bio-Nanosystems Laboratory, Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary
| | - Jozsef Tovari
- Department of Experimental Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - Laszlo Takacs
- Laboratory of Monoclonal Antibody Proteomics, Department of Human Genetics, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Fanni Foldes
- National Virology Laboratory, BSL-4 Laboratory, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pecs, Pecs, Hungary
| | - Balazs Somogyi
- National Virology Laboratory, BSL-4 Laboratory, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pecs, Pecs, Hungary
| | - Ferenc Jakab
- National Virology Laboratory, BSL-4 Laboratory, Szentagothai Research Centre, University of Pecs, Pecs, Hungary
- Institute of Biology, Faculty of Sciences, University of Pecs, Pecs, Hungary
| | - Andras Guttman
- Research Institute of Biomolecular and Chemical Engineering, Faculty of Engineering, University of Pannonia, Veszprem, Hungary.
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Merrill KA, Krallman KA, Loeb D, Standage SW, Mattoon D, Shan D, Goldstein SL, Schuh MP. First-Time Use of the Seraph ® 100 Microbind ® Affinity Blood Filter in an Adolescent Patient with Severe COVID-19 Disease: A Case Report. Case Rep Nephrol Dial 2023; 13:1-6. [PMID: 36741548 PMCID: PMC9891843 DOI: 10.1159/000527290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 09/14/2022] [Indexed: 01/28/2023] Open
Abstract
The Seraph® 100 Microbind® Affinity Blood Filter (Seraph® 100) is a hemoperfusion device designed to adsorb bacteria, viruses, and toxins when added to extracorporeal circuits. The FDA granted emergency use authorization in adults, but this device had never been utilized in children. A 17-year-old patient with asthma presented with respiratory distress due to COVID-19. His course was complicated by respiratory failure, rhabdomyolysis, and stage 3 AKI requiring initiation of continuous kidney replacement therapy (CKRT) on ICU day 3. The Seraph® 100 filter was added on ICU day 4. He was treated with 3 filters from ICU day 4 to 8. On ICU day 8, he was extubated and CKRT discontinued. He required no further kidney replacement therapy but did not have laboratory work post-discharge. In conclusion, this adolescent patient with COVID-19 and AKI requiring CKRT tolerated treatment with the Seraph® 100 Microbind® Affinity Blood Filter without significant adverse events.
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Affiliation(s)
- Kyle A. Merrill
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kelli A. Krallman
- Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel Loeb
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Stephen W. Standage
- Division of Critical Care Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Stuart L. Goldstein
- Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Meredith P. Schuh
- Division of Nephrology and Hypertension, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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7
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Chang K, Li Y, Qin Z, Zhang Z, Wang L, Yang Q, Geng J, Deng N, Chen S, Su B. Effect of extracorporeal hemoadsorption in critically ill patients with COVID-19: A narrative review. Front Immunol 2023; 14:1074465. [PMID: 36817416 PMCID: PMC9936071 DOI: 10.3389/fimmu.2023.1074465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 01/25/2023] [Indexed: 02/05/2023] Open
Abstract
COVID-19 has been affecting the world unprecedentedly and will remain widely prevalent due to its elusive pathophysiological mechanism and the continuous emergence of new variants. Critically ill patients with COVID-19 are commonly associated with cytokine storm, multiple organ dysfunction, and high mortality. To date, growing evidence has shown that extracorporeal hemoadsorption can exert its adjuvant effect to standard of care by regulating immune homeostasis, reducing viremia, and decreasing endotoxin activity in critically ill COVID-19 cases. However, the selection of various hemofilters, timing of initiation and termination of hemoadsorption therapy, anticoagulation management of extracorporeal circuits, identification of target subgroups, and ultimate survival benefit remain controversial. The purpose of this narrative review is to comprehensively summarize the rationale for the use of hemoadsorption in critically ill patients with COVID-19 and to gather the latest clinical evidence in this field.
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Affiliation(s)
- Kaixi Chang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Yupei Li
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Zheng Qin
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhuyun Zhang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Liya Wang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Qinbo Yang
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Jiwen Geng
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Ningyue Deng
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Shanshan Chen
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China
| | - Baihai Su
- Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.,Med-X Center for Materials, Sichuan University, Chengdu, China.,Med+ Biomaterial Institute of West China Hospital, Sichuan University, Chengdu, China
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8
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Hämoperfusion und Plasmapherese auf der Intensivstation. DIE NEPHROLOGIE 2022. [PMCID: PMC9768770 DOI: 10.1007/s11560-022-00620-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Neben Nierenersatzverfahren werden auf der Intensivstation mehrere andere extrakorporale Verfahren eingesetzt. In den 1970er- bis 2000er-Jahren stand die Hämoperfusion mit Aktivkohlekapseln zur Entfernung von Toxinen im Vordergrund. Dies ist mittlerweile aufgrund der effektiven Dialyseverfahren, die im Vergiftungsfall auch stark proteingebundene Toxine entfernen, fast bedeutungslos geworden. Vor 10 Jahren erlebte ein Zytokinadsorber die Markteinführung, der darauf gerichtet ist, den „Zytokinsturm“ zu überstehen. Dieser erfreut sich trotz ernüchternder Daten aus prospektiven, randomisierten, kontrollierten Studien wachsender Beliebtheit. Ein gänzlich anderes Therapiekonzept ist der biomimetische Pathogenadsorber, der Bakterien, Viren und Pilze durch Bindung an immobilisiertes Heparin aus dem Blutstrom entfernt. Ob sich diese schnelle Reduktion der Pathogenlast in eine Verbesserung klinisch relevanter Endpunkte übersetzt, ist unklar, da hier prospektive, randomisierte und kontrollierte Studien gänzlich fehlen. Für ein sehr altes Verfahren, nämlich die Plasmapherese, werden wir für die Frühphase der Sepsis bis zum Jahr 2025/2026 Ergebnisse aus 2 großen randomisierten, kontrollierten Studien aus Europa und Kanada erhalten. Neben der Entfernung von Zytokinen erhofft man sich durch die Verwendung von Frischplasma als Austauschflüssigkeit auch das Wiederauffüllen reduzierter protektiver Faktoren wie Angiopoietin 1, ADAMTS13 („a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13“) und Protein C. Alle genannten Verfahren funktionieren nicht nur unterschiedlich, sondern werden auch zu unterschiedlichen Zeitpunkten der Blutstrominfektion/Sepsis eingesetzt.
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Niazi NS, Nassar TI, Stewart IJ, Honore PM, Sharma K, Chung KK. A Review of Extracorporeal Blood Purification Techniques for the Treatment of Critically Ill Coronavirus Disease 2019 Patients. ASAIO J 2022; 68:1219-1227. [PMID: 35417433 PMCID: PMC9521577 DOI: 10.1097/mat.0000000000001761] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
In late 2019, a novel betacoronavirus, later termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was discovered in patients with an unknown respiratory illness in Wuhan, China. SARS-CoV-2 and the disease caused by the novel coronavirus, coronavirus disease 2019 (COVID-19), spread rapidly and resulted in the World Health Organization declaring a pandemic in March 2020. In a minority of patients infected with SARS-CoV-2, severe illness develops characterized by a dysregulated immune response, acute respiratory distress syndrome, and multisystem organ failure. Despite the development of antiviral and multiple immunomodulatory therapies, outcomes of severe illness remain poor. In response, the Food and Drug Administration in the United States authorized the emergency use of several extracorporeal blood purification (EBP) devices for critically ill patients with COVID-19. Extracorporeal blood purification devices target various aspects of the host response to infection to reduce immune dysregulation. This review highlights the underlying technology, currently available literature on use in critically ill COVID-19 patients, and future studies involving four EBP platforms: 1) oXiris filter, 2) CytoSorb filter, 3) Seraph 100 Microbind blood affinity filter, and 4) the Spectra Optia Apheresis System with the Depuro D2000 Adsorption Cartridge.
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Affiliation(s)
- Nicholas S. Niazi
- From the Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Tareq I. Nassar
- From the Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Ian J. Stewart
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Patrick M. Honore
- ICU Department, Brugmann University Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Kumar Sharma
- From the Department of Medicine, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - Kevin K. Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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10
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Schmidt JJ, Borchina DN, van't Klooster M, Bulhan-Soki K, Okioma R, Herbst L, Rodríguez DS, Premužić V, Büttner S, Bader B, Serednicki W, Zasada E, Schmitz M, Quabach RA, Hrincheva M, Fühner T, Kielstein JT. Interim analysis of the COSA (COVID-19 patients treated with the Seraph® 100 Microbind® Affinity filter) registry. Nephrol Dial Transplant 2022; 37:673-680. [PMID: 34875087 PMCID: PMC8689741 DOI: 10.1093/ndt/gfab347] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The Seraph® 100 Microbind® Affinity Blood Filter is a haemoperfusion device that is licensed for the reduction of pathogens, including several viruses, in the blood. It received Emergency Use Authorization for the treatment of severe coronavirus disease 2019 (COVID-19) by the Food and Drug Administration (FDA). Several studies have shown that the blood viral load of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) correlates with adverse outcomes and removal of the nucleocapsid of the SARS-CoV-2 virus by the Seraph® 100 has been recently demonstrated. The aim of this registry was to evaluate the safety and efficacy of Seraph® 100 treatment for COVID-19 patients. METHODS Twelve hospitals from six countries representing two continents documented patient and treatment characteristics as well as outcome parameters without reimbursement. Additionally, mortality and safety results of the device were reported. A total of 102 treatment sessions in 82 patients were documented in the registry. Four patients were excluded from mortality analysis due to incomplete outcome data, which were available in the other 78 patients. RESULTS Overall, a 30-day mortality rate of 46.2% in the 78 patients with complete follow-up was reported. The median treatment time was 5.00 h (4.00-13.42) and 43.1% of the treatments were performed as haemoperfusion only. Adverse events of the Seraph® 100 treatment were reported in 8.8% of the 102 treatments and represented the premature end of treatment due to circuit failure. Patients who died were treated later in their intensive care unit (ICU) stay and onset of COVID symptoms. They also had higher ferritin levels. Multivariate Cox regression revealed that delayed Seraph® 100 treatment after ICU admission (>60 h), as well as bacterial superinfection, were associated with mortality. While average predicted mortality rate according to Sequential Organ Failure Assessment (SOFA) score in ICU patients was 56.7%, the observed mortality was 50.7%. In non-ICU patients, Coronavirus Clinical Characterisation Consortium (4C) score average predicted a mortality rate of 38.0%, while the observed mortality rate was 11.1%. CONCLUSIONS The treatment of COVID-19 patients with Seraph® 100 is well tolerated and the circuit failure rate was lower than previously reported for kidney replacement therapy (KRT) in COVID-19 patients. Mortality correlated with late initiation of Seraph treatment after ICU admission and bacterial superinfection. Compared with predicted mortality according to 4C and SOFA scores, mortality of Seraph® 100-treated patients reported in the registry was lower.
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Affiliation(s)
- Julius J Schmidt
- Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany
| | - Dan Nicolae Borchina
- Medical Clinic V Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
| | - Mariet van't Klooster
- Department of Respiratory and Critical Care Medicine, KRH Klinikum Siloah, Hannover, Germany
| | | | | | - Larissa Herbst
- Department of Nephrology and Hypertension, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Diego Sandoval Rodríguez
- Unitat de Hemodiàlisi, Servei de Nefrologia, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Vedran Premužić
- Department for Nephrology, Hypertension, Dialysis and Transplantation, University Hospital Center Zagreb, Zagreb, Croatia
| | - Stefan Büttner
- Medizinische Klinik I–Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - Birgit Bader
- St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Wojciech Serednicki
- The Department of Anesthesiology and Intensive Care No. 1, University Hospital, Krakow, Poland
| | - Ewa Zasada
- Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michael Schmitz
- Department of Nephrology, Städtisches Klinikum Solingen, Solingen, Germany
| | - Ralf A Quabach
- Klinik für Anästhesie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Solingen, Germany
| | - Maria Hrincheva
- Department of Nephrology and Dialysis, Military Medical Academy, Sofia, Bulgaria
| | - Thomas Fühner
- Department of Respiratory and Critical Care Medicine, KRH Klinikum Siloah, Hannover, Germany
| | - Jan T Kielstein
- Medical Clinic V Nephrology | Rheumatology | Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany
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Weber C, Rigby A, Lip GYH. Thrombosis and Haemostasis 2021 Editors' Choice Papers. Thromb Haemost 2022; 122:163-170. [PMID: 35038760 DOI: 10.1055/s-0041-1741072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Christian Weber
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich, Germany.,German Centre for Cardiovascular Research (DZHK), partner site Munich Heart Alliance, Munich, Germany.,Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne Rigby
- Institute for Cardiovascular Prevention (IPEK), LMU Munich, Munich, Germany
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom.,Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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12
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Kelly MM, Wilkinson JD, Rastegar M, Lewis MS, Betancourt J. Two Patients With Severe COVID Pneumonia Treated With the Seraph-100 Microbind Affinity Blood Filter. J Intensive Care Med 2021; 36:1228-1232. [PMID: 34516306 DOI: 10.1177/08850666211039744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We present 2 patients with rapidly escalating oxygen requirements from severe acute respiratory syndrome coronavirus 2 infection (COVID-19) treated with the Seraph100 Microbind Affinity Blood Filter under Emergency Use Authorization from the US Federal Drug Administration. The Seraph100 is an extracorporeal hemoperfusion filter previously demonstrated to remove viral particles and pro-inflammatory cytokines from the blood. Treatment with the Seraph100 filter was associated with a rapid improvement in oxygenation and both patients were discharged from the hospital without supplemental oxygen.
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Affiliation(s)
- Mark M Kelly
- 8783UCLA, Los Angeles, CA, USA.,19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jared D Wilkinson
- 8783UCLA, Los Angeles, CA, USA.,19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mandana Rastegar
- 8783UCLA, Los Angeles, CA, USA.,19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michael S Lewis
- 8783UCLA, Los Angeles, CA, USA.,19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jaime Betancourt
- 8783UCLA, Los Angeles, CA, USA.,19975VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Kielstein JT, Borchina DN, Fühner T, Hwang S, Mattoon D, Ball AJ. Hemofiltration with the Seraph ® 100 Microbind ® Affinity filter decreases SARS-CoV-2 nucleocapsid protein in critically ill COVID-19 patients. Crit Care 2021; 25:190. [PMID: 34074339 PMCID: PMC8169409 DOI: 10.1186/s13054-021-03597-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/06/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jan T Kielstein
- Medical Clinic V, Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Salzdahlumer Strasse 90, 38126, Braunschweig, Germany.
| | - Dan-Nicolae Borchina
- Medical Clinic V, Nephrology
- Rheumatology
- Blood Purification, Academic Teaching Hospital Braunschweig, Salzdahlumer Strasse 90, 38126, Braunschweig, Germany
| | - Thomas Fühner
- Department of Respiratory Medicine, Hannover Medical School, 30623, Hannover, Germany
| | - Soyoon Hwang
- Quanterix Corporation, Billerica, MA, 01821, USA
| | - Dawn Mattoon
- Quanterix Corporation, Billerica, MA, 01821, USA
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