Hemoperfusion, Plasmaperfusion And Other Clinical Uses Of General, Biospecific, Immuno And Leucocyte Adsorbents

Chang Thomas Ming Swi; Endo Yoshihiro; Nikolaev Volodymyr G

BOOK

Hemoperfusion, Plasmaperfusion And Other Clinical Uses Of General, Biospecific, Immuno And Leucocyte Adsorbents

Chang Thomas Ming Swi | Endo Yoshihiro | Nikolaev Volodymyr G

(2017)

Additional Information

Book Details

ISBN: 978-981-4749-08-4
Edition
Language: English
Pages: 1015
Subjects: Biomedical engineering
Nanotechnology
Biotechnology

Abstract

Written by 30 worldwide leading scientists, experts and medical doctors, this comprehensive book provides a broad, multi-disciplinary overview on hemoperfusion. The research of the subject was started by TMS Chang — the pioneer and inventor of microcapsules who is well known as the 'the Father of Microcapsules.' The book presents the numerous recent developments in this field. A series of tailor-made, toxin removing and cell separating adsorbents or microcapsules with unique properties have been designed, prepared and produced for use in the treatment of diseases such as autoimmune disease, drug over-dose, acute inflammation, etc., in which ordinary medical treatments shows little or no efficacy. Various modalities of hemoperfusion treatments and results are described to provide readers with up-to-date information on the highly interdisciplinary field of hemoperfusion.

Section Title	Page	Action	Price
Contents	v
I. Introduction	1
Chapter 1 First Design and Clinical Use in Patients of Surface Modified Sorbent Hemoperfusion Based on Artificial Cells for Poisoning, Kidney Failure, Liver Failure and Immunology	3
1. Introduction	3
1.1. A Brief Historical Overview	3
1.2. Basic Principle of Surface Modifications Based on the Principle of Artificial Cells	5
1.3. Clinical Trials	7
1.4. Treatment of Patients with Severe Accidental or Suicidal Poisoning	8
1.5. Hemoperfusion for the Removal of Unwanted or Toxic Substances from Blood in Other Conditions Including Terminal Renal Failure, Liver Failure and Immunology	9
1.6. Treatment of Patients with Terminal Kidney Failure	9
1.7. Treatment of Patients with Hepatic Coma	10
1.8. Immunoadsorbent and Specific Absorbents	10
2. Detailed Analysis of the Principle of Artificial Cells in Surface Modification for Adsorbent Hemoperfusion	11
2.1. Permeability and Transport Characteristics	11
2.2. Experimental Analysis	13
2.3. Artificial Cells Containing Activated Charcoal in Hemoperfusion	14
2.4. Device Configuration	16
2.5. Effects on Embolism	17
2.6. Effects of Hemoperfusion on Platelets	17
2.7. Clearance of the ACAC Artificial Cell Artificial Kidney	19
2.8. Improvements in Hydrodynamic	20
3. Hemoperfusion in Acute Suicidal or Accidental Poisoning	22
3.1. Preclinical Studies	22
3.2. Criteria for Drug Removal	22
3.3. Protocol for Clinical Trials	22
3.4. Result of Clinical Trial on 11 Adult Patients with Suicidal or Accidental Drug Poisoning	24
3.5. Time–dose Cytotoxicity Relationship: Pediatric Patient with Accidental Theophylline Overdose	30
3.7. Routine Clinical Uses in Patients Around the World	33
4. Hemoperfusion in Terminal Renal Failure Patients	34
4.1. Rationales	34
4.2. Hemoperfusion Alone Supplemented by Hemodialysis	35
4.3. Hemoperfusion and Removal of Uremic Metabolites	40
4.4. Conjoint Hemoperfusion-Hemodialysis	40
4.5. Miniaturized Artificial Kidney-basedon Hemoperfusi on-ultrafiltration	44
4.6. Urea Removal Systems	46
5. Hemoperfusion in Liver Failure	47
5.1. First Observation of Recovery of Consciousness in Hepatic Coma	47
5.2. Results around the World on Effect of Hemoperfusion on Hepatic Coma	48
5.3. Control Studies in Galactosamine-induced Hepatic Failure Rats	49
6. Selective Adsorbents and Immunosorbents	51
6.1. Surface Modification in Immunoadsorption	51
6.2. Synthetic Immunosorbents for Blood Group	53
6.3. Selective Synthetic Adsorbent for Endotoxin	54
7. APPENDIX	55
7.1. Detailed Procedures for the Laboratory Preparation of the ACAC Hemoperfusion Device	55
7.2. Procedure for Hemoperfusion	55
8. Useful Websites	55
9. References	56
II. General Adsorbents	79
Chapter 2 Hemoperfusion	81
1. The Progress of Hemoperfusion	81
2. The Principle of Hemoperfusion	83
3. The Hemoperfusion Device	83
3.1. Adsorptive Agent and Coating Technique	83
3.1.1. Activated charcoal	83
3.1.2. Resin	84
3.1.3. Microcapsule technique	85
3.1.4. Hemoditoxifier	85
3.2. Hemoperfusion Device	86
4. The Clinical Application of Hemoperfusion	87
4.1. Drug or Toxin Poisoned Patients	87
4.1.1. Characteristics of hemoperfusion	88
4.1.2. Factors which impact the curative effect of hemoperfusion	88
4.1.3. Curative effect evaluation in clinical	88
4.2. Uremia	89
4.3. Hepatic Encephalopathy	91
4.4. Immune Diseases	92
4.5. The Application of Hemoperfusion in Combined Tumor Chemotherapy	93
4.6. Infection-related Conditions	93
4.7. Other Diseases	94
References	94
Chapter 3 Pathophysiology and Types of Poisoning	97
1. Introduction	97
2. Poisoning Profile	98
3. Influencing Factors of Blood Purification in Poison Removal	100
4. Technical Points of Hemoperfusion	102
5. Detoxification by Hemoperfusion	103
5.1. Organophosphate Poisoning	103
5.2. Caffeine Poisoning	104
5.3. Herbicide Poisoning	105
5.4. Acetaminophen Poisoning	105
5.5. Digoxin Poisoning	106
6. Hemoperfusion-related Side Effects	107
7. The Future of Detoxification by Hemoperfusion	107
8. References	107
Chapter 4 Application of Hemoperfusion in Artificial Kidney	111
1. Introduction	111
2. Kidney Diseases and Artificial Kidney Technology	112
2.1. An Overview of Kidney Disease	112
2.2. Kidney Disease and Uremic Toxins	113
2.3. Treatment of Kidney Disease with Artificial Kidney	116
3. Hemoperfusion and Combined Artificial Kidney	117
3.1. The Emergence of the Combined Artificial Kidney	117
3.2. The Development of the Combined Artificial Kidney	118
3.3 Treatment Modalities of the Combined Artificial Kidney	120
4. The Clinical Application of the Combined Artificial Kidney	121
4.1. Removal of Uremic Toxins	122
4.2. Improvements in Clinical Symptoms	129
5. The Promise of Hemoperfusion and the Artificial Kidney	134
References	135
Chapter 5 Fundamental Knowledge of Hemoperfusion and Plasmaperfusion	141
1. Introduction	141
1.1. What is Hemoperfusion?	141
1.2. Usage of Module	141
2. Selection of a Module with High Blood Compatibility	142
2.1. Prevention of Release of Harmful Substances from Adsorbent	143
2.1.1. Minute particles	143
2.1.2. Heavy metal ions	143
2.1.3. Solvent and reagent	144
2.2. Prevention of Thrombus Formation	144
2.2.1. Mechanism of blood coagulation	144
2.3. Prevention of Thrombus during Hemoperfusion	147
2.4. Features of Individual Anticoagulants	147
2.5. Activation of Complement	150
2.6. Prevention of Hypotension by Module	151
2.7. Biocompatible Polymer	153
2.8. Suppression of Hemolysis	156
2.9. Suppression of Loss of Useful Substances	156
3. Filter-type Module	157
3.1. Hollow Fiber Membrane	157
3.2. Theory of Preparation of Hollow Fiber Membrane	158
3.3. Usage of Hollow Fiber Membrane	159
4. Adsorbent-type Module	159
4.1. Adsorption Phenomenon	159
4.2. Estimation of Adsorptive Capacity of Adsorbent	161
4.3. Design of Adsorbent	163
4.4. Adsorbent for a Molecule of Low Molecular Weight	164
4.5. Adsorbent of Endotoxin from Gram-Negative Bacteria	165
4.6. Adsorbent of Lipoprotein	167
4.7. Adsorbent of Protein Relative to Autoimmune Diseases	168
4.8. Adsorbent of White Blood Cells	169
5. Future Perspective	169
5.1. Adsorbent of Immunosuppressive Protein	169
6. References	170
Chapter 6 Hemoperfusion in Artificial Liver Support Systems	173
1. Introduction	173
1.1. Metabolic Functions of the Liver	173
1.2. Definition of Liver Failure	174
1.3. Development of Artificial Liver Support System	175
1.4. The Role of Hemoperfusion in Artificial Liver Support System	177
2. Toxic Substances Accumulating in the Blood of Patients with Liver Failure	179
2.1. The Pathophysiological Mechanism of Liver Failure	179
2.2. Toxin Accumulation during Liver Failure	179
2.3. Cytokines Released during Liver Failure	180
2.4. Endotoxemia during Liver Failure	181
2.5. Characteristics of Toxic Substances in Hepatic Failure	181
3. Adsorbent Materials used in Liver Failure Hemoperfusion	182
4. Removal of Toxic Substances by Hemoperfusion in Liver Failure Patients	183
4.1. Bilirubin Adsorption	183
4.2. Endotoxin and Hemoperfusion	184
4.3. Other Absorbent and Endotoxemia	185
4.4. Hemoperfusion and Cytokines Removal	186
4.5. Remove Amino Acids through Hemoperfusion	187
5. Application of only Hemoperfusion in Liver Failure Patients	188
5.1. Bilirubin Adsorption	188
5.2. The Effect of Hemoperfusion on Hepatic Coma Patients	190
6. Li Non-Bioartificial Liver (LiNBAL)	192
6.1. The Development of LiNBAL	192
6.2. Effect of LiNBAL on Patients with Severe Viral Hepatitis: A Study of 400 Cases	194
6.3. Paired Plasma Exchange Filtration Adsorption	195
6.4. LiNBAL Combined with Liver Transplantation in the Treatment of Patients with Acute-on-Chronic Liver Failure	197
7. Mars System	199
7.1. MARS System Composition	199
7.2. MARS Complications and Countermeasures	200
7.3. The Clinical Applications of MARS	201
8. Prometheus System	203
9. Simple Albumin Dialysis (SAD)	206
10. Continued Albumin Purification System (CAPS) and Protein Adsorbent Recirculating System (PARS)	206
11. Biologic-DT System and Biologic-DTPF System	208
12. The Application of Hemoperfusion in Bioartificial Liver	211
12.1. Hemoperfusion Enrolled as the Non-Biological Component	212
12.2. Hemoperfusion Enrolled as the Biological Part	214
References	216
Chapter 7 Sorption Therapy with the Use of Activated Carbons: Effects on Regeneration of Organs and Tissues	221
Summary	221
1. Introduction	222
2. Hemosorption (DHP)	224
3. Enterosorption	230
4. Application-Sorption Therapy	236
Conclusion	239
References	240
Chapter 8 Adsorptive Treatment of Acute Radiation Sickness: Past Achievements and New Prospects	245
Abstract	245
Introduction	246
Radiation Injuries Today	247
Sorption Therapy of Acute Radiation Sickness	248
Myelostimulating Cytokines for Treatment of Bone Marrow Syndrome in Acute Radiation Sickness	250
Possibilities of Enterosorption upon Cytostatic Myelodepression	251
Acknowledgements	253
References	253
III. Selective Adsorbents	257
Chapter 9 Hemoperfusion Selective Removal	259
References	262
Chapter 10 Hemoperfusion Method for Removing Endotoxin	265
1. Introduction	265
2. Endotoxin and Septicemia	266
3. Removal of Endotoxins by Adsorbents in Hemoperfusion	269
3.1. Activated Charcoal and Resin Adsorbents	269
3.2. Adsorbents with Polymyxin B and other Cations as Ligands	270
3.3. Immunosorbent	273
3.4. Adsorbents with Amino Acids and Small Peptide Molecules as Ligands	274
3.5. Adsorbent with Supramolecular Compounds as the Ligand	276
3.6. Adsorbents with Other Compounds as Ligands	277
4. Conclusion	278
References	279
Chapter 11 Direct Hemoperfusion with b2-microglobulin Adsorption Column for Patients with End-stage Kidney Disease	285
1. Introduction	285
2. b2-microglobulin in Patients with Chronic Kidney Disease	286
3. Dialysis-related Amyloidosis	287
3.1. Dialysis-related Amyloidosis as One of Systemic Amyloidosis	287
3.2 Clinical Characteristics of Dialysis-related Amyloidosis	287
4. Motility	289
5. Removal of β2-microgloblin with Blood Purification	290
5.1. Overview	290
5.2. b2-m Adsorption Column	290
6. Conclusion	294
References	294
Chapter 12 Endotoxin Adsorption: Direct Hemoperfusion with a Polymyxin B-Immobilized Fiber Column (Toraymyxin)	297
1. Introduction	297
2. Development of Polymyxin B-Immobilized Fibers	299
2.1. Polymyxin B-Immobilized Fibers	299
2.2. Endotoxin Adsorption Capacity of Polymyxin B-Immobilized Fibers In Vitro	300
2.3. Endotoxin Adsorption Capacity of Polymyxin B-Immobilized Fibers In Vivo	302
3. Toraymyxin for Human Use	303
3.1. Architecture and Specification of Toraymyxin	303
3.2. Use of Toraymyxin in Hemoperfusion	306
4. Clinical Efficacy of Toraymyxin Therapy for Endotoxemia and Septic Shock	307
5. Mechanism of Favorable Effects of Toraymyxin Therapy in Sepsis	312
5.1. Removal of Endotoxin	312
5.2. Other Potential Mechanisms of Toraymyxin Therapy	313
References	315
Chapter 13 Polyvinyl Alcohol Adsorbent in Hemoperfusion	319
1. Introduction	319
2. PVA Synthesis and Characteristics	320
2.1. PVA Synthesis	320
2.2. Biocompatibility of PVA	321
3. Applications in Hemoperfusion	322
3.1. PVA Adsorbents for Bilirubin Removal	322
3.2. PVA Adsorbents for TG and LDL Removal	325
3.3. PVA Adsorbents for the Removal of other Endogenous Toxins	330
4. Influencing Factors of PVA-based Adsorbent on Adsorption Performance	332
1. Crosslinking Degree of Adsorbents	332
2. Ligand Immobilized to Adsorbents	333
3. Particle Size of Adsorbent	335
4. Temperature	337
References	339
Chapter 14 Ion Exchange Resin in Hemoperfusion	341
1. Introduction	341
1.1. Ion Exchange Resin	341
1.2. Basic Features of Ion Exchange Resin for Use in Hemoperfusion	343
1.2.1. Exchange capacity	343
1.2.2. Selectivity	344
1.2.3. Porosity	344
1.3. Hemoperfusion by Ion Exchange Resin	344
2. Ion Exchange Resins in Hemoperfusion	346
2.1. Ion Exchange Resins Used in Removing Ions and Drugs	346
2.2. Ion Exchange Resin Used in Removing Bilirubin	348
2.2.1. Ion exchange resin with quaternary aligand	349
2.2.2. Ion exchange resin with amino ligand	352
2.2.3. Ion exchange resin with amino acid ligand	354
2.2.4. Ion exchange resin with guanidine ligand	354
2.2.5. General discussion	355
2.3. Ion Exchange Resin Used in Removing Low Density Lipoprotein (LDL)\r	356
2.3.1. Ion exchange resin with heparin ligand	356
2.3.2. Ion exchange resin with dextran sulfate or sulfuric acid ligand	357
2.3.3. Ion exchange resin with polyacrylate or carboxyl ligand	358
2.3.4. Ion exchange resin with phosphate ligand	359
2.3.5. Ion exchange resin with amino acid ligand	360
2.3.6. Ion exchange resin with amphiphilic ligand	361
2.3.7. General discussion	361
2.4. Ion Exchange Resin Used in Removing Endotoxin	363
2.4.1. Ion exchange resin with polymyxin B ligand	363
2.4.2. Ion exchange resin with amino acid ligand	366
2.4.3. Ion exchange resin with other cationic or polycationicligand	369
2.4.4. General discussion	370
3. Mechanism and Features of Ion Exchange Resins in Hemoperfusion	371
4. The Key Issues of Ion Exchange Resins in Hemoperfusion	373
References	374
Chapter 15 LDL Adsorption	385
1. Introduction	385
2. Method of LDL Selective Absorption	386
3. Preventive Effects of LDL Apheresis on Atherosclerosis	387
3.1. Mechanism of Preventive Effect on Atherosclerosis	387
3.2. Clinical effect of LDL apheresis and therapeutical target LDLC level	388
3.2.1. LDL apheresis in homozygous FH	388
3.2.2. LDL apheresis in heterozygous FH	391
3.2.3. LDL apheresis in PAD	392
3.2.4. LDL apheresis in FSGS	393
4. Conclusion	393
References	394
Chapter 16 Treatment of Metabolic Diseases by Hemoperfusion	399
1. Introduction	399
2. The Technical Characteristics of the Extracorporeal Lipid Purification Therapy	400
2.1. Non-Selective	400
2.1.1. Plasma exchange (PE)	400
2.2. Semi-Selective	400
2.2.1. Double filtration plasmapheresis therapy (DFPP)	400
2.3. Highly Selective	403
2.3.1. Immunosorbent assay (immunoadsorption, IA)	403
2.3.2. Dextran sulfate cellulose adsorption, DSA	405
2.3.3. Heparin mediated extracorporeal LDL precipitation system (HELP) (Seidel D et al., 1996):	405
2.3.4. Direct adsorption of lipoprotein from whole blood (DALI)	406
3. Evaluation of Extracorporeal Blood Lipid Purification Treatments	408
4. Effect of Extracorporeal Blood Lipid Purification Treatment	410
4.1. Regulate Plasma Lipids	410
4.2. Improvement of Hemorheology	412
4.3. Significant Decrease of Oxidative Stress and Inflammation	413
4.4. Improvement of the Endothelial Function	414
5. Clinical Application of Extracorporeal Blood Lipid Purification Treatments	414
5.1. Indications (Bohl S et al., 2009; Schwartz J et al., 2013)	414
5.1.1. Familial hyperlipidemia with high LDL levels	414
5.1.2. Phytanic acid storage disease (Refsum disease)	415
5.1.3. Acute ischemic vascular disease with lipid metabolism or microcirculation disorder	415
5.1.4. Acute pancreatitis with severe disorders of lipid metabolism	415
5.2. Clinical Applications	415
5.2.1. Cardiovascular disease	415
5.2.2. Acute ischemic stroke	417
5.2.3. Acute occlusive arterial sclerosis	420
5.2.4. Hormone resistance of nephritic syndrome	420
5.2.5. Other diseases	421
6. Adverse Reactions of Extracorporeal Lipid Purification Therapy	422
6.1. Symptomatic Hypotension	422
6.2. Allergic Reactions	423
6.3. Fever and Sepsis	423
6.4. Non-specific Reactions	423
6.5. Hemolysis	423
6.6. Anemia	424
6.7. Puncture Site Hematoma	424
6.8. Bleeding	424
7. Contraindications of Lipid Separation Therapy	424
8. Conclusion: Clinical Comparison of Vitro Blood Lipid Purification Treatment	425
References	426
Chapter 17 Cytokine Adsorbing Membrane: PMMA	433
1. Introduction	433
1.1. Development of the PMMA Membrane	433
1.2. Features of the PMMA Membrane	434
2. Development of Continuous Hemodiafiltration using a PMMA Membrane Hemofilter	435
3. Cytokine Removal with PMMA Membrane	436
3.1. Investigation in Clinical Cases	436
3.2. In Vitro Study	440
3.3. Mechanism of Cytokine Adsorption using PMMA Membrane	442
4. Clinical Application of PMMA-CHDF	443
4.1. Introduction of a Rapid Assay for IL-6	443
4.2. Efficacy on Severe Acute Pancreatitis (SAP)	445
4.3. Efficacy on Severe Sepsis/Septic Shock	445
5. Future Perspective	448
References	449
Chapter 18 Clinical Aspects of Biospecific Sorbents	453
1. Introduction	453
2. Biospecific Anti-Proteinase Hemosorbent in Treatment of Acute Destructive Pancreatitis	454
3. Hemoperfusion in Treatment of IgE-dependent Pathology	460
3.1. Efferent Methods in Complex Treatment of Septic Pathology	463
References	469
Chapter 19 Macroporous Polystyrene Adsorbent Resin and Its Application in Hemoperfusion	471
1. Introduction	471
1.1. History and Development of Polystyrene Adsorbent Resins	473
2. Preparation and Properties of Macroporous Polystyrene Adsorbent Resin	477
2.1. Preparation of Adsorbent Resin by Suspension Polymerization	477
2.2. Post-crosslinking Preparation of Adsorbent Resin	479
2.2.1. Friedel–Crafts crosslinking reaction of linear polystyrene	481
2.2.1.1. Friedel–Crafts crosslinking reaction of Gel-type S-DVB copolymers	481
2.2.1.2. Friedel–Crafts crosslinking of macroporous low crosslinking S-DVB copolymers	482
2.2.1.3. Friedel–Crafts crosslinking of macroporous low crosslinking copolymers of S-DVB and polar monomers\r	482
2.3. Parameters of Macroporous Polystyrene Network	483
2.3.1. Specific surface area	484
2.3.2. Pore size and its distribution	484
2.4. Effect of Porogen	484
2.4.1. Using good solvent as porogen (ν-induced syneresis)	486
2.4.2. Using nonsolvent as porogen	487
2.4.3. Using linear polymers as porogen	487
2.4.4. Using oligomers as porogen	488
2.5. Effect of Crosslinking Agent	490
3. Application of Macroporous Polystyrene Adsorbent in Hemoperfusion	495
3.1. Removal of Endogenous Toxins	498
3.1.1. β2 Microglobulin	498
3.1.2. Lysozyme	500
3.1.3. Cytokines	500
3.1.4. Bilirubin	501
3.1.5. Low Density Lipoprotein (LDL)	503
3.1.6. Bile acid	503
3.2. Removal of the Exogenous Toxins	507
References	509
IV. Immunosorbent	515
Chapter 20 Immunoadsorbent in Hemoperfusion	517
1. Introduction	517
1.1. Protein A as Ligand	520
1.2. Tryptophane as Ligand	522
1.3. Phenylanaline as Ligand	523
1.4. DNA as Ligand	524
1.5. Dextran Sulfate as Ligand	531
1.6. Synthetic or Recombinant Peptide as Ligand	532
1.7. LDL Antibody as Ligand	534
1.8. Anti-HBs as Ligand	535
1.9. Immunoglobulin as Ligand	536
1.10. IgG as Ligand	538
1.11. IgE Antibody as Ligand	539
1.12. IgA as Ligand	540
1.13. C1q as Ligand	540
1.14. Heparin as Ligands	541
1.15. Poly-L-Lysine as Ligand	543
1.16. Polyanion as Ligand	544
1.17. 4-Mercaptoethylpyridine as Ligand	544
1.18. Cell Membrane Proteins as Ligand	545
1.19. Avidin as Ligand for Cancer Therapy	545
1.20. Receptor for AGE (RAGE) as Ligand	546
1.21. scFv as Ligand	546
1.22. Other Ligands	548
2. Mechanism and Features of Immunoadsorbent	548
2.1. Comparison of Surface Area for Small and Large-Size Particles	551
2.2. Pore Size	553
2.3. Chemical Structure	554
2.4. Adsorption Kinetics	554
2.5. Spacer Effect	555
2.6. Diseases Treated with Immunoadsorbents	556
3. General Discussions	557
3.1. Perspectives of Immunoadsorbent	557
3.2. Carriers	557
3.3. Ligand	560
3.4. Spacer	565
3.5. Social and Economic Impact	566
References	568
Chapter 21 Natural Polysaccharide Adsorbent in Hemoperfusion	583
1. Introduction	583
2. Preparation, Activation and Evaluation of Natural Polysaccharide Adsorbent in Hemoperfusion	585
2.1. Preparation and Activation of Agarose (Agarose/Agar) Beads	585
2.1.1. Preparation of agarose (agarose/agar) beads	585
2.1.2. Activation of agarose (agarose/agar) beads	586
2.2. Preparation and Activation of Cellulosic Beads	587
2.2.1. Preparation of cellulosic beads	587
2.2.2. Activation of cellulose beads	588
2.3. Preparation and Activation of Chitosan Beads	589
2.3.1. Preparation of chitosan beads	589
2.3.2. Activation of chitosan beads	591
2.4. Preparation and Activation of Dextran Beads	592
2.4.1. Preparation of dextran beads	592
2.4.2. Activation of dextran beads	593
2.5. Evaluation of Natural Polysaccharide Beads	593
3. Typical Natural Polysaccharide Bioactive Bead Adsorbent for use in Blood Purification	594
3.1. Agarose/Agar-based Adsorbent in Hemoperfusion	594
3.1.1. Agarose bead-based adsorbent for the treatment of IgA nephropathy	594
3.1.2. Agar bead-based adsorbent for the treatment of rheumatoid arthritis	596
3.1.3. Agar bead-based IgE adsorbents for the treatment of bronchial asthma	596
3.1.4. Agar bead-based adsorbents for the removal of TNF-α	601
3.1.5. Agar bead-based adsorbents for the removal of LDL	602
3.2. Cellulosic Adsorbent in Hemoperfusion	602
3.2.1. Cellulosic adsorbents for removing low-density lipoprotein-cholesterol (LDL-C)	602
3.2.2. Cellulosic adsorbents for the removal of rheumatoid factors	606
3.2.3. Cellulosic adsorbents for removal of endotoxin	608
3.2.4. Cellulosic adsorbents for the removal of anti-DNA antibodies in the treatment of systematic lupus erythematosus	610
3.2.5. Cellulosic adsorbent for the treatment of myasthenia gravis	612
3.2.6. Cellulosic adsorbents for the treatment of IgA nephropathy	614
3.2.7. Cellulosic adsorbents for the removal of bilirubin	616
3.3. Chitosan-based Adsorbents in Hemoperfusion	616
3.3.1. Chitosan bead-based adsorbent for the treatment of MODS	616
3.3.2. Chitosan bead-based adsorbents for the removal of LDL	619
3.3.3. Chitosan bead-based adsorbents for the removal of bilirubin	620
3.4. Dextran-based Adsorbents in Hemoperfusion	620
3.4.1. Dextran-based adsorbent for the removal of LDL	620
4. Conclusion and Future Perspectives	622
References	622
Chapter 22 Adsorbents for the Treatment of Autoimmune Diseases through Hemoperfusion	629
1. Introduction	629
2. Commercial Adsorbents for Autoimmune Diseases	631
2.1. Non-Selective Adsorbents	631
2.2. Semi-Selective Adsorbents	633
2.3. Highly-selective Adsorbents	636
3. Recent Developments on Adsorbents for Autoimmune Diseases	637
3.1. Adsorbents Using Phema Membrane and Cryogel as Matrices	637
3.2. Adsorbents Using Mep As Ligand	639
4. Perspectives	644
References	644
Chapter 23 Treatment of Dermatonosus by Hemoperfusion	649
1. Psoriasis	649
1.1. Pathogenesis of Psoriasis	650
1.1.1. Genes associated with psoriasis	650
1.1.2. Environmental factors	651
1.1.3. Viral infection	652
1.1.4. Neovascularization	653
1.1.5. Immunological pathogenesis of psoriasis	653
1.1.5.1. The role of T cells in psoriatic lesions	653
1.1.5.2. The interaction between T cells and KCs	654
1.1.5.3. Dendritic cells	655
1.1.5.4. Cytokine abnormalities in psoriasis	656
1.1.5.5. Vascular endothelial cells, adhesion molecules and complements	658
1.2. General Treatments of Psoriasis	659
1.2.1. Ultraviolet (UV) light therapy	659
1.2.2. Psoralen-Ultraviolet A (PUVA) therapy	659
1.2.3. Topical treatments	660
1.2.4. Methotrexate (MTX)	660
1.2.5. Cyclosporine	661
1.2.6. Alitretinoin	661
1.2.7. Clinical application of combination therapy	661
1.2.8. Strategies for antibody treatments for psoriasis	661
1.2.8.1. Anti-CD4 antibody	662
1.2.8.2. Anti-CD25 antibody	662
1.2.8.3. Anti-tumor necrosis factor α (TNF-α) antibody	663
1.2.8.4. CD11a antibody	663
1.2.8.5. Anti-IL-8 antibody	663
1.2.8.6. Anti-IL-12 antibody	664
1.2.8.7. Anti-IL-6R antibody	664
1.3. Hemadsorption Treatment of Psoriasis	664
References	673
2. Pemphigus	678
2.1. Introduction	678
2.2. Pathogenesis of Pemphigus	679
2.2.1. The pemphigus antigen	679
2.2.2. The pemphigus “clinical drift” phenomenon	681
2.2.3. Protease and pemphigus	681
2.2.4. Pemphigus and cell-mediated immunity	682
2.3. The Diagnosis of Pemphigus	685
2.4. General Treatment of Pemphigus	687
24.1. Corticosteroids	687
2.4.2. Other immunosuppressive drugs	688
2.4.3. Intravenous immune globulin method	690
2.4.4. Photochemical therapy and hematopoietic stem cell transplantation	690
2.5. Circulative Clearing Therapy for Pemphigus	691
2.5.1. Plasmapheresis	691
2.5.2. Immunoadsorption therapy	700
References	707
Chapter 24 Use of Sorption-based Methods in Treatment of Asthma and Allergic Diseases\r	715
Abstract	715
1. Introduction: Types and Clinical Impact of Allergic Reactions	716
1.1. Types of Allergic Reactions	716
1.2. Allergic Diseases and Basic Principles of Their Treatment	718
1.2.1. Pharmacotherapy of allergic diseases	719
1.2.2. Allergen-specific immunotherapy	721
2. Physical-Chemical Basis and Clinical Effects of Efferent Methods of Therapy	721
2.1. Historical Perspective on Efferent Methods of Therapy in Russia	721
2.2. Physical and Chemical Basis for Therapeutic Efficiency of Sorption-Based Methods of Therapy	722
3. Our Clinical Experience in The Use of Sorption-based Methods in Treatment of Allergic Diseases	725
3.1. Non-selective Hemosorption	727
3.1.1. Clinical case no. 1	728
3.1.2. Clinical case no. 2	729
3.2. Selective Hamosorption	733
3.2.1. Clinical case no. 3	736
3.2.2. Clinical case no. 4	736
3.3. Plasma Sorption	739
3.4. Enterosorption	740
3.5. Hemosorption Use in Treatment of Other Allergic Diseases	740
3.6. Adverse Effects of Hemosorption	740
3.7. General Considerations on the Use of Efferent Therapy in Treatment of Allergic Diseases	742
Conclusions	746
References	746
Chapter 25 Immunoadsorption for Collagen and Rheumatic Diseases\r	749
1. Introduction	749
2. Indications and Target Conditions	750
3. Types and Methods	750
3.1. Phenylalanine Columns	752
3.2. Dextran Sulfate Columns	754
3.3. Protein A Columns	755
3.4. Ig-Columns	756
3.5. Gam-Columns	756
4. Immunoadsorption Plasmapheresis to Treat Collagen and Rheumatic Diseases	757
4.1. Rheumatoid Arthritis (RA)	757
4.2. Systemic Lupus Erythematosus (SLE)	758
5. Summary	761
References	762
Chapter 26 Treatment of Rheumatoid Arthritis by Hemoperfusion	765
1. The Characteristics of Rheumatoid Arthritis (RA)	765
1.1. Etiology and Pathogenesis	766
1.2. Clinical Manifestation	766
1.3. Diagnosis	767
1.4. Treatment	767
2. Terms and Technical Features of Hemoperfusion and General Efficacy on Rheumatic and Autoimmune Diseases	768
2.1. The Term “Hemoperfusion”	768
2.2. SPA Immunoadsorption	769
3. Application of Hemoperfusion Therapies in Treating RA	771
3.1. Staphylococcal Protein A (SPA) Immnoadsorption in Treating RA	771
3.2. Other Immunoadsorbent Columns in Treating RA	773
3.3. Other Plasmapheresis Techniques in Treating RA	775
4. Complications of Hemoperfusion	776
5. Conclusions	778
References	778
Chapter 27 Immunomodulator of Nervous System Disease	781
1. Introduction	781
2. Immunomodulation by Immunoadsorption Plasmapheresis	782
3. Immunoadsorption in Myasthenia Gravis	783
3.1. Immunoadsorption with IM-TR	783
3.2. Immunoadsorption with Protein A	785
3.3. Approaches to Specific Removal of Anti-Acetylcholine Receptor Antibodies in Myasthenia Gravis	786
4. Immunoadsorption in Guillain-Barré Syndrome and Fisher’s Syndrome	787
4.1. Immunoadsorption with IM-TR	787
4.2. Immunoadsorption with Disialylgalactose Glycoconjugate	789
5. Immunoadsorption in Chronic Inflammatory Demyelinating Polyradiculoneuropathy	789
6. Immunoadsorption in Multiple Sclerosis	790
7. Immunoadsorption in Neuromyelitis Optica	791
8. Immunoadsorption in other Neurological Disorders	793
8.1. Immunoadsorption in Acquired Neuromyotonia	793
8.2. Immunoadsorption in Autoimmune Encephalitis	793
8.3. Immunoadsorption in Paraneoplastic Syndromes	794
References	795
V. Selective Cell Removal	801
Chapter 28 Leukocyte Apheresis Using Adsorbent	803
References	805
Chapter 29 White Blood Cell Adsorption: LCAP (Basic Aspect)	807
1. Introduction	807
2. Basic Principle of Leukocyte Apheresis with Microfiber Non-Woven Cloth\r	809
3. Application of Leukocyte Removal Filters to Blood Transfusion	811
4. CELLSORBA® System for Leukocyte Apheresis	814
4.1. Types of CELLSORBA	815
4.2. Basic Structure of CELLSORBA	816
4.3. CELLSORBA CS-100 and CS-180S	817
4.4. CELLSORBA-E Type (EX and EI)	819
4.5. Efficacy and Safety of CELLSORBA	821
4.5.1 Prevention of clogging by blood coagulation	821
4.5.2. Inhibition of negative charge on the surface of fibers	824
4.5.3. Adsorptivity of drug	825
5. Extracorporeal System for CELLSORBA	828
5.1 Plasauto-LC	828
5.2 Plasauto-Σ	830
6. Extension of the Technique to Separation of Targeted Materials by Antibody Fixation (Onodera et al., 1998)	831
7. Conclusion	832
References	833
Chapter 30 Leukocytapheresis (LCAP) with Cellsorba Leukocyte Removal Filter Column as One Therapeutic Option for Inflammatory Bowel Disease	835
1. Introduction	835
2. The First Report for the Patients with LCAP (Non-Centrifugal Method)	840
3. Overshoot Phenomenon for the Leukocyte Count after LCAP (Fig. 30.4)	840
4. Prospective Multicenter Pilot Study for Crohn’s Disease using LCAP	842
5. Multicenter Randomized Controlled Trial for the Treatment of Ulcerative Colitis with a Leukocytapheresis Column	843
6. Leukocytapheresis in Ulcerative Colitis: Results of a Multicenter Double-Blind Prospective Case-Control Study with Sham Apheresis as Placebo Treatment\r	843
7. Leukocytapheresis for Management of Fulminant Ulcerative Colitis with Toxic Megacolon\r	845
8. A Large-Scale, Prospective, Observational Study of Leukocytapheresis for Ulcerative Colitis: Treatment Outcomes of 847 Patients in Clinical Practice	846
9. Safety of Leukocytapheresis for Patients with UC ((Yokoyama et al., 2014; Nagase et al., 1998; Ashizuka et al., 2006; Muratov et al., 2010)	846
10. Mechanism of LCAP Action	847
11. Japanese Food “WASHOKU,” Traditional Dietary Cultures of the Japanese May Well Match Cytapheresis Treatment	848
References	849
Chapter 31 Adacolumn for Hemoperfusion to Deplete Inflammatory Leucocytes as an Alternative or Complementary to Drug Therapy in Patients with Immune Disorders: Basic Mechanisms and Concepts for Therapeutic Efficacy	853
Abstract	853
1. Introduction	855
1.1. The Evolution of Apheresis as a Therapeutic Practice	855
2. The Work Featured in this Chapter	857
3. The Adacolumn Design Features	858
4. The Perceptions that Inspired Development of the Adacolumn	859
5. Target Cells for the Adacolumn GMA	860
6. The Adacolumn Hemoperfusion System	864
7. GMA Related Potential Immunomodulatory Observations	866
8. Down-Modulation of the Chemokine Receptor CXCR3	869
9. Effect of GMA on Tissue Level of Myeloid Leucocytes	869
10. The Incurable Nature of a Dysfunctioning Immune System	872
11. The Logics of Therapeutic GMA in IBD Patients	873
12. Effective Dosage of GMA in UC Patients	874
13. GMA Responder and Non-Responder Features of IBD Patients	876
14. Colonoscopic Features of GMA Responders and Non-Responders	877
15. GMA to Suppress Clinical Relapse in IBD Patients	879
16. GMA in other Diseases Involving Leucocytes	880
16.1. Rheumatoid Arthritis	880
16.2. Patients with HIV Infection	881
16.3. Treatment of Pyoderma Gangrenosum and Psoriasis-Like Skin Lesions	883
16.4. Hepatitis C Infection	884
16.5. Behcet’s Disease	885
17. Conclusions & Future Perspectives	886
18. Acknowledgements	888
List of Abbreviations used in this Chapter	888
References	889
Chapter 32 Efficacy Outcomes for Adacolumn Adsorptive Granulocyte and Monocyte Apheresis Applied as a Non-Pharmacologic Treatment Option in Patients with Inflammatory Bowel Disease	901
Abstract	901
1. Introduction	903
2. GMA, Mechanisms of Action in Brief	904
3. GMA Procedures	905
4. GMA in the Treatment of Patients with UC	905
4.1. The Existing Concept	905
4.2. The Efficacy of GMA in UC Patients	906
4.3. The Efficacy Outcomes for GMA Evaluated in a Retrospective Setting	908
4.4. The Relationship between GMA Processed Blood Volume and Bodyweight	913
4.5. GMA as Maintenance Therapy in UC Patients	915
4.6. Factors Associated with Long-term Prognosis of UC patients Undergoing GMA	916
5. GMA in the Treatment of Crohn’s Disease	924
5.1. Background	924
5.2. The Efficacy of GMA in CD Patients	924
5.3. The Efficacy of GMA in a CD Case Complicated by Hepatitis B Virus	925
6. Concluding Remarks	928
Acknowledgements	928
List of Abbreviations used in this Chapter	928
References	929
Chapter 33 Granulocyte and Monocyte Adsorption Apheresis (GMA) in Dermatology	935
1. Introduction	935
1.1. Neutrophils	935
1.2. Pyoderma Gangrenosum	936
1.3. Arthropathy Associated with Neutrophilic Dermatosis	936
1.4. Granulocyte and Monocyte Adsorption Apheresis	937
1.5. Assessment of the Therapeutic Efficacy of GMA in Pyoderma Gangrenosum	937
1.6. Activated Neutrophils and Mac-1	939
2. Clinical Study of GMA for Skin Disorders and Related Arthropathy	939
2.1. Patients	939
2.2. GMA	940
2.3. Clinical and Laboratory Evaluation	941
2.4. Results of the Clinical Study	942
2.4.1. Response of skin lesions to GMA	942
2.4.2. Response of arthropathy to GMA	943
2.4.3. Laboratory examinations	945
2.4.4. Adverse events	945
2.5. Conclusion of the Clinical Study	945
3. Prospective and Multi-Center Study of GMA for Pustular Psoriasis	945
3.1. Pustular Psoriasis	945
3.2. Patients	946
3.3. Determination of GPP Severity and Treatment Efficacy	946
3.4. GMA Procedures	948
3.5. Ethical Considerations	948
3.6. Results of the Multi-Center Study	949
3.6.1. Patients’ baseline demographic variables	949
3.6.2. Study safety and patient compliance	949
3.6.3. Efficacy outcomes	950
3.7. Conclusion of the Multi-Center Study	952
4. Conclusion and the Future of GMA for Skin Diseases	953
References	953
Chapter 34 New White Blood Cell Adsorbent: Immunopure	957
Abstract	957
1. Introduction	958
1.1. Platelets as Therapeutic Targets in Inflammatory Bowel Disease	958
1.2. Adsorptive Cytapheresis — Current Situation	962
1.3. Immunopure Adsorber	963
2. Basic Aspects	965
2.1. In Vitro Circulation Experiments — Setup	965
2.2. In Vitro Circulation Experiments — Results	966
2.3. Adsorptive-Type Cytapheresis in a Pig Model	976
3. Clinical Aspects	984
3.1. Introduction	984
3.2. Uncontrolled Studies — Results	985
3.3. Controlled Studies	992
Acknowledgements	993
Abbreviations	993
References	994
Index	999

Hemoperfusion, Plasmaperfusion And Other Clinical Uses Of General, Biospecific, Immuno And Leucocyte Adsorbents

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