Coupled plasma filtration adsorption: Rationale, technical development and early clinical experience

Claudio Ronco, Alessandra Brendolan, Vincenzo D'Intini, Zaccaria Ricci, Mary Lou Wratten, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

47 Citations (Scopus)

Abstract

The adjuvant treatment of sepsis remains a major therapeutic challenge. Blood purification is theoretically appealing if the humoral theory of sepsis is accepted as the basis for intervention. In this setting, blood purification would provide a broad-based restoration of humoral homeostasis thereby avoiding both excessive inflammation and counterinflammation. Several techniques of blood purification have been tried or are under active investigation. One of these is the so-called coupled plasma filtration adsorption (CPFA). CPFA is a novel extracorporeal blood purification therapy aimed at nonselectively reducing the circulating levels and activities of both pro- and anti-inflammatory mediators during sepsis and multiorgan failure. In vitro studies have shown CPFA to be effective in binding a broad range of such mediators proving its technical efficacy. Subsequent animal models have shown a beneficial effect on survival in endotoxemia. These studies have provided the necessary technical developments and biologic rationale for initial human studies. Two phase I/IIa clinical studies have now been performed. Both studies have shown that CPFA improves blood pressure and restores immune function in patients with severe sepsis and multiorgan dysfunction. In this article, we will discuss some of the basic principles involved in sorbent technology, and how these may contribute to treatment efficacy, review animal experiments with CPFA and finally discuss the results of recent human studies and their implications.

Original languageEnglish
Pages (from-to)409-416
Number of pages8
JournalBlood Purification
Volume21
Issue number6
DOIs
Publication statusPublished - 11 Nov 2003
Externally publishedYes

Keywords

  • Acute renal failure
  • Adsorption
  • Cytokines
  • Extracorporeal therapy
  • Hemodiafiltration
  • Hemofiltration
  • Sepsis

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