Bioartificial Therapy of Sepsis: Changes of Norepinephrine-Dosage in Patients and Influence on Dynamic and Cell Based Liver Tests during Extracorporeal Treatments

Biomed Res Int. 2016:2016:7056492. doi: 10.1155/2016/7056492. Epub 2016 Jun 28.

Abstract

Purpose. Granulocyte transfusions have been used to treat immune cell dysfunction in sepsis. A granulocyte bioreactor for the extracorporeal treatment of sepsis was tested in a prospective clinical study focusing on the dosage of norepinephrine in patients and influence on dynamic and cell based liver tests during extracorporeal therapies. Methods and Patients. Ten patients with severe sepsis were treated twice within 72 h with the system containing granulocytes from healthy donors. Survival, physiologic parameters, extended hemodynamic measurement, and the indocyanine green plasma disappearance rate (PDR) were monitored. Plasma of patients before and after extracorporeal treatments were tested with a cell based biosensor for analysis of hepatotoxicity. Results. The observed mortality rate was 50% during stay in hospital. During the treatments, the norepinephrine-dosage could be significantly reduced while mean arterial pressure was stable. In the cell based analysis of hepatotoxicity, the viability and function of sensor-cells increased significantly during extracorporeal treatment in all patients and the PDR-values increased significantly between day 1 and day 7 only in survivors. Conclusion. The extracorporeal treatment with donor granulocytes showed promising effects on dosage of norepinephrine in patients, liver cell function, and viability in a cell based biosensor. Further studies with this approach are encouraged.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / metabolism
  • Cell Count
  • Cohort Studies
  • Cytochrome P-450 CYP1A2
  • Cytokines / metabolism
  • Dose-Response Relationship, Drug
  • Extracorporeal Circulation / methods*
  • Hemodynamics
  • Hep G2 Cells
  • Humans
  • Inflammation / pathology
  • L-Lactate Dehydrogenase / metabolism
  • Liver / pathology*
  • Liver Function Tests
  • Liver, Artificial*
  • Male
  • Middle Aged
  • Norepinephrine / administration & dosage
  • Norepinephrine / therapeutic use*
  • Sepsis / pathology*
  • Sepsis / therapy*
  • Survival Analysis
  • Treatment Outcome

Substances

  • Biomarkers
  • Cytokines
  • L-Lactate Dehydrogenase
  • Cytochrome P-450 CYP1A2
  • Norepinephrine