CARBON BLOCK VS. GRANULAR COLUMNS FOR BINDING OF LIVER FAILURE TOXINS Stephen R. Ash MD FACP and...
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Transcript of CARBON BLOCK VS. GRANULAR COLUMNS FOR BINDING OF LIVER FAILURE TOXINS Stephen R. Ash MD FACP and...
![Page 1: CARBON BLOCK VS. GRANULAR COLUMNS FOR BINDING OF LIVER FAILURE TOXINS Stephen R. Ash MD FACP and David J. Carr MsChe HemoCleanse, Inc. and Clarian Arnett.](https://reader036.fdocuments.us/reader036/viewer/2022062516/56649e245503460f94b12847/html5/thumbnails/1.jpg)
CARBON BLOCK VS. GRANULAR COLUMNS FOR BINDING OF LIVER FAILURE
TOXINS
Stephen R. Ash MD FACP and David J. Carr MsChe
HemoCleanse, Inc. and Clarian Arnett Health Lafayette, IN
ESAO 2007, Krems, Austria
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The Problem
• Capacity for high molecular weight and protein-bound toxins has limited carbon’s efficacy in extracorporeal therapy (and other sorbents). Most of the active carbon surface in granules is in the interior, hidden from the flowing stream and protein-bound toxins.
• Small particle size allows direct interaction of sorbents with macromolecules and bound toxins. However, particles of 1-10 microns are impossible to directly fabricate into columns.
• Sorbent suspensions are difficult to retain during convection at membranes.
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Adsorption Background
Transport ProcessesBulk ConvectionAxial Dispersion
Film DiffusionPore Diffusion
Surface Diffusion
Adsorption ProcessesAggregationAdsorption
DenaturationInterference
Solid Phase Reaction
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Adsorption ProcessesAdsorption Processes Diagram
Diagram courtesy Dr.
N.-H. L. Wang
S o rb en t P ar tic le
B u lk C on vection
A xia l D isp ersion
P ore D iffu sion
F ilm D iffu sion A d sorp tion S ites
P ore F lu id
S u rface D iffu sion
B u lk F lu id
In terferen ce
A d sorp tion
D en atu ra tion
S o lid P h ase R eaction
A ggregation
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Micropores vs. Mesopores
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Using sorbent regeneration avoids need for large amounts of plasma and sterile replacement fluid, making the system
easier to implement and control...
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But if the sorbents saturate, there is decreasing clearance of hepatic toxins during the treatment. Example: decreasing clearance of bilirubin over time in the MARS system (partly due to column saturation):
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Further evidence for sorbent capacity limitations
PrometheusTM : “Blood clearances of protein-bound toxins decrease over time. The rate and the efficiency of removal of albumin-bound toxins are interrelated to both the strength of the albumin binding and the saturation of the adsorption columns” (Cl tB 29.3 ± 5.1 vs. 13.7 ± 3.7)
*P. Evenepoel, Y. Vanrenterghem et al., Detoxifying Capacity and Kinetics of Prometheus® - A New Extracorporeal System for the Treatment of Liver Failure , Blood Purification
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Our Project Goals:
• Develop method of screening sorbents for detoxification applications to predict removal of small and protein-bound toxins.
• Compare efficacy of toxin removal by mesoporous carbons in several physical forms.
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Activated Carbons TestedDescription Surface Area,
m2/gramBulk Density, g/mL
Preliminary Study
MaxsorbPellets
1.5mm diameter 2,060 0.31
MaxsorbPowder
25 to 75 μm 2,060 0.31
Norit A Powder, 1 to 25 μm
1,700 0.22
Granular Norit C Gran:840 -1,700 μm
1,400 0.20
HSGD Synthetic beads, 100 -1,000 μm
~1,600 0.10
Block Immobilized powder 1,300 0.41Nanofiber Immobilized powder 800 0.21
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HSGD
500 microns 50 microns
10.0 microns 2.0 microns 1.0 microns
Micrographs courtesy Dr. VG Nikolaev
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Maxsorb Pellets
Carbon Block
Nanofiber
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Preliminary Study
Bilirubin adsorption of two carbons with similar surface areas was compared as a function of particle size. Maxsorb carbon is commercially available in pellets. It was tested as pellets and as powder after grinding in a mortar and pestle and sieving.
Equilibrium binding of bilirubin in 5% albumin was tested for these carbons. Initial [bilirubin] was up to 12 mg/dL.
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Bilirubin Adsorption by Activated CarbonPowdered vs. Granular
Bilirubin in 5% albumin at 37C
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0 9.0 10.0
Equilibrium Concentration, mg bilirubin / dL
Am
ou
nt
Bo
un
d, m
g /
g c
arb
on
Norit Powder Maxsorb Powder Maxsorb Pellets
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Results of Preliminary StudyLangmuir coefficients for bilirubin
Powdered carbons had much higher bilirubin capacity than granular carbon.
Maximum Capacity,
mg/g carbon
Relative Capacity
Binding Constant,mL/mg bilirubin
Relative Binding
Constant
Maxsorb Pellets 0.069 1 32.8 17.4
Maxsorb Powder 3.5 51 1.9 1.0
Norit A 20.7 300 4.0 2.1
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Materials & MethodsActivated carbons were tested as powders in mixed
suspension and as columns of beads or immobilized particles. Test conditions were scaled from human clinical application. Isothermal adsorption of 3 compounds from aqueous solution at low concentration (50-100 ppm) was used as a screening criterion: methylene blue (MW 320), albumin (MW 66,000) and blue dextran (MW 2,000,000).
Three carbons with the highest large-molecule adsorption were tested in columns. Adsorption at 37°C and constant pH of bilirubin (MW 585) or cytokines (IL-1β, IL-6, & IL-10) from plasma was tested in a system that recirculated treated plasma to a tank simulating a patient for 10 hours.
Removal efficiency is the final toxin concentration in the tank is expressed as a percentage of the initial tank concentration.
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Results: Binding of Marker Results: Binding of Marker Molecules Molecules
Methylene Blue Removal EfficiencyInitial [Methylene Blue] = 50 ppm
94.04% 95.33% 99.22%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Granular HSGD Block
Activated Carbon
Met
hyl
ene
Rem
ova
l %
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Results: Binding of Marker Results: Binding of Marker Molecules Molecules
Albumin Removal EfficiencyInitial [Albumin] = 50 ppm
19.10%
94.13% 99.85%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Granular HSGD Block
Activated Carbon
Alb
um
in R
emo
val %
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Results: Binding of Marker Results: Binding of Marker Molecules Molecules
Blue Dextran Removal EfficiencyInitial [Blue Dextran] = 100 ppm
16%
46%
55%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Granular HSGD Block
Activated Carbon
Blu
e D
extr
an R
emo
val
%
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Results: Binding of BilirubinResults: Binding of Bilirubin
Bilirubin Removal EfficiencyInitial [Bilirubin] = 4 mg%
30%
67% 66%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Nanofiber HSGD BlockActivated Carbon
Bili
rub
in R
emo
val %
Granular carbon=near zero
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Results: Binding of CytokinesResults: Binding of Cytokines
Cytokine Removal EfficiencySingle Cytokine in 5% Albumin
49%
73%
59%
11%
80%
33%29%
59%
35%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Nanofiber HSGD Block
Activated Carbon
Cy
tok
ine
Re
vm
ov
al %
IL-1β IL-6 IL-10
Granular carbon=near zero
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Results SummaryResults Summary•Methylene blue performance is similar for all the carbons tested. •Carbon adsorbs blue dextran in proportion to its mesoporous character AND to the surface area exposed to flowing fluid. •Carbons with significant blue dextran interaction also remove bilirubin and cytokines from plasma.•Carbon block (powdered) removes bilirubin and cytokines about as well as HSGD, the best clinically tested carbon.
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Carbon Comparison Carbon Block HSGD Nanofiber
Granular
Carbon Density +++ ++ + ++Lack of Fines +++ -- ++ --
Small Toxin Capacity ++++++
++++++
Bilirubin Capacity ++++++
++
Cytokine Capacity +++++
+++
Hemoperfusioncapable -
+++
-With coating
Additional sorbent capable + - ++ -
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Conclusions
• Blue dextran adsorption from aqueous solution is indicative of in-vitro bilirubin and cytokine binding capacities.
• Mesoporous carbons with high surface area in contact with flowing fluid are the best candidates for clinically effective sorption of protein-bound toxins.
• Examples are HSGD and carbon block (pore size range = 2 to 50 nanometers)
• For reasons of density, lack of fines, flexibility, carbon block is a practical and effective choice.
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Progress towards Carbon Block for Biological Fluid Regeneration
• Carbon type, particle size, and size of block• Purity of perfusate-AANSI standards for metals,
endotoxin, bacteria• Free of organics-GCMS assay• Case design• Sterilization of product• Priming with sterile fluid• Platform definition-regenerate dialysate, then
albumin-dialysate and plasma.
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Alternative Carbon to Consider: carbide-derived carbon
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Once the artificial liver is built, how to test it? Rats!
Peritoneal implants 107 Cells in membranes
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Sorbent-Based Pheresis in the Rat
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Plasmafilter and Sorbent Reactors
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Animal Interface
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Hydraulic Performance
R at B lo o d an d Plasm a Treatm en t Volum es
0
100
200
300
400
500
600
700
5B 7B 40B 50B 52N 56N 60N 58N 52V 43V 44V 49V 51V 55V 61V 63V Rat Number
Vo
lum
e T
reated
(m
L)
Blood Volume Treated mL) Plasma Volume Treated (mL)
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Blood cellular and chemical component testsFigure 14
Average IL-1b Treated vs Control
0
100
200
300
400
500
600
700
800
900
Pre-d
ose
Pst-d
ose2h
Pre-tr
t
Early
trt i
n
Early
trt o
ut
Late
trt in
Late
trt o
utDay
3
Day 4
time/day
pg
/ml
Treated Control
Figure 12Average WBC Treated vs Control
0
5
10
15
20
25
30
pre-dose post-dose 2h pre-trt post-trt day 2 day 3 day 4
time/day
WB
C C
ou
nt,
10
00 /
uL
Treat Control
P= 0.89
Figure 15Average IL-10 for Treated vs Control Animals
-200
0
200
400
600
800
1000
1200
1400
Pre
-do
se
Pst
-do
se2h
Pre
-trt
Ear
ly t
rt a
Ear
ly t
rt b
Lat
e tr
t a
Lat
e tr
t b
Day
3
Time
IL-1
0 co
nce
ntr
atio
n, p
g/m
L
Treated Control
1 rat
P= 0.2
P= 0.0
P= 0.1
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Treatment Results include survival to death or euthanasia by defined criteria
Average survival in hours
0.00
20.00
40.00
60.00
80.00
100.00
120.00
140.00
T re a te d C o n tro l
Ho
urs
Pheresis with sorbents and/or cells is possible for a rat liver failure model
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Artificial liver support therapy for patients with fulminant hepatic failurecurrently used in Japan- TAD, Yoshiba et al.
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Evidence for sorbent capacity limitations
MARS : The removal efficiency of albumin-bound toxins drops after the initiation of treatment to become insignificant after 6 hours due to both the strength of the albumin binding and the saturation of the adsorption columns*
*P. Evenepoel, Y. Vanrenterghem et al., Detoxifying Capacity and Kinetics of the Molecular Adsorbent Recycling SystemContribution of the Different Inbuilt Filters, Blood Purification
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