Endotoxin and Cytokine Removal with a New (CA) Sorbent Cartridge

Introduction: Endotoxin, also referred to as lipopolysaccharide (LPS), is a major stimulus of the inflammatory response capable of leading to sepsis and septic shock. Extracorporeal blood purification therapies are increasingly employed in the treatment of sepsis. Timely and thorough removal of endotoxin and cytokines can help mitigate the inflammatory cascade during septic shock. Hemoadsorption (HA) is a promising approach to achieve this goal. In this study, we analyzed different prototypes of a new CA cartridge: we performed in vitro circulations to define endotoxin and cytokine removal capacity. Methods: In vitro HA was performed using GALILEO testing platform, and customized circuits with mini-modules of CA cartridge were prepared. A batch of 500 mL of blood preconditioned with LPS was utilized for each circulation. We collected samples at different time points: endotoxin activity and removal ratio (RR) of LPS, interleukin 6 (IL-6), and interleukin-1 beta (IL-1β) were assessed. Results: The prototypes showed different performances, highlighting promising adsorption affinity toward the target molecules. A potentially clinically meaningful reduction of endotoxin activity by CA mini-module was observed. Concentration of the LPS, and cytokines IL-6 and IL-1β showed a significant reduction over time, as confirmed by the RRs. Conclusion: Our experiments allowed to characterize the prototypes in terms of adsorption capacity for both endotoxin and cytokines. After this preliminary approach, the final CA mini-module was tested under the same experimental conditions and displayed excellent adsorption capacity, indicating its potential application for endotoxin removal.