Extracorporeal blood purification techniques have emerged and evolved in the recent years as a potential therapy for the purpose of immunomodulation in acute conditions like sepsis. Understanding the extent of immune system dysregulation involved in the pathophysiology of these conditions, resulted in the development of such treatment strategies aiming at restoring a balanced inflammatory response. Beyond conventional continuous renal replacement therapy, high volume hemofiltration, high cut-off membranes, adsorption alone and coupled plasma filtration adsorption are well-described techniques in the literature. The evidence to support their routine use, however, is conflicting and insufficient at this stage. Despite the low-quality level of evidence in favor of utilizing these techniques, studies to further explore their effectiveness, safety, and potential novel applications, continue to evolve. Our review aims at focusing on adsorption therapy, particularly using the adsorption columns Cystosorb.

Keywords:
Extracorporeal therapy, Adsorption, Sepsis, Cardiac surgery, Cytokines, Sorbents
1.
Ankawi G, Neri M, Zhang J, Breglia A, Ricci Z, Ronco C. Extracorporeal techniques for the treatment of critically ill patients with sepsis beyond conventional blood purification therapy: the promises and the pitfalls.
Crit Care
. 2018 Oct;22(1):262.
2.
Datzmann T, Träger K. Extracorporeal membrane oxygenation and cytokine adsorption.
J Thorac Dis
. 2018 Mar;10(Suppl 5):S653–60.
3.
Eichhorn T, Rauscher S, Hammer C, Gröger M, Fischer MB, Weber V. Polystyrene-Divinylbenzene-Based Adsorbents Reduce Endothelial Activation and Monocyte Adhesion Under Septic Conditions in a Pore Size-Dependent Manner.
Inflammation
. 2016 Oct;39(5):1737–46.
4.
Gruda MC, Ruggeberg KG, O’Sullivan P, Guliashvili T, Scheirer AR, Golobish TD, et al. Broad adsorption of sepsis-related PAMP and DAMP molecules, mycotoxins, and cytokines from whole blood using CytoSorb® sorbent porous polymer beads.
PLoS One
. 2018 Jan;13(1):e0191676.
5.
Friesecke S, Stecher SS, Gross S, Felix SB, Nierhaus A. Extracorporeal cytokine elimination as rescue therapy in refractory septic shock: a prospective single-center study.
J Artif Organs
. 2017 Sep;20(3):252–9.
6.
Kogelmann K, Jarczak D, Scheller M, Drüner M. Hemoadsorption by CytoSorb in septic patients: a case series.
Crit Care
. 2017 Mar;21(1):74.
7.
Schädler D, Porzelius C, Jörres A, Marx G, Meier-Hellmann A, Putensen C, et al. A multicenter randomized controlled study of an extracorporeal cytokine hemoadsorption device in septic patients.
Crit Care
. 2013;17(Suppl 2):P62.
8.
Schädler D, Pausch C, Heise D, Meier-Hellmann A, Brederlau J, Weiler N, et al. The effect of a novel extracorporeal cytokine hemoadsorption device on IL-6 elimination in septic patients: A randomized controlled trial.
PLoS One
. 2017 Oct;12(10):e0187015.
9.
Träger K, Fritzler D, Fischer G, Schröder J, Skrabal C, Liebold A, et al. Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series.
Int J Artif Organs
. 2016 May;39(3):141–6.
10.
Bernardi MH, Rinoesl H, Dragosits K, Ristl R, Hoffelner F, Opfermann P, et al. Effect of hemoadsorption during cardiopulmonary bypass surgery – a blinded, randomized, controlled pilot study using a novel adsorbent.
Crit Care
. 2016 Apr;20(1):96.
11.
Träger K, Skrabal C, Fischer G, Datzmann T, Schroeder J, Fritzler D, et al. Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass – a case series.
Int J Artif Organs
. 2017 May;40(5):240–9.
12.
Calabrò MG, Febres D, Recca G, Lembo R, Fominskiy E, Scandroglio AM, et al. Blood Purification With CytoSorb in Critically Ill Patients: Single-Center Preliminary Experience.
Artif Organs
. 2019 Feb;43(2):189–194.
13.
Nemeth E, Kovacs E, Racz K, Soltesz A, Szigeti S, Kiss N, et al. Impact of intraoperative cytokine adsorption on outcome of patients undergoing orthotopic heart transplantation–an observational study.
Clin Transplant
. 2018 Apr;32(4):e13211.
14.
Kellum JA, Venkataraman R, Powner D, Elder M, Hergenroeder G, Carter M. Feasibility study of cytokine removal by hemoadsorption in brain-dead humans.
Crit Care Med
. 2008 Jan;36(1):268–72.
15.
Hartmann J, Harm S. Removal of bile acids by extracorporeal therapies: an in vitro study.
Int J Artif Organs
. 2017 Sep;41(1):52–57.
16.
Koertge A, Wasserkort R, Wild T, Mitzner S. Extracorporeal Hemoperfusion as a Potential Therapeutic Option for Critical Accumulation of Rivaroxaban.
Blood Purif
. 2018;45(1-3):126–8.
17.
Angheloiu GO, Gugiu GB, Ruse C, Pandey R, Dasari RR, Whatling C. Ticagrelor Removal From Human Blood.
JACC Basic Transl Sci
. 2017 Apr;2(2):135–45.
18.
Angheloiu GO, Hänscheid H, Wen X, Capponi V, Anderson WD, Kellum JA. Experimental first-pass method for testing and comparing sorbent polymers used in the clearance of iodine contrast materials.
Blood Purif
. 2012;34(1):34–9.
19.
Reiter K, Bordoni V, Dall’Olio G, Ricatti MG, Soli M, Ruperti S, et al. In vitro removal of therapeutic drugs with a novel adsorbent system.
Blood Purif
. 2002;20(4):380–8.
20.
Friesecke S, Träger K, Schittek GA, Molnar Z, Bach F, Kogelmann K, et al.
International registry on the use of the CytoSorb
®
adsorber in ICU patients
: Study protocol and preliminary results. Med Klin Intensivmed Notfmed. 2017 Sep 4.
21.
Winchester JF, Silberzweig J, Ronco C, Kuntsevich V, Levine D, Parker T, et al. Sorbents in acute renal failure and end-stage renal disease: middle molecule and cytokine removal.
Blood Purif
. 2004;22(1):73–7.
22.
Malard B, Lambert C, Kellum JA. In vitro comparison of the adsorption of inflammatory mediators by blood purification devices.
Intensive Care Med Exp
. 2018 May;6(1):12.
23.
Yakoub-Agha I, Moreau AS, Ahmad I, Borel C, Hadhoum N, Masouridi-Levrat S, et al. [Management of cytokine release syndrome in adult and pediatric patients undergoing CAR-T cell therapy for hematological malignancies: Recommendation of the French Society of Bone Marrow and cellular Therapy (SFGM-TC)].
Bull Cancer
. 2019 Jan;106 1S:S102–9.
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2019
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