title: Removal selectivity of Prometheus: a new extracorporeal liver support device.
abstract: OBJECTIVE
  To evaluate whether treatment with the Prometheus reg system significantly affects cytokines, coagulation factors and other plasma proteins.
  
  
  METHODS
  We studied nine patients with acute-on-chronic liver failure and accompanying renal failure. Prometheus reg therapy was performed on 2 consecutive days for up to 6 h in all patients. Several biochemical parameters and blood counts were assessed at regular time points during Prometheus reg treatment.
  
  
  RESULTS
  We observed a significant decrease of both protein-bound (e.g. bile acids) and water-soluble (e.g. ammonia) substances after Prometheus reg therapy. Even though leukocytes increased during treatment (P<0.01), we found no significant changes of C-reactive protein, interleukin-6, and tumor necrosis factor-alpha plasma levels (all P>0.5). Further, antithrombin 3, factor II and factor V plasma levels did not decrease during Prometheus reg therapy (all P>0.5), and the INR remained unchanged (P=0.4). Plasma levels of total protein, albumin, and fibrinogen were also not altered during Prometheus reg treatment (all P>0.5). Finally, platelet count did not change significantly during therapy (P=0.6).
  
  
  CONCLUSIONS
  Despite significant removal of protein-bound and water-soluble substances, Prometheus reg therapy did not affect the level of cytokines, coagulation factors or other plasma proteins. Thus, the filters and adsorbers used in the system are highly effective and specific for water-soluble substances and toxins bound to the albumin fraction.
authors.affiliation: Division of Gastroenterology, Hepatology and Endocrinology, Department of Internal Medicine, Medical School Hannover, Carl Neuberg Strasse 1, Hannover 30625, Germany. rifai.k@gmx.de
authors.forename: Kinan
authors.initials: K
authors.lastname: Rifai
authors.forename: Thomas
authors.initials: T
authors.lastname: Ernst
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kretschmer
authors.forename: Hermann
authors.initials: H
authors.lastname: Haller
authors.forename: Michael Peter
authors.initials: MP
authors.lastname: Manns
authors.forename: Danilo
authors.initials: D
authors.lastname: Fliser
mesh_terms: D001779:Blood Coagulation Factors; D001798:Blood Proteins / Q000378:metabolism; D004867:Equipment Design; D006801:Humans; D017093:Liver Failure / Q000628:therapy; D019164:Liver, Artificial; D010976:Platelet Count; D006435:Renal Dialysis
chemical_list: D001779:Blood Coagulation Factors; D001798:Blood Proteins