title: Effects of coupled plasma filtration adsorption on immune function of patients with multiple organ dysfunction syndrome.
abstract: OBJECTIVE
  To investigate the effects of coupled plasma filtration adsorption (CPFA) on the immune function of patients with multiple organ dysfunction syndrome (MODS).
  
  
  METHODS
  This study was a prospective, pilot, before-and-after self-crossover, clinical trial. Seven patients diagnosed with MODS and severe infection were randomly allocated to both 10 hours of CPFA and 10 hours of high-volume hemofiltration (HVHF) with a 12-hour interval and in random order. Serum concentrations of 7 cytokines including tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), interleukin-1beta (IL-1beta), interleukin-10 (IL-10), interleukin-1 receptor antagonist (IL-1Ra), and soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) were measured during each treatment. The HLA-DR expression by the blood monocytes and the TNF-alpha production by the patients' blood (both spontaneous and lipopolysaccharide stimulated) were tested before and after the treatment. TNF-alpha production of normal human monocytes (THP-1 cells) incubated in vitro with the patient plasma was also measured.
  
  
  RESULTS
  During CPFA, the fall in serum TNF-alpha and rise in serum IL-1Ra coincided with the rise in ratios of sTNFR2/TNF-alpha and IL-1Ra/IL-1beta (p<0.05), which were different from those seen within HVHF (p<0.05). HLA-DR expression increased after CPFA (84.32%-/+4.63% vs. 73.65%-/+11.52%, p=0.037), but there was no change after HVHF (p>0.05). Spontaneous and lipopolysaccharide-induced TNF-alpha production increased over time with CPFA (p=0.038, p=0.034, respectively), but did not change with HVHF (p>0.05). Patient plasma suppressed the production of TNF-alpha by cultured normal monocytes. This effect decreased over time with CPFA (p=0.041), but there was no effect with HVHF (p>0.05).
  
  
  CONCLUSIONS
  CPFA was superior to HVHF in increasing the ratios of antiinflammatory to proinflammatory mediators, improving antigen presentation ability, and restoring leukocyte responsiveness. These findings suggest a potential role for CPFA in the treatment of MODS.
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, PR China. huijuanmao@126.com
authors.forename: H-J
authors.initials: HJ
authors.lastname: Mao
authors.forename: S
authors.initials: S
authors.lastname: Yu
authors.forename: X-B
authors.initials: XB
authors.lastname: Yu
authors.forename: B
authors.initials: B
authors.lastname: Zhang
authors.forename: L
authors.initials: L
authors.lastname: Zhang
authors.forename: X-R
authors.initials: XR
authors.lastname: Xu
authors.forename: X-Y
authors.initials: XY
authors.lastname: Wang
authors.forename: C-Y
authors.initials: CY
authors.lastname: Xing
mesh_terms: D000327:Adsorption; D000328:Adult; D017951:Antigen Presentation; D002478:Cells, Cultured; D018592:Cross-Over Studies; D016207:Cytokines / Q000097:blood; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D006440:Hemofiltration; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000276:immunology; D009102:Multiple Organ Failure / Q000276:immunology / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D017582:Renal Replacement Therapy; D018805:Sepsis / Q000276:immunology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D016207:Cytokines; D006684:HLA-DR Antigens; D018836:Inflammation Mediators