In vitro assessment of mixed matrix hemodialysis membrane for achieving endotoxin-free dialysate combined with high removal of uremic toxins from human plasma
In vitro assessment of mixed matrix hemodialysis membrane for achieving endotoxin-free dialysate combined with high removal of uremic toxins from human plasma
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DOI：
10.1016/j.actbio.2019.04.009
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发表时间：
2019-05-01
影响因子：
9.7
通讯作者：
Stamatialis, Dimitrios
中科院分区：
文献类型：
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作者：
Geremia, Ilaria;Bansal, Ruchi;Stamatialis, Dimitrios
单次血液透析需要消耗近 500 L 的水来获得无热原透析液。然而，需要付出许多努力来避免系统中形成生物膜，并且污染的风险可能持续存在。水资源短缺和水净化设施不足加剧了发展中国家的污染风险。在这里，我们研究了活性炭（AC）/聚醚砜/聚乙烯吡咯烷酮混合基质膜（MMM）的应用，首次实现了无内毒素透析液和用单膜从人血浆中高度去除尿毒症毒素。与商用纤维相比，MMM 借助吸附剂 AC，可以从透析液中去除大约 10 倍的内毒素。研究了热原通过 MMM 的运输，分析了与透析回路样品一起孵育的 THP-1 单核细胞的炎症，揭示了 MMM 的安全屏障特性。重要的是，可以同时去除透析液中的内毒素和人血浆中的蛋白质结合毒素，而不会影响 AC 的吸附能力。我们估计仅需要 0.15 m(2) 的 MMM 即可完全去除每天产生的蛋白质结合毒素硫酸吲哚酚和马尿酸，并完全去除可穿戴人工肾 (WAK) 装置中的内毒素。我们的研究结果可能为低耗水量透析治疗（包括 WAK）以及水的纯度和稀缺性成为血液透析治疗的限制因素开辟新的可能性。 意义声明血液透析是肾脏疾病的一种维持生命的体外治疗方法，但是无热原透析液的生产成本非常昂贵且需要水。系统中生物膜的形成加剧了细菌污染风险。热原可能转移到患者的血液中并引发炎症。在这里，我们首次证明由聚醚砜/聚乙烯吡咯烷酮和活性炭组成的混合基质膜可以同时完全去除透析液中的内毒素和高度去除人体血浆中的尿毒症毒素，而不会影响活性炭的吸附能力。混合基质膜未来可用于同步血液净化和透析液去热原，从而降低可穿戴人工肾装置的耗水量，以及水的纯度和稀缺性阻碍血液透析治疗的情况。 (C) 2019 Acta Materialia Inc. 由 Elsevier Ltd 出版。保留所有权利。
For a single hemodialysis session nearly 500 L of water are consumed for obtaining pyrogen-free dialysis fluid. However, many efforts are required to avoid biofilm formation in the system and risk of contamination can persist. Water scarcity and inadequate water purification facilities worsen contamination risk in developing countries. Here, we investigated the application of an activated carbon (AC)/polyethersulfone/polyvinylpyrrolidone mixed matrix membrane (MMM) for achieving for the first time endotoxin-free dialysate and high removal of uremic toxins from human plasma with a single membrane. The MMM, thanks to sorbent AC, can remove approximately 10 times more endotoxins from dialysis fluid compared to commercial fibers. Pyrogens transport through the MMM was investigated analyzing inflammation in THP-1 monocytes incubated with samples from the dialysis circuit, revealing safety-barrier properties of the MMM. Importantly, endotoxins from dialysate and protein-bound toxins from human plasma can be removed simultaneously without compromising AC adsorption capacity. We estimated that only 0.15 m(2) of MMM is needed to totally remove the daily production of the protein-bound toxins indoxyl sulfate and hippuric acid and to completely remove endotoxins in a wearable artificial kidney (WAK) device. Our results could open up new possibilities for dialysis therapy with low water consumption including WAK and where purity and scarcity of water are limiting factors for hemodialysis treatment.Statement of SignificanceHemodialysis is a life-sustaining extracorporeal treatment for renal disease, however the production of pyrogen-free dialysate is very costly and water demanding. Biofilm formation in the system worsens bacteria contamination risk. Pyrogens could be transferred into the patients' blood and trigger inflammation. Here, we show for the first time that a mixed matrix membrane composed of polyethersulfone/polyvinyl pyrrolidone and activated carbon can achieve simultaneous complete removal of endotoxins from dialysate and high removal of uremic toxins from human plasma without compromising activated carbon adsorption capacity. The mixed matrix membrane could find future applications for simultaneous blood purification and dialysate depyrogenation thus lowering water consumption as for wearable artificial kidney devices and where purity and scarcity of water hamper hemodialysis treatment. (C) 2019 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.