Summary: Elimination of toxic or biologically active substances from body fluids by interaction with a sorbent medium. The types of media include absorbents, adsorbents, ion-exchange materials, and complexing agents. Detoxification can be extracorporeal (hemodialysis, hemofiltration, hemoperfusion, plasmapheresis), or occur inside the body (enterosorption, peritoneal dialysis).
- Sen S, Jalan R, Williams R. Liver failure: basis of benefit of therapy with the molecular adsorbents recirculating system. Int J Biochem Cell Biol. 2003;35:1306-11 pubmed..The results of larger controlled clinical trials, as well as studies investigating the pathophysiological basis of its effect, are awaited. ..
- Sen S, Williams R, Jalan R. Emerging indications for albumin dialysis. Am J Gastroenterol. 2005;100:468-75 pubmed
- van de Kerkhove M, de Jong K, Rijken A, de Pont A, van Gulik T. MARS treatment in posthepatectomy liver failure. Liver Int. 2003;23 Suppl 3:44-51 pubmed..In this paper, a MARS treatment regimen for PHLF is suggested based on literature and our own experience. ..
- Guo L, Liu J, Xu D, Li B, Han H, Wang L, et al. Application of Molecular Adsorbents Recirculating System to remove NO and cytokines in severe liver failure patients with multiple organ dysfunction syndrome. Liver Int. 2003;23 Suppl 3:16-20 pubmed..5%. We can confirm the positive therapeutic impact and safety to use MARS on liver failure patients with MODS associated with elevated levels of NO and cytokines. ..
- Boonsrirat U, Tiranathanagul K, Srisawat N, Susantitaphong P, Komolmit P, Praditpornsilpa K, et al. Effective bilirubin reduction by single-pass albumin dialysis in liver failure. Artif Organs. 2009;33:648-53 pubmed publisher..In conclusion, SPAD is salutarily effective in reducing bilirubin in patients with liver failure. The procedure is safe and simply set up. ..
- Schmidt L, Wang L, Hansen B, Larsen F. Systemic hemodynamic effects of treatment with the molecular adsorbents recirculating system in patients with hyperacute liver failure: a prospective controlled trial. Liver Transpl. 2003;9:290-7 pubmed..In conclusion, systemic hemodynamic values tend to normalize, whereas systemic VO(2) decreases during MARS treatment in patients with HALF. These effects cannot be explained by the degree of cooling associated with MARS. ..
- Mitzner S, Stange J, Klammt S, Peszynski P, Schmidt R, Nöldge Schomburg G. Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure. J Am Soc Nephrol. 2001;12 Suppl 17:S75-82 pubmed..It is concluded that the MARS method can contribute to the treatment of critically ill patients with liver failure and different underlying diseases. ..
- Schmidt L, Sørensen V, Svendsen L, Hansen B, Larsen F. Hemodynamic changes during a single treatment with the molecular adsorbents recirculating system in patients with acute-on-chronic liver failure. Liver Transpl. 2001;7:1034-9 pubmed..05), and urea levels, from 19.1 +/- 13.9 to 6.7 +/- 5.1 mmol/L (P < .05). In conclusion, MARS treatment proved safe in critically ill patients with no attributing side effects. ..
- Bergis D, Friedrich Rust M, Zeuzem S, Betz C, Sarrazin C, Bojunga J. Treatment of Amanita phalloides intoxication by fractionated plasma separation and adsorption (Prometheus®). J Gastrointestin Liver Dis. 2012;21:171-6 pubmed
- Kellersmann R, Gassel H, Buhler C, Thiede A, Timmermann W. Application of Molecular Adsorbent Recirculating System in patients with severe liver failure after hepatic resection or transplantation: initial single-centre experiences. Liver. 2002;22 Suppl 2:56-8 pubmed..However, beneficial effects observed in our patients justify its continuous use and may stimulate further evaluation in controlled studies with surgical patients. ..
- Kramer L, Gendo A, Madl C, Ferrara I, Funk G, Schenk P, et al. Biocompatibility of a cuprophane charcoal-based detoxification device in cirrhotic patients with hepatic encephalopathy. Am J Kidney Dis. 2000;36:1193-200 pubmed..We suggest further developments in design and appropriate strategies of anticoagulation to improve the biocompatibility of artificial liver support. ..
- Sentürk E, Esen F, Ozcan P, Rifai K, Pinarbasi B, Cakar N, et al. The treatment of acute liver failure with fractionated plasma separation and adsorption system: Experience in 85 applications. J Clin Apher. 2010;25:195-201 pubmed publisher..The system is useful as a symptomatic treatment before liver transplantation; in up to 1/3 of the cases, it can even be used as a sole method of treatment. ..
- Novelli G, Rossi M, Pretagostini M, Pugliese F, Ruberto F, Novelli L, et al. One hundred sixteen cases of acute liver failure treated with MARS. Transplant Proc. 2005;37:2557-9 pubmed..In patients with PDF, it is used for a waiting recovery of the transplanted organ. Therefore MARS can also limit the necessity to perform further transplants. ..
- Faybik P, Bacher A, Kozek Langenecker S, Steltzer H, Krenn C, Unger S, et al. Molecular adsorbent recirculating system and hemostasis in patients at high risk of bleeding: an observational study. Crit Care. 2006;10:R24 pubmed..According to TEG-based results, MARS does not enhance fibrinolysis. ..
- Steiner C, Mitzner S. Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the International MARS Registry. Liver. 2002;22 Suppl 2:20-5 pubmed..The results are confirming observations of other trials before which have shown MARS therapy to be an effective and safe extracorporeal liver support in liver failure. ..
- Faybik P, Hetz H, Baker A, Bittermann C, Berlakovich G, Werba A, et al. Extracorporeal albumin dialysis in patients with Amanita phalloides poisoning. Liver Int. 2003;23 Suppl 3:28-33 pubmed..The relative late onset of symptoms is a distinct diagnostic feature of Amanita intoxication and also the main reason of failure for extracorporeal removal of Amanita-specific toxins from the gut and circulation...
- Sen S, Mookerjee R, Davies N, Williams R, Jalan R. Review article: the molecular adsorbents recirculating system (MARS) in liver failure. Aliment Pharmacol Ther. 2002;16 Suppl 5:32-8 pubmed..Data regarding MARS experience in acute liver failure and in primary graft dysfunction are encouraging but limited. Its real usefulness in these settings is, at present, under evaluation in randomized controlled clinical trials. ..
- Gong D, Ren B, Ji D, Tao J, Xu B, Liu Z, et al. Selective albumin exchange: a novel and simple method to remove bilirubin. Int J Artif Organs. 2008;31:425-30 pubmed..This study reports a novel way to perform selective albumin exchange (SAE) by using a secondary plasma separator and aims to study its depurative capacity in the removal of bilirubin...
- Hommann M, Kasakow L, Geoghegan J, Kornberg A, Schotte U, Fuchs D, et al. Application of MARS artificial liver support as bridging therapy before split liver retransplantation in a 15-month-old child. Pediatr Transplant. 2002;6:340-3 pubmed..MARS-dialysis is practical in the small child. In this case, it did not provide definitive treatment but was an excellent bridging therapy before retransplantation. ..
- Thyer J, Unal A, Hartel G, Middleton D, Bingham J, Braun M, et al. Investigation of prion removal/inactivation from chromatographic gel. Vox Sang. 2006;91:301-8 pubmed..Spiked prion infectivity does bind to DEAE Sepharose gel; however, the cleaning cycle removed infectivity to levels below that detectable by bioassay. ..
- Rozga J. Liver support technology--an update. Xenotransplantation. 2006;13:380-9 pubmed
- Wang Y, He N, Niu R, Liu J, Wen H, Li J, et al. [Preliminary evaluation on the effects of a hybrid bioartificial liver support system in the treatment of hepatic failure]. Zhonghua Gan Zang Bing Za Zhi. 2003;11:461-3 pubmed..3%) discharged due to worsening of disease. The hybrid artificial liver support system has prominent liver support effects for hepatic failure, which can be regarded as an efficient measure for the treatment of severe hepatitis. ..
- Wallukat G, Muller J, Hetzer R. Specific removal of beta1-adrenergic autoantibodies from patients with idiopathic dilated cardiomyopathy. N Engl J Med. 2002;347:1806 pubmed
- Yang T, Lin B, Ma Y, Chou K. In vitro removal of beta-2-microglobulin from uremic blood with an immunoadsorption wall. Artif Organs. 2012;36:78-86 pubmed publisher..We believe that this breakthrough might provide a promising path to successful treatment of DRA as well as establish a useful platform for studying removal of certain pathological toxins accumulated in the blood. ..
- Scheingraber S, Richter S, Igna D, Girndt M, Flesch S, Kleinschmidt S, et al. Indocyanine green elimination but not bilirubin indicates improvement of graft function during MARS therapy. Clin Transplant. 2007;21:689-95 pubmed..Conclusively, monitoring of PDR(ICG) is superior to bilirubin and PT measurements to determine the graft function especially in patients with PNF and GDF undergoing MARS therapy. ..
- Hassanein T, Tofteng F, Brown R, McGuire B, Lynch P, Mehta R, et al. Randomized controlled study of extracorporeal albumin dialysis for hepatic encephalopathy in advanced cirrhosis. Hepatology. 2007;46:1853-62 pubmed..Because this 5-day study was not designed to examine the impact of MARS on survival, a full assessment of the role of albumin dialysis awaits the results of additional controlled trials. ..
- Bañares R, Nevens F, Larsen F, Jalan R, Albillos A, Dollinger M, et al. Extracorporeal albumin dialysis with the molecular adsorbent recirculating system in acute-on-chronic liver failure: the RELIEF trial. Hepatology. 2013;57:1153-62 pubmed publisher..However, MARS has an acceptable safety profile, has significant dialysis effect, and nonsignificantly improves severe HE. ..
- Kinoshita H, Ohtake F, Ariga Y, Kimura K. Comparison and characterization of biosorption by Weissella viridescens MYU 205 of periodic group 12 metal ions. Anim Sci J. 2016;87:271-6 pubmed publisher..Our data shows lactic acid bacteria may be powerful heavy metal sorbents for detoxification. ..
- Hishida A. [Acute renal failure]. Nihon Jinzo Gakkai Shi. 2002;44:94-101 pubmed
- Muller G. Aspirin, other salicylates and non-steroidal anti-inflammatory agents. SADJ. 2004;59:283 pubmed
- Okada K, Okawa E, Shibahara H, Maruyama T, Maruyama N, Matsumoto K, et al. Combination therapy with angiotensin-converting enzyme inhibitor and oral adsorbent of uremic toxins can delay the appearance of glomerular sclerosis and interstitial fibrosis in established renal failure. Kidney Blood Press Res. 2004;27:218-25 pubmed..01). ACEI and AST-120 in combination can delay progression of established CRF in rats by inhibiting the appearance of glomerular sclerosis and interstitial fibrosis. ..
- Homma N, Gejyo F. [Diagnosis of and therapy for patients with dialysis amyloidosis]. Nihon Rinsho. 2004;62 Suppl 6:348-52 pubmed
- Hassanein T, Oliver D, Stange J, Steiner C. Albumin dialysis in cirrhosis with superimposed acute liver injury: possible impact of albumin dialysis on hospitalization costs. Liver Int. 2003;23 Suppl 3:61-5 pubmed..Therefore, it appears that the benefits of MARS therapy are enough to justify the cost of treatment and safe hospital costs, at least in the described population. However, further studies are needed to confirm these results. ..
- Mikhalovsky S. Emerging technologies in extracorporeal treatment: focus on adsorption. Perfusion. 2003;18 Suppl 1:47-54 pubmed..Since the 1990s interest in the use of adsorbents in extracorporeal medical devices has been rising again. In this paper some recent developments in synthesis and application of novel uncoated medical adsorbents are discussed. ..
- Tao W, Deyo D, Alpard S, Vertrees R, Hoang V, Zwischenberger J. Significant reduction in circuit pressure with modified plasma separation chamber for a heparin removal device. ASAIO J. 1999;45:50-2 pubmed..01 between groups). There were no significant differences in ACT between groups. We conclude that enlarged chamber ports significantly lower circuit pressures for the HRD without changing heparin removal capability. ..
- Hofmann A. Cholestatic liver disease: pathophysiology and therapeutic options. Liver. 2002;22 Suppl 2:14-9 pubmed..Extracorporeal dialysis against albumin offers promise of a realistic albeit partial simulation of hepatic excretory function. ..
- Martin I, Kriaa F, Proulle V, Guillet B, Kaplan C, d Oiron R, et al. Protein A Sepharose immunoadsorption can restore the efficacy of platelet concentrates in patients with Glanzmann's thrombasthenia and anti-glycoprotein IIb-IIIa antibodies. Br J Haematol. 2002;119:991-7 pubmed..Our experience suggests that IA-PA, which restores the haemostatic efficacy of platelet transfusion, is a valuable therapeutic strategy in patients with Glanzmann's thrombasthenia and anti-GPIIb-IIIa isoantibodies. ..
- Muller P, Brocker E, Klinker E, Stoevesandt J, Benoit S. Adjuvant treatment of recalcitrant bullous pemphigoid with immunoadsorption. Dermatology. 2012;224:224-7 pubmed publisher..Our data demonstrate that PA-IA might be a safe and effective adjuvant treatment in severe and recalcitrant BP. ..
- Grek O, Mishenina S, Pupyshev A. Protective effect of enterosgel on rat liver lysosomes during cytostatic treatment. Bull Exp Biol Med. 2002;134:355-8 pubmed..Enterosgel stabilized liver lysosomes and reduced manifestation of hepatocyte cytolysis. ..
- Genuis S, Birkholz D, Ralitsch M, Thibault N. Human detoxification of perfluorinated compounds. Public Health. 2010;124:367-75 pubmed publisher..Serum levels of all PFCs subsequently declined after regular use of CSM. Further study is required but this report suggests that CSM therapy may facilitate gastrointestinal elimination of some PFCs from the human body. ..
- Choi J, Yoon K, Park J, Kim J, Ahn S, Paik Y, et al. [Usefulness and safety of extracorporeal liver support therapy using MARSR for patients with liver failure: a preliminary report]. Korean J Gastroenterol. 2009;54:28-35 pubmed..However, MARSR without liver transplantation did not improve survival. MARSR may be useful as a bridge therapy to liver transplantation in patients with liver failure. ..
- Bakos A, Rikker C, Tóvárosi S, Kárteszi M. [Therapeutic effect of the latest extracorporal elimination procedure (Prometheus treatment) in acute liver failure caused by intoxication]. Orv Hetil. 2007;148:1981-8 pubmed..It is a safe elimination technique. In cases untreatable with conservative therapy it makes possible maintaining the patients alive until the liver regenerates spontaneously, or liver transplantation is feasible. ..
- Hu W, Liu Z, Ji D, Xie H, Gong D, Li L. Staphylococcal protein A immunoadsorption for Goodpasture's syndrome in four Chinese patients. J Nephrol. 2006;19:312-7 pubmed..IA could remove serum anti-GBM antibody and resolve pulmonary hemorrhage effectively; the efficacy of IA in improving renal function is markedly determined by the severity of renal damage. ..
- Naja G, Mustin C, Volesky B, Berthelin J. A high-resolution titrator: a new approach to studying binding sites of microbial biosorbents. Water Res. 2005;39:579-88 pubmed..arrhizus and C. glutamicum, respectively. The applications of titration techniques become a powerful tool for the characterization of heterogeneous materials involved in biosorption and bioremediation processes. ..
- Cunningham J, Lin L. Fate of amoxicillin in mixed-culture bioreactors and its effects on microbial growth and resistance to silver ions. Environ Sci Technol. 2010;44:1827-32 pubmed publisher..This paper reports for the first time that low levels of AMX (<100 mg L(-1)) could induce bacterial cross-resistance to silver ion in an aqueous system mimicking an active biological system for wastewater treatment. ..
- Umehara M, Totsuka E, Ishizawa Y, Nara M, Hakamada K, Umehara Y, et al. A bioartificial liver that combines plasma dialysis and whole liver perfusion. Hepatogastroenterology. 2008;55:1216-21 pubmed..Extracorporeal liver, perfused with oxygenated plasma, functioned for 6 h without hyperacute rejection. This type of hybrid bioartificial liver may be useful for treating FHF patients. ..
- Ichai P, Samuel D. Extracorporeal liver support with MARS in liver failure: has it a role in the treatment of severe alcoholic hepatitis?. J Hepatol. 2003;38:104-6 pubmed
- Rifai K. Fractionated plasma separation and adsorption: current practice and future options. Liver Int. 2011;31 Suppl 3:13-5 pubmed publisher..Furthermore, there have been promising results with FPSA in the treatment of refractory cholestatic pruritus. Regarding acute liver failure, only few data are currently available. ..
- ..Firm up on the facts and considerations associated with acetaminophen toxicity. ..
- Visvardis G, Manou E, Griveas I, Meimaridou D, Mitsopoulos E, Kyriklidou P, et al. Therapeutic apheresis of immune diseases in nephrology department. Ren Fail. 2004;26:569-74 pubmed..The therapeutic apheresis consists of a continuously improving therapeutic method for diseases with high mortality and morbidity, especially in cases with poor outcome by using current medications. ..
- Prazak J, Laszikova E, Pantoflicek T, Ryska O, Koblihova E, Ryska M. Cerebral microdialysis reflects the neuroprotective effect of fractionated plasma separation and adsorption in acute liver failure better and earlier than intracranial pressure: a controlled study in pigs. BMC Gastroenterol. 2013;13:98 pubmed publisher..The role of glutamine as a marker of the efficacy of FPSA treatment for ALF appears promising, but needs further evaluation. ..
- Montanher S, Oliveira E, Rollemberg M. Removal of metal ions from aqueous solutions by sorption onto rice bran. J Hazard Mater. 2005;117:207-11 pubmed..The adsorption equilibrium was well described by the Freundlich isotherm model. The negative Gibbs free energy values obtained in this study with rice bran confirm the feasibility of the process and the spontaneous nature of sorption. ..