Removal of metabolites, cytokines and hepatic growth factors by extracorporeal liver support in children.

Abstract

BACKGROUND:

Molecular Adsorbents Recirculating System (MARS)-mini has recently been approved and applied in children with hepatic failure. However, its indication, efficacy and capability to induce liver regeneration remain unclear. The aim of our pilot study in children was to analyse the impact of MARS on markers of detoxification and regeneration.

METHODS:

In children with fulminant Wilson's disease and bridged with MARSmini for liver transplantation, we analyzed toxic metabolites (bile acids, bilirubin, lactate, ammonia, tryptophan and copper), regulators of the inflammatory cascade [nitrate, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), methionine, cystine and hyaluronic acid] and hepatic growth factors [hepatocyte growth factor (HGF), epidermal growth factor (EGF), transforming growth factor-beta1 (TGF-beta1), cortisol, corticosteroid-binding globulin (CBG), insulin-like growth factor-1 (IGF-1), angiogenin, vascular endothelial growth factor (VEGF), IL-6 and TNF-alpha] from blood, albumin circuit and haemodialysate from four applications.

RESULTS:

In all four applications, transfer of toxic metabolites (6/6) and inflammatory mediators (6/6), but also of hepatic growth factors (9/10), into the albumin circuit of MARS was consistently detected. Corresponding blood levels were decreased for 3/6 metabolites, 3/6 inflammatory mediators and 1/10 growth factors and increased for 1/10 growth factors. Bridging for liver transplantation was successful with MARS.

CONCLUSIONS:

In our prospective study, substantial extraction of albumin-bound and water-soluble candidate substances was detected with variable effect on respective blood levels. Notably, essential factors inducing liver regeneration were simultaneously removed. These data provide a basis for evaluation of liver restoration and efficacy of liver support in children with liver failure to devise a collaborative, multicentre trial.

• Authors: Marcus K H Auth, Hyun Soo Kim, Mechthild Beste, Klaus E Bonzel, Ulrich Baumann, Antje Ballauff, Michael Wallot, Tanja Borchers, Udo Vester, Corinna Grasemann, Berthold Hauffa, Peter F Hoyer, Guido Gerken, Thomas Voit
• Journal: Journal of pediatric gastroenterology and nutrition (J Pediatr Gastroenterol Nutr) Vol. 40 Issue 1 Pg. 54-9 (Jan 2005) ISSN: 0277-2116 [Print] United States
• PMID: 15625427 (Publication Type: Case Reports, Journal Article)

Chemical References

• Cytokines
• Toxins, Biological

Topics

• Adolescent
• Child
• Cytokines (blood)
• Extracorporeal Circulation (methods)
• Female
• Hepatolenticular Degeneration (complications)
• Humans
• Liver (growth & development)
• Liver Failure (blood, etiology, therapy)
• Liver Transplantation
• Prospective Studies
• Renal Dialysis
• Sorption Detoxification
• Toxins, Biological (blood)
• Treatment Outcome