Adsorption of Pathogens and Blockade of Sepsis Cascade.

Abstract

Sepsis is caused by the host response to an infectious organism. It is common among hospitalized patients and is associated with significant morbidity and mortality. The current standard of care for sepsis is predominantly supportive, with early detection followed by prompt antibiotic administration. While this approach has undoubtedly improved patient outcomes, it has significant limitations. First, mortality from sepsis remains unacceptably high. Second, emerging pathogen resistance to antimicrobial therapies threatens a return to the pre-antimicrobial era of patient care. Lastly, the early stages of a pandemic (e.g., the recent coronavirus 19 pandemic) lack effective therapeutics. Given these limitations, novel treatment strategies are needed to advance the field and care for patients. One potential class of therapy is extracorporeal blood purification (EBP). While EBP is a broad classification, encompassing a wide range of techniques, this article will focus on three emerging EBP therapies that have been shown to bind and remove a wide variety of viral, bacterial, and fungal pathogens directly from circulation. These devices utilize different mechanisms of action for pathogen removal. The Seraph® 100 is composed of heparin coated beads. The Hemopurifier® combines the concept of plasma exchange with mannose-binding lectin (MBL). Lastly, the GARNET® utilizes a MBL fused to an IgG antibody. Via these mechanisms, these devices have been demonstrated to remove pathogens and pathogen-associated molecular patterns. The hope is that by directly removing pathogens, these EBP techniques may result in the biggest breakthrough in the management of sepsis since the advent of antibiotics almost 100 years ago.