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19th ISAD

The International Liver Support Meeting Rostock

Biologicals to modulate immune cell function

Sepsis and septic shock remain to be major challenges in the hospital, both medically and economically. Because every patient in sepsis is different from many perspectives (e.g. different pathogens, different location of primary infection, different underlying diseases and different stage of sepsis) only a personalized treatment strategy modulating the paralyzed immune system of the patient can be successful. Earlier data show that especially the dysfunction of immune cells in particular impairment of phagocytosis, reduced HLA-DR expression on monocytes leading to a signal disruption between native and adaptive immune system and dysregulated cytokine release may contribute to severity of sepsis. 

Given the fact that the first defence response against a bacterial infection is mainly enforced by phagocytes in particular granulocytes we tested the idea of using these cells in an extracorporeal treatment procedure called Immune Competence Enhancement (ICE). In principle a continuous plasmapheresis is performed, the plasma being introduced into a second circuit containing immune cell apheresates donated by healthy blood donor volunteers. With the same flow rate of introducing the patient’s plasma into the immune cell circuit treated plasma is leaving the immune cell circuit, being re-combined with patients blood cells and re-infused into the patients.

Two human clinical studies investigated whether an extracorporeal plasma treatment with such an immune cell “bioreactor” is safe and effective in patients with septic shock. Beside the cellular treatment also cellular function of immune cells was investigated prior, during and post treatment. Due to the fact that liver function often is impaired during sepsis we also investigated the liver cell function both in the patient as well as in vitro. Data both from the cellular function and the treatments will be presented and their interconnection discussed. 

Ultimate goal is the combination of cellular diagnostic and extracorporeal cellular therapy with donor immune cells.

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