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Case Reports
. 2017 Jul 12;2(6):1259-1264.
doi: 10.1016/j.ekir.2017.06.131. eCollection 2017 Nov.

Immunomodulatory Device Therapy in a Pediatric Patient With Acute Kidney Injury and Multiorgan Dysfunction

David T Selewski  1 , Stuart L Goldstein  2 , Erin Fraser  1 , Katie Plomaritas  1 , Theresa Mottes  2 , Tara Terrell  2 , H David Humes  3   4   5
Affiliations
Case Reports

Immunomodulatory Device Therapy in a Pediatric Patient With Acute Kidney Injury and Multiorgan Dysfunction

David T Selewski et al. Kidney Int Rep. .
No abstract available

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Figures

Figure 1
Figure 1
Extracorporeal blood circuit under standard continuous renal replacement therapy (CRRT) (solid lines) and after the integration of the selective cytopheretic device (SCD) into the circuit. The blood flow path in the SCD is in the extracapillary space along the outside surfaces of the hollow fibers. This flow path results in low shear force along the fibers, which allows for activated neutrophils and monocytes to selectively bind to the membrane. The low ionized calcium (iCa) environment promotes deactivation and release of the bound cells back to the systemic circulation. This process results in continuous leukocyte cell processing and immunomodulation of the excessive systemic inflammatory response state of acute kidney injury., , , , , , , , The SCD is changed every 24 hours for up to 7 days of treatment, a treatment time found to be effective in previous clinical studies. *Side ports of SCD for elution sampling.
Figure 2
Figure 2
Leukocyte characteristics associated with a selective cytopheretic device (SCD) compared with blood. (a–c) Leukocytes that were eluted from the SCD after treatment days 1, 3, 5, and 7. Elution of the cells from the SCD was accomplished as previously described after placing elution buffer into the SCD via the perfusion side ports. The percentage of neutrophils, monocytes, and lymphocytes of total cells in peripheral blood and the SCD elutions are presented as mean ± SE for n = 4 as measured at 1, 3, 5, and 7 days of SCD treatment, when the SCD bound cells were evaluated after elution. The total number of SCD eluted cells and the selectivity of binding of neutrophils and monocytes to the SCD were similar to preclinical animal models., ,
Figure 3
Figure 3
The acute activation state of neutrophils and monocytes were assessed with cytometric analysis as previously described., , , The higher mean fluorescent intensity (MFI) of CD11b on the cell surface was associated with higher activation of these leukocytes., , , CD11b is a membrane protein involved in the adherence of leukocytes to activated endothelium as the first step to extravasation to a site of inflammation., , The increase in MFI CD11b at day 5 and day 7 correlated with the development of sepsis clinically. As demonstrated, the activation levels of both neutrophils and monocytes bound to the selective cytopheretic device (SCD) membranes were elevated throughout the time course of treatment. On the final day of treatment (day 7), the selectivity of binding of the highest activated leukocytes was demonstrated compared with the CD11b MFI of the circulating cells in the peripheral blood. This selectivity was repeatedly observed in preclinical animal models., ,
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References

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