Research priorities for therapeutic plasma exchange in critically ill patients

Sascha David^{1

2}, Lene Russell^{3

4}, Pedro Castro⁵, Andry van de Louw⁶, Lara Zafrani⁷, Tasneem Pirani⁸, Nathan D Nielsen⁹, Eric Mariotte⁷, Bruno L Ferreyro¹⁰, Jan T Kielstein¹¹, Luca Montini¹², Anne C Brignier¹³, Matthias Kochanek¹⁴, Joan Cid¹⁵, Chiara Robba^{16

17}, Ignacio Martin-Loeches^{18

19

20}, Marlies Ostermann²¹, Nicole P Juffermans^{22

23}; Nine-I investigators

Affiliations

¹ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland. Sascha.david@usz.ch.
² Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany. Sascha.david@usz.ch.
³ Department of Intensive Care, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Medical Intensive Care Unit, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
⁶ Medical Intensive Care Unit, Penn State Health Hershey Medical Center, Hershey, PA, USA.
⁷ Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France.
⁸ King's College Hospital, General and Liver Intensive Care, London, UK.
⁹ Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA.
¹⁰ Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada.
¹¹ Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Brunswick, Germany.
¹² Department of Intensive Care Medicine and Anesthesiology, "Fondazione Policlinico Universitario Agostino Gemelli IRCCS" Università Cattolica del Sacro Cuore, Rome, Italy.
¹³ Apheresis Unit, Saint-Louis Hospital, AP-HP, University of Paris Cite, Paris, France.
¹⁴ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO), University of Cologne, Cologne, Germany.
¹⁵ Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
¹⁶ IRCCS per Oncologia e Neuroscienze, Genoa, Italy.
¹⁷ Dipartimento di Scienze Chirurgiche Diagnostiche ed Integrate, Universita' di Genova, Genoa, Italy.
¹⁸ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, D08 NHY1, Ireland.
¹⁹ Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, D02 PN91, Ireland.
²⁰ Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Universidad de Barcelona, Ciberes, Barcelona, Spain.
²¹ Department of Intensive Care, Guy's & St Thomas' Hospital, King's College London, London, UK.
²² Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands.
²³ Laboratory of Translational Intensive Care, Erasmus MC, Rotterdam, The Netherlands.

PMID: 37150798
PMCID: PMC10164453
DOI: 10.1186/s40635-023-00510-w

Review

Research priorities for therapeutic plasma exchange in critically ill patients

Sascha David et al. Intensive Care Med Exp. 2023.

. 2023 May 8;11(1):26.

doi: 10.1186/s40635-023-00510-w.

Authors

Affiliations

¹ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland. Sascha.david@usz.ch.
² Department of Nephrology and Hypertension, Hannover Medical School, Hannover, Germany. Sascha.david@usz.ch.
³ Department of Intensive Care, Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
⁴ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
⁵ Medical Intensive Care Unit, Hospital Clínic of Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
⁶ Medical Intensive Care Unit, Penn State Health Hershey Medical Center, Hershey, PA, USA.
⁷ Medical Intensive Care Unit, Saint-Louis Hospital, AP-HP, University of Paris Cité, Paris, France.
⁸ King's College Hospital, General and Liver Intensive Care, London, UK.
⁹ Division of Pulmonary, Critical Care and Sleep Medicine & Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, USA.
¹⁰ Department of Medicine, Sinai Health System and University Health Network, Toronto, Canada.
¹¹ Medical Clinic V, Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital Braunschweig, Brunswick, Germany.
¹² Department of Intensive Care Medicine and Anesthesiology, "Fondazione Policlinico Universitario Agostino Gemelli IRCCS" Università Cattolica del Sacro Cuore, Rome, Italy.
¹³ Apheresis Unit, Saint-Louis Hospital, AP-HP, University of Paris Cite, Paris, France.
¹⁴ Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO), University of Cologne, Cologne, Germany.
¹⁵ Apheresis and Cellular Therapy Unit, Department of Hemotherapy and Hemostasis, ICMHO, Clínic Barcelona, IDIBAPS, University of Barcelona, Barcelona, Spain.
¹⁶ IRCCS per Oncologia e Neuroscienze, Genoa, Italy.
¹⁷ Dipartimento di Scienze Chirurgiche Diagnostiche ed Integrate, Universita' di Genova, Genoa, Italy.
¹⁸ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital, Dublin, D08 NHY1, Ireland.
¹⁹ Department of Clinical Medicine, School of Medicine, Trinity College Dublin, Dublin, D02 PN91, Ireland.
²⁰ Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Hospital Clinic, Universidad de Barcelona, Ciberes, Barcelona, Spain.
²¹ Department of Intensive Care, Guy's & St Thomas' Hospital, King's College London, London, UK.
²² Department of Intensive Care, OLVG Hospital, Amsterdam, The Netherlands.
²³ Laboratory of Translational Intensive Care, Erasmus MC, Rotterdam, The Netherlands.

PMID: 37150798
PMCID: PMC10164453
DOI: 10.1186/s40635-023-00510-w

Abstract

Therapeutic plasma exchange (TPE) is a therapeutic intervention that separates plasma from blood cells to remove pathological factors or to replenish deficient factors. The use of TPE is increasing over the last decades. However, despite a good theoretical rationale and biological plausibility for TPE as a therapy for numerous diseases or syndromes associated with critical illness, TPE in the intensive care unit (ICU) setting has not been studied extensively. A group of eighteen experts around the globe from different clinical backgrounds used a modified Delphi method to phrase key research questions related to "TPE in the critically ill patient". These questions focused on: (1) the pathophysiological role of the removal and replacement process, (2) optimal timing of treatment, (3) dosing and treatment regimes, (4) risk-benefit assumptions and (5) novel indications in need of exploration. For all five topics, the current understanding as well as gaps in knowledge and future directions were assessed. The content should stimulate future research in the field and novel clinical applications.

Keywords: Apheresis; Expert panel; Gaps; Knowledge; Plasma exchange; Plasmapheresis; Research.

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Conflict of interest statement

SD has received research support and lecture honoraria from Terumo Blodd and Cell Technology, Octapharms and Bayer. JC received research funding from Cerus, Kawasumi Laboratories, Sanofi, Janssen, Incyte, and Sobi; he also received speaker or advisory fees from Cerus, Fresenius Kabi, Grifols, Macopharma, Pharm-Olam, Sanofi, and Terumo Blood and Cell Technologies. ACB received support from Octapharma for attending a meeting. PC has received honoraria for scientific collaboration with Pfizer, MSD and Gilead, and has participated in Advisory Boards for Alexion, Janssen and Gilead.

Figures

**Fig. 1**
Schematic illustration of key research questions addressed in this article. *TPE* therapeutic plasma exchange

**Fig. 2**
Schematic illustration of potential (explorative) targets for replacement and removal by plasma exchange (adjusted from [99]). *DAMPs* damage associated molecular patterns, *VWF* von Willebrand factor, *ULVWM* ultralarge von Willebrand multimers, *Angpt-1/-2* angiopoietin, *VEGF* vascular endothelial growth factor, *Hpa-1/-2* heparanase, *ATIII* antithrombin III, *ADAMTS13* A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13

See this image and copyright information in PMC

References

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Research priorities for therapeutic plasma exchange in critically ill patients

Affiliations

Research priorities for therapeutic plasma exchange in critically ill patients

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Full Text Sources