Abstract
Recent studies report promising results regarding extracorporeal magnetic separation-based blood purification for the rapid and selective removal of disease-causing compounds from whole blood. High molecular weight compounds, bacteria and cells can be eliminated from blood within minutes, hence offering novel treatment strategies for the management of intoxications and blood stream infections. However, risks associated with incomplete particle separation and the biological consequences of particles entering circulation remain largely unclear. This article discusses the promising future of magnetic separation-based purification while keeping important safety considerations in mind.
Highlights
The direct removal of disease-causing compounds is an inherently attractive treatment modality for a range of pathological conditions, including intoxications and blood stream infections [1]
Review Magnetic separation-based blood purification is especially attractive for the removal of high molecular weight compounds, which are poorly removed by conventional blood purifications systems (Fig. 2) [2]
A range of chemically diverse target compounds, including heavy metal ions (uranyl [3], lead [4–6] and cadmium ions [7], small molecule drugs, proteins, bacteria and bacterial compounds [10] have been successfully removed ex vivo from whole blood in the past decade (Table 1). Such targeted compound removal generally requires the use of magnetic beads with a pathogen-specific capturing agent and has been significantly limiting the future applicability of magnetic blood purification
Summary
The direct removal of disease-causing compounds is an inherently attractive treatment modality for a range of pathological conditions, including intoxications and blood stream infections [1]. A range of chemically diverse target compounds, including heavy metal ions (uranyl [3], lead [4–6] and cadmium ions [7], small molecule drugs (digoxin [5, 6, 8], diazepam [9]), proteins (cytokines [5, 8]), bacteria and bacterial compounds [10] have been successfully removed ex vivo from whole blood in the past decade (Table 1) Such targeted compound removal generally requires the use of magnetic beads with a pathogen-specific capturing agent and has been significantly limiting the future applicability of magnetic blood purification. Other important safety aspects include non-specific adsorption of blood constituents (coagulation and complement factors, cells, etc.) as well as activation of inflammatory reactions in the blood compartment [13] Such possible side effects have to be evaluated in detail and ruled out before this new operation is translated into a clinical scenario. It is of major importance to establish strategies to gain insight into the potential risks—both short-term and long-term—associated with magnetic blood purification and, to balance risks adequately with therapeutic benefits
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