The Alteco LPS Adsorber works through adsorption technology to remove endotoxin (lipopolysaccharides, LPS) from the bloodstream.
What is endotoxin?
Endotoxin is the toxic part of gram-negative bacteria, present in the outer membrane of the bacteria cell wall, released when the bacterial cell disintegrates. Endotoxin is the source of differentiation to cytokines and macrophages, which in turn activates the inflammatory response in the immune system. By removing endotoxin from the bloodstream, monocyte activity will be reduced. This will in turn impact the scale of differentiation into macrophages and cytokines. 1
Endotoxin induces inflammatory cytokines
Endotoxin is the initial trigger of the inflammatory response in the immune system, starting with TNF-a and IL-1. When LPS binds to Toll-like receptors (TLRs), it activates a signaling cascade causing a release of pro-/anti-inflammatory cytokines such as interleukin (IL-6) and coagulation disturbances. 2,3 By removing endotoxin from the bloodstream, the cascade release of cytokines could be decreased and thus less disturbance will occur in the immune system, which may avoid first organ failure – the kidneys.
When is endotoxin a potential problem?
Endotoxin is one of the strongest bacterial inducers of inflammatory cytokines. High levels of endotoxin activity are associated with organ failure and death. 4 There are many medical conditions and situations where gram-negative bacteria and endotoxin may be a problem and could cause sepsis. Gram-negative bacteria such as escherichia coli (E. coli), pseudomonas aeruginosa, klebsiella and enterobacteriaceae can cause infections in surgical wounds, the bloodstream, brain, lungs or urinary tract, potentially progressing to sepsis. 5 Endotoxin is not only related to gram-negative bacterial infections per se, but also to translocation and exposure to complement activation of the immune system.
Antibiotic-induced endotoxin release
Antibiotics have the potential to liberate endotoxin from the bacterial cell-wall when killing the bacteria, and this can lead to a rapid clinical deterioration for the patient. 6 Antibiotic treatment in the absence of a bacterial infection can also cause a release of endotoxin, triggering endotoxemia and over-production of pro-inflammatory cytokines – an antibiotic-induced inflammatory storm. 7 Therefore, Alteco LPS Adsorber is a valuable complement when patients are treated with antibiotics.
Alteco Medical’s adsorption technology
Adsorption is a process where molecules or particles attach to the surface of the adsorbent material and are captured there, and this is exactly what happens inside the Alteco LPS Adsorber.
The Alteco LPS Adsorber is safe, specific and effective. The device contains a 100% specific, non-toxic peptide, tailor-made to bind LPS with high affinity. The peptide in the Alteco LPS Adsorber binds to the toxic part of gram-negative bacteria: lipid-A, which is constant in all gram-negative bacterial strains.
The peptide in the Alteco LPS Adsorber is 100% synthetic, hence it is not genetically engineered but produced by solid phase peptide synthesis. It is not derived from human or animal origins and there are no reports of allergic reactions.
Optimized surface area
When blood comes into contact with large artificial surfaces, it induces a systemic response. 8 For this reason, the Alteco LPS Adsorber uses an optimized surface and adsorption area of 3m 2. The smaller, the better!
Specific endotoxin elimination
The Alteco LPS Adsorber is specific and only removes endotoxin. There are no indications of other substances being captured or of interactions with other substances when using the Alteco LPS Adsorber.
Endotoxin capturing principle
How does the Alteco LPS Adsorber capture and bind endotoxin? The housing of the device contains discs made of porous polyethylene (PE), with an average pore size of 100 microns. In the pores on the surface of the discs, the covalently immobilized cationic peptide captures the negatively charged endotoxin molecules.
The product can bind several times the amount of endotoxin found in the patients’ blood. The level of endotoxin in the patient’s blood cannot saturate the device.
Endotoxin binding to the cationic peptide.
Endotoxin: lipid-A (purple) consisting of fatty acids and glucosamine, with its core polysaccharide and O-antigen (yellow). Schematic figure showing the three main parts of the lipopolysaccharide molecule.
Medical device class IIa (EU MDD)
Designed to specifically
Results in 2 hours
1 treatment = 1 adsorber
Applications and clinical use
More about endotoxin
High endotoxin levels correlate with higher mortality and can be associated with both gram-negative and -positive infections. Increased endotoxin levels at ICU admission significantly associated with development of severe sepsis.
Did you know that endotoxemia can be present in critically ill patients with COVID-19, independent of superimposed gram-negative infections? A leaky gut barrier might contribute to endotoxin translocation. Study observes elevated endotoxin activity in 75% of critically ill patients with COVID-19 – and higher acute kidney injury rates.
1 The immunopathogenesis of sepsis
2 The immunopathogenesis of sepsis
3 Endotoxin stimulates hepatocyte interleukin-6 production
4 Exotoxins and endotoxins: Inducers of inflammatory cytokines
5 Winchester Hospital, Health Library
6 Clinical implications of antibiotic-induced endotoxin release in septic shock
7 Possible Cause of Inflammatory Storm and Septic Shock in Patients Diagnosed with (COVID-19)
8 Sepsis After Cardiac Surgery: From Pathophysiology to Management