The Alteco LPS Adsorber works through adsorption technology to remove endotoxin (lipopolysaccharides, LPS) from the bloodstream. 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.

In clinical use

Inside the Alteco LPS Adsorber, a tailor-made synthetic peptide binds to Lipid A; the toxic part of endotoxin. By adsorbing harmful levels of endotoxin from the patient’s bloodstream during extracorporeal treatment in the ICU, the Alteco LPS Adsorber breaks the chain of immune system over-reactions that can spiral into septic shock. This can turn the course of sepsis and stabilize the patient’s hemodynamic parameters in 2 hours. 1

Endotoxin adsorption technology

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.

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.

Optimized surface area

When blood comes into contact with large artificial surfaces, it induces a systemic response. 2 For this reason, the Alteco LPS Adsorber uses an optimized surface and adsorption area of 3m 2. The smaller the surface area, the less complement activation in the immune system – hence, an optimized surface area is beneficial.

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.

Take endotoxin out of the picture

View our product animation to learn more about endotoxin removal and the Alteco LPS Adsorber.

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. 3

Endotoxin induces inflammatory cytokines

Endotoxin is well known to induce a strong response from the immune system, leading to release of inflammatory mediators and potentially sepsis, or even septic shock. 4 More than half of critically ill patients “have circulating endotoxin levels >2 SDs above those detected in healthy control subjects” on the day of admission. 5

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. 6,7 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.

Why endotoxin is a problem

Endotoxin is one of the strongest bacterial inducers of inflammatory cytokines. High levels of endotoxin activity are associated with organ failure and death. 8 

Animal studies show that administering endotoxin “leads to the activation of macrophages, neutrophils, endothelial cells, and the coagulation cascade and to the release of a complex cascade of host-derived inflammatory mediators. 9

In addition, symptoms of septic shock such as organ failure and acute lethality are reproduced in animal experiments using systemic administration of very small endotoxin amounts. 10,11 In humans, large amounts of endotoxin produce sepsis shock and multiple organ failure (MODS). 12

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. 13 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. 14 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. 15 Therefore, Alteco LPS Adsorber is a valuable complement when patients are treated with antibiotics.

Endotoxin: lipid-A consisting of fatty acids and glucosamine, with its core polysaccharide and O-antigen. Schematic figure showing the three main parts of the lipopolysaccharide molecule.

Applications

Manage sepsis in the ICU

Learn more about Alteco LPS Adsorber for treating sepsis and septic shock.

Preventive endotoxin removal in cardiac surgery

Endotoxin from gram-negative bacteria is a potent trigger of the inflammatory response, and endotoxemia is known to occur in cardiac surgery using extracorporeal circulation.

Sepsis in COVID-19 ICU patients

Learn more about Alteco LPS Adsorber for treating sepsis and septic shock in COVID-19 ICU patients, and the rationale for removing endotoxin.

Scientific articles

SAFE

No contraindications
Medical device class IIa (EU MDD)


SPECIFIC

Designed to specifically
remove endotoxin


EFFECTIVE

Results in 2 hours
1 treatment = 1 adsorber 


References

1  2 B. Adamik, Prolonged Cardiopulmonary Bypass is a Risk Factor for Intestinal Ischaemic Damage and Endotoxaemia

2  Sepsis After Cardiac Surgery: From Pathophysiology to Management

The immunopathogenesis of sepsis

4 Pathophysiology of endotoxic shock, ICU Management & Practice, Volume 18 – Issue 3, 2018 

5  John C. Marshall, Debra Foster, Jean-Louis Vincent, Deborah J. Cook, Jonathan Cohen, R. Phillip Dellinger, Steven Opal, Edward Abraham, Stephen J. Brett, Terry Smith, Sangeeta Mehta, Anastasia Derzko, Diagnostic and Prognostic Implications of Endotoxemia in Critical Illness: Results of the MEDIC Study, The Journal of Infectious Diseases, Volume 190, Issue 3, 1 August 2004, Pages 527–534

6  The immunopathogenesis of sepsis

Endotoxin stimulates hepatocyte interleukin-6 production

Exotoxins and endotoxins: Inducers of inflammatory cytokines

9 Rietschel ET, Brade H, Holst O, et al. Bacterial endotoxin: chemical constitution, biological recognition, host response, and immunological detoxification, Curr Top Microbiol Immunol, 1996, vol. 216 (pg. 39-81)

10 Natanson C, Eichenholz PW, Danner RI, et al. Endotoxin and tumor necrosis factor challenges in dogs simulate the cardiovascular profile of human septic shock, J Exp Med, 1989, vol. 169 (pg. 823-32)

11 Suffredini AF, Fromm RE, Parker MM, et al. The cardiovascular response of normal humans to the administration of endotoxin, N Engl J Med, 1989, vol. 321 (pg. 280-7)

12 Taveira Da Silva AM, Kaulach HC, Chuidian FS, Lambert DR, Stuffredini AF, Danner RL. Brief report: shock and multiple organ dysfunction after self administration of salmonella endotoxin, N Engl J Med, 1993, vol. 328 (pg. 1457-60)

13 Winchester Hospital, Health Library

14 Clinical implications of antibiotic-induced endotoxin release in septic shock

15 Possible Cause of Inflammatory Storm and Septic Shock in Patients Diagnosed with (COVID-19)