Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support.

@article{Stange1999MolecularAR,
  title={Molecular adsorbent recycling system (MARS): clinical results of a new membrane-based blood purification system for bioartificial liver support.},
  author={Jan Stange and Steffen R. Mitzner and Teut Risler and Christiane M. Erley and Werner Lauchart and Hermann Josef Goehl and Sebastian Klammt and Piotr Peszynski and Jennifer O. Freytag and Heiko Hickstein and Matthias L{\"o}hr and S. Liebe and Wolfgang D. Schareck and Ullrich Theodor Hopt and Reinhardt Schmidt},
  journal={Artificial organs},
  year={1999},
  volume={23 4},
  pages={
          319-30
        }
}
The use of xenogenic or genetically engineered cell types in bioartificial liver support systems requires separation methods between the patients' blood and the liver support bioreactors that guarantee the sufficient transfer of pathophysiologically relevant substances but prevent complications. The present paper describes a new membrane separation system that is nearly impermeable to proteins but enables the exchange of water soluble and protein bound toxins by a special membrane and a… 
The molecular adsorbents recycling system as a liver support system based on albumin dialysis: a summary of preclinical investigations, prospective, randomized, controlled clinical trial, and clinical experience from 19 centers.
TLDR
In treating liver failure and cholestasis, MARS was associated with hemodynamic stabilization, improvement of hepatic and kidney function, and disappearance of pruritus, and a prospective, randomized, controlled trial of MARS treatment was able to prolong survival time significantly.
Detoxifying Capacity and Kinetics of the Molecular Adsorbent Recycling System
TLDR
Evaluated data suggest that the rate and efficacy of removal of albumin-bound toxins are related to both the strength of the albumin binding and the saturation of the adsorption columns, and both album in-bound and water-soluble toxins are adequately removed by the MARS.
Equipment review: The molecular adsorbents recirculating system (MARS®)
TLDR
Preliminary experience with MARS therapy, instituted late in the clinical course of five patients with severely impaired liver function, indicates some clinical efficacy, but the overall survival rate remained poor and the overall impact on outcome remained poor.
The role of the Molecular Adsorbents Recirculating System (MARS) in the management of liver failure
TLDR
The Molecular Adsorbents Recirculating System (MARS) is an extracorporeal liver support device based on dialysis across an albumin-impregnated membrane, using 20% albumin as dialysate and charcoal and anion exchange resin columns in the circuit help cleanse and regenerate the dialysates.
Extracorporeal detoxification using the molecular adsorbent recirculating system for critically ill patients with liver failure.
TLDR
It is concluded that the molecular adsorbent recirculating system can contribute to the treatment of critically ill patients with liver failure and different underlying diseases.
Review Equipment review: The molecular adsorbents recirculating
TLDR
Preliminary experience with MARS therapy, instituted late in the clinical course of five patients with severely impaired liver function, indicates some clinical efficacy, but the overall survival rate remained poor and the overall impact on outcome remained poor.
First Use of the Molecular Adsorbent Recirculating System Technique on Patients with Hypoxic Liver Failure After Cardiogenic Shock
TLDR
It is concluded that despite the limited number of patients included in this analysis, MARS can be recommended for patients with acute, hypoxic liver failure because it might prolong survival.
Stability of therapeutic albumin solutions used for molecular adsorbent recirculating system-based liver dialysis.
TLDR
In vitro results suggest limited direct influence of the presence of stabilizers in therapeutic albumin solutions on baseline binding properties of human albumin, but in vitro incubations of these albumins for several hours resulted in supplier-specific changes in warfarin binding, suggesting an influence of stabilizer on the stability of binding properties.
The role of molecular adsorbent recirculating system dialysis for extracorporeal liver support in children
TLDR
The benefits of extracorporeal liver support systems need to be balanced against the costs and the risk of volume and nitrogen overload if repeated plasma infusion is required, and plasma exchange in combination with hemodialysis should be preferred.
...
...

References

SHOWING 1-10 OF 15 REFERENCES
A Carrier-Mediated Transport of Toxins in a Hybrid Membrane. Safety Barrier between a Patients Blood and a Bioartificial Liver
TLDR
The presented hybrid membrane may be used like an “intellegent membrane” as a safety barrier between the patients blood and cell devices and a significant reduction of protein bound toxins and a transport of metabolically relevant solutes, like amino acids, was shown.
Development of a bioartificial liver: Properties and function of a hollow‐fiber module inoculated with liver cells
TLDR
A reproducible large‐animal model of acute ischemic liver failure was developed and dogs with acute liver failure had significantly lower serum ammonia and lactate levels and significantly higher serum glucose levels than did control animals treated with a bioartificial liver system inoculated with microcarriers alone.
Nonbiological liver support: historic overview.
TLDR
Nonbiological liver support technologies can substitute for select liver functions in acute and chronic disease and can be useful because hepatocytes possess a regenerative capacity and temporary support is helpful.
Reversal of fulminant hepatic failure using an extracorporeal liver assist device
TLDR
A device consisting of a highly differentiated human liver cell line cultured in a hollow fiber cartridge is capable of supporting dogs with acetaminopheninduced fulminant hepatic failure for a period long enough for their own livers to resume function, allowing recovery of hepatocytes that would otherwise have lysed.
Cell Sources for Bioartificial Liver Support
TLDR
It is postulated that the results expected from a bioartificial liver, are closely related to the source and type of cells used.
Clinical experience with a bioartificial liver in the treatment of severe liver failure. A phase I clinical trial.
TLDR
A bioartificial liver to treat patients with severe liver failure until they can be either transplanted or recover spontaneously and the authors' clinical experience with the BAL has yielded encouraging results.
Effect of nitric oxide on the ligand-binding activity of albumin.
TLDR
Kinetic analysis revealed that S-nitrosylation of Cys-34 on bovine serum albumin (BSA) decreased its binding activity for PSP and NO also decreased the ligand-binding activity of fresh plasma samples from rat and human.
Control of hepatocyte replication by two serum factors.
Serum proteins from hepatectomized or control rats were separated by gel permeation chromatography and assayed for stimulation of hepatocyte proliferation in primary cultures of hepatocytes. Two
Nitric oxide circulates in mammalian plasma primarily as an S-nitroso adduct of serum albumin.
TLDR
It is found that naturally produced nitric oxide circulates in plasma primarily complexed in S-nitrosothiol species, principal among which is S-Nitroso-serum albumin, which likely serves as a reservoir with which plasma levels of highly reactive, short-lived free nitrics can be regulated for the maintenance of vascular tone.
Role of Toxins and Synergism in Hepatic Encephalopathy
TLDR
Of these toxins, ammonia is the most important and has the most cumulative evidence for its role as an etiologic factor, however, the relative importance of each toxin may vary with the pathologic process.
...
...