Original Paper Blood Purif 2003;21:409–416 DOI: 10.1159/000073444 Coupled Plasma Filtration Adsorption: Rationale, Technical Development and Early Clinical Experience Claudio Ronco a Alessandra Brendolan a Vincenzo d’Intini a Zaccaria Ricci a Mary Lou Wratten b Rinaldo Bellomo c a Department of Nephrology, St. Bortolo Hospital, Vicenza, and b Scientific Research Department, Bellco SpA, Mirandola, Italy; c Department of Intensive Care, Austin & Repatriation Medical Centre, Melbourne, Australia Accepted: September 1, 2003 Claudio Ronco, MD Department of Nephrology, St. Bortolo Hospital, Viale Rodolfi IT–36100 Vicenza (Italy) Tel. +39 0444 993 869, Fax +39 0444 993 949 E-Mail cronco@goldnet.it ABC Fax + 41 61 306 12 34 E-Mail karger@karger.ch www.karger.com © 2003 S. Karger AG, Basel 0253–5068/03/0216–409$19.50/0 Accessible online at: www.karger.com/bpu Key Words Sepsis W Hemodiafiltration W Adsorption W Cytokines W Acute renal failure W Hemofiltration W Extracorporeal therapy Abstract The adjuvant treatment of sepsis remains a major thera- peutic challenge. Blood purification is theoretically ap- pealing if the humoral theory of sepsis is accepted as the basis for intervention. In this setting, blood purification would provide a broad-based restoration of humoral homeostasis thereby avoiding both excessive inflamma- tion and counterinflammation. Several techniques of blood purification have been tried or are under active investigation. One of these is the so-called coupled plas- ma filtration adsorption (CPFA). CPFA is a novel extracor- poreal blood purification therapy aimed at nonselective- ly reducing the circulating levels and activities of both pro- and anti-inflammatory mediators during sepsis and multiorgan failure. In vitro studies have shown CPFA to be effective in binding a broad range of such mediators proving its technical efficacy. Subsequent animal mod- els have shown a beneficial effect on survival in endotox- emia. These studies have provided the necessary techni- cal developments and biologic rationale for initial human studies. Two phase I/IIa clinical studies have now been performed. Both studies have shown that CPFA im- proves blood pressure and restores immune function in patients with severe sepsis and multiorgan dysfunction. In this article, we will discuss some of the basic principles involved in sorbent technology, and how these may con- tribute to treatment efficacy, review animal experiments with CPFA and finally discuss the results of recent hu- man studies and their implications. Copyright © 2003 S. Karger AG, Basel