INTRODUCTION
A high hematic level of toxins, both from endogenous
and exogenous sources, damage the biological and
physiological mechanisms, depressing the clinical state of
the patient and often leading to death. In many cases, this
pathological condition is due to some acute or chronic
disease of liver, which, among many other important
functions, is entrusted with the task of detoxifying the
blood. In order to overcome these natural organ
shortcomings, much effort has been made over the last 40
years to attempt to artificially remove toxic compounds
from the blood, while waiting for spontaneous regeneration
of the liver or for transplantation of a suitable new organ.
Most of blood or plasma detoxification treatments involve
adsorption of toxic compounds over charcoal or resins (1-
4). This kind of operation can be performed on plasma
directly, as in hemoperfusion or in plasma-adsorption, or
can be exploited for regenerating dialysis fluids used in
some membrane devices, such as MARS
®
(Molecular
Adsorbent Recirculating System) (5-7), that do not use
single-pass albumin solution as dialisate (8).
Obviously, due to the complexity of the functions
performed by the liver, such simple solutions are not fully
adequate for the management of liver failure, especially in
long treatments. The liver is a very complex organ devoted
not only to perform detoxification functions but also to
carry out biotransformation, synthesis of proteins and
metabolic pathway regulation. Supplementation of hepatic
products by plasma exchange with abundant fresh frozen
plasma or bio-artificial devices, in which the synthetic
functions of the liver are exploited by a biological
component, are two possible biomedical techniques but
nowadays they are far from being really effective (9-11),
especially for the bioartificial liver.
Anyway, both in artificial and bioartificial devices,
adsorption units play a significant role in treatment
efficiency, mainly for clearing blood of albumin-bound
water insoluble compounds where specific adsorbents
activated by an “acceptor” substance are required.
Several works are reported in the literature dealing with
natural and synthetic adsorbent for removal of toxic
compounds: most of them refer to bilirubin adsorption (12-
15). Recently, bioaffinity systems with adsorbent
containing dye or albumin itself as the specific ligand have
been proposed (16-18) to obtain higher removal efficiency
from aqueous solution or from plasma.
However, most technical solutions proposed and often
used in clinical treatments are based on empirical
approaches. An assembly of one or more operations
Bioengineering and Nanotechnology
The International Journal of Artificial Organs / Vol. 28 / no. 7, 2005 / pp. 686-693
Bilirubin removal from albumin - containing solution
by adsorption on polymer resin
M.C. ANNESINI, L. DI PAOLA , L. MARRELLI, V. PIEMONTE, L. TURCHETTI
Department of Chemical Engineering, University of Rome “La Sapienza”, Rome - Italy
©
Wichtig Editore, 2005 0391-3988/686-08 $15.00/0
ABSTRACT: Adsorption equilibrium of bilirubin onto polymeric resins is studied. Solutions containing
albumin are used in order to simulate the behavior of systems for removal of albumin-bound
substances from blood, serum or dialysis fluids. The effect of albumin pre-loading on the resin is also
analysed. Results are explained by a chemically based model that accounts for binding reaction
between albumin and bilirubin in the liquid phase.
Thermodynamic equilibria and physical models are essential tools for designing adsorption columns
aimed at detoxification treatments. (Int J Artif Organs 2005; 28: 686-93)
KEY WORDS: Bilirubin, Albumin, Adsorption