CytoSorbents Corporation (CTSO)

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Some Medasorb detractors suggest cytokine removal and/or breaking the cytokine storm are insignificant remedies for treating sepsis.

However, many medical experts continue to the point to the removal of various cytokines as a (the?) key consideration for the effective treatment of sepsis.

Indeed some medical and scientific experts even say using a cytokine adsorbing hemofilter to remove various cytokines from the circulating blood is a "safe" and "effective" treatment for severe sepsis and septic shock.

For example, a recent article published in the medical journal, "Acute Kidney Injury," says,

"It is widely accepted that cytokines play a pivotal role in the pathophysiology of severe sepsis and septic shock. However...no anticytokine therapy has been effectively applied in clinical settings in the management of severe sepsis and septic shock..."

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowFreePage&ArtikelNr=0000102127&Ausgabe=0&ProduktNr=233035&filefp=0000102127fp.pdf

http://content.karger.com/produktedb/produkte.asp?doi=10.1159/0000102127&typ=pdf

"Continuous hemodiafiltration (CHDF) using a polymethmethacrylate(PMMA) membrane hemofilter (PMMA-CHDF) can effectively and continously remove various cytokines from the circulating blood. PMMA-CHDF can decrease the blood levels of various cytokines when the blood levels of cytokines are high prior to the initiation of CHDF. The main mechanisms of cytokine removal with PMMA-CHDF is the adsorption of cytokines to the hemofilter membrane and this characteristics were not observed in the other membrane material. PMMA-CHDF could improve blood pressure, the depressed monocytic HLA-DR expression and recover the delayed neutrohphil apoptosis in septic patients. Thus cytokine removal PMMA-CHDF would be effective for the treatment of sepsis and septic shock."

As these authors state, no anticytokine therapy has been effective applied in clinical settings in the management of sepsis. Obviously, MSBT shareholders wait for that statement to be proven wrong by the outcome of the company's European study.

And there's the well known article published in 2000 on Hemofiltration and Sepsis by MSBT advisor/consultant, John Kellum, and Rinaldo Bellomo.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC137329/pdf/cc659.pdf

"Immune effector cells, especially neutrophils, possess potent cytotoxic capacity and when unchecked this response can cause significant tissue injury...

"Hemofiltration as an adjunct to therapy for sepsis is now 10years old. Despite early successes and SIGNIFICANT theoretical advantages, the treatment remains experimental.

"Lee et al reported a survival benefit associated with hemofiltration in septic pigs, and Bellomo et al showed that some of the interleukins and tumor necrosis factor could be removed from the circulation of humans with sepsis...

http://journals.lww.com/ccmjournal/Abstract/2008/05000/Effects_of_hemoadsorption_on_cytokine_removal_and.28.aspx

"Several pharmacologic agents are more effective than hemofiltration in reducing serum cytokine activity, and yet none have been shown to produce survival benefit. Indeed several spectacular failures have occurred as a result of attempts to modulate the inflammatory response in sepsis, occasionally even resulting in increased mortality...

"The ideal strategy might well be limited in its effect to the cirulating pool of mediators, rather than influencing the tissue levels where their activity may be beneficial. In theory, hemofiltration is perhaps the only available treatment strategy that can, in theory, achieve all of these goals...

The authors point out: "Not all hemofiltration modalities are the same..."

Remember, the Kellum and Bellomo article is now over ten years old.

There have been a number of other articles/studies published about the significance of removing certain cytokines through hemoadsorption as an important treatment for sepsis. For example, this article published in Critical Care Medicine in May 2008, and co-authored by Dr Kellum, actually references MSBT's Cytosorb hemoadsorption device.

http://journals.lww.com/ccmjournal/Abstract/2008/05000/Effects_of_hemoadsorption_on_cytokine_removal_and.28.aspx

"Our previous studies have shown that a hemoadsorption device (Cytosorb) removes both pro and anti-inflammatory cytokines and improves survival in endotoxemia.

"Conclusion: hemoadsorption reduced circulating cytokines, reduced MAP and resulted in better short term survival in CLP induced septic rats."

It would seem from the author's words, that Kellum has already found his ideal hemoadsorption device in MSBT. We may know soon enough with results from MSBT's clinical trials?