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Related Experiment Videos

Review article: clinical experience with Prometheus.

Kinan Rifai1, Michael P Manns

  • 1Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Hannover Germany. rifai.k@gmx.de

Therapeutic Apheresis and Dialysis : Official Peer-Reviewed Journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy
|May 11, 2006
PubMed
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Prometheus, a novel extracorporeal liver support device using fractionated plasma separation and adsorption (FPSA), effectively removes albumin-bound and water-soluble toxins. It shows promise for treating severe hepatorenal syndrome and refractory cholestatic pruritus.

Area of Science:

  • Hepatology
  • Nephrology
  • Biomedical Engineering

Background:

  • Acute-on-chronic liver failure (ACLF) often presents with concomitant renal failure, leading to a complex buildup of toxins.
  • Current extracorporeal liver support systems have limitations in removing both albumin-bound and water-soluble toxins.
  • Hepatorenal syndrome (HRS) is a severe complication of advanced liver disease requiring effective detoxification strategies.

Purpose of the Study:

  • To evaluate the safety and efficacy of the Prometheus device for artificial liver support.
  • To compare the toxin removal capacity of Prometheus with the Molecular Adsorbent Recirculating System (MARS).
  • To assess the potential of Prometheus in managing severe hepatorenal syndrome and related complications.

Main Methods:

Related Experiment Videos

  • Pilot trial involving 11 patients with ACLF and renal failure treated with Prometheus.
  • Crossover study comparing Prometheus and MARS in five patients.
  • Monitoring of blood levels for protein-bound and water-soluble toxins, cytokines, and coagulation factors.
  • Fractionated Plasma Separation and Adsorption (FPSA) method utilized by the Prometheus device.

    • Main Results:

    • Prometheus therapy was safe, with reversible hypotension as the main adverse event; three cases of secondary system clotting occurred.
    • Significant improvements observed in blood levels of conjugated bilirubin, bile acids, ammonia, creatinine, and urea.
    • Prometheus demonstrated significantly higher reduction ratios for bilirubin, ammonia, and urea compared to MARS.
    • No significant removal of important cytokines or coagulation factors was detected, indicating selective toxin removal.

    Conclusions:

    • Prometheus represents a promising new therapeutic option for artificial liver support, particularly in severe hepatorenal syndrome.
    • The device effectively removes both protein-bound and water-soluble toxins without significant unselective removal of vital substances.
    • Early improvements in biochemical parameters were noted after just two treatments, highlighting its potential clinical utility.