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Automated Measurement of Cryptococcal Species Polysaccharide Capsule and Cell Body
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Automated Measurement of Cryptococcal Species Polysaccharide Capsule and Cell Body

Published on: January 11, 2018

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Novel Treatment of Cryptococcal Meningitis via Neurapheresis Therapy

Gordon J Smilnak1, Lefko T Charalambous1, Drew Cutshaw1

  • 1Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina.

The Journal of Infectious Diseases
|May 23, 2018
PubMed

Insights

Neurapheresis therapy offers a novel, one-time treatment for cryptococcal meningitis (CM) by filtering yeasts from cerebrospinal fluid. This extracorporeal method rapidly clears fungal pathogens, improving outcomes for this life-threatening infection.

Area of Science:

  • Mycology
  • Infectious Diseases
  • Medical Technology

Background:

  • Cryptococcal meningitis (CM) is a leading cause of life-threatening fungal meningitis globally.
  • Current antifungal regimens improve survival but do not consistently achieve a cure.
  • The fungal pathogen in CM is slowly cleared by conventional treatments, contributing to morbidity and mortality.

Purpose of the Study:

  • To introduce Neurapheresis therapy as a novel, one-time treatment for CM.
  • To evaluate the efficacy of Neurapheresis in clearing fungal yeasts and antigens from cerebrospinal fluid (CSF).
  • To assess the in vivo efficacy of a closed-loop Neurapheresis system in a relevant animal model.

Main Methods:

  • In vitro filtration of CSF using the Neurapheresis platform to assess yeast and polysaccharide antigen reduction.
  • Utilizing an analogous closed-loop Neurapheresis system in a rabbit model of CM.
  • Measuring the clearance rate of yeasts from the subarachnoid space in the animal model.

Main Results:

  • In vitro filtration demonstrated a 5-log reduction in yeast concentration and a 1-log reduction in polysaccharide antigen over 24 hours.
  • The closed-loop system achieved 97% clearance of yeasts from the subarachnoid space in rabbits within 4-6 hours.
  • This study provides the first evidence of rapid in vitro and in vivo clearance of the CM fungal pathogen.

Conclusions:

  • Neurapheresis therapy is a promising novel approach for the one-time treatment of CM.
  • The technology demonstrates significant potential for rapidly reducing fungal burden in the CSF.
  • Further development and clinical trials are warranted to establish Neurapheresis as a standard treatment for CM.

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