Global threat to humanity

welt.de 13.9.2014

from Erik Klapp

On September 13, doctors all over the world celebrate the World Sepsis Day – and for the first time have hope for a cure: A new medical technology can stop the deadly disease.

Mariana Bridi was 20 when she was admitted in a Brazilian hospital shortly after Christmas. She looked fantastic and she was still relatively good. She had elevated temperature, and was diagnosed with an infection of the urethra, nothing earth shattering. Then, within days, her condition worsened dramatically, the doctors lost control. The kidneys failed, hands and feet began to die. In emergency operations, her limbs were amputated and the kidneys and part of the stomach were removed – too late. End of January the supermodel died from sepsis, in English: blood poisoning.
That was in 2009 and since then more than 130 million people worldwide are suffering from sepsis, nearly 45 million have died from the insidious disease, including many celebrities. The sepsis victims include Prince Rainier of Monaco, Superman actor Christopher Reeves, publisher Rudolf Augstein, Chancellor wife Loki Schmidt and TV presenter Ilona Christen.
Sepsis is the leading cause of death of children and newborns, the overall infection rate increases each year by about ten percent. The National Academies of Sciences of the G-States are already warning of a “global threat to humanity”. Therefore, on September 13, physicians from all over the world celebrate the World Sepsis Day to draw attention to cases such as that of Bridi and the largely unknown and underestimated disease.

Complex overreaction of the immune system
For Germany Professor Konrad Reinhart, chief of the Department of Anesthesiology and Intensive Care at the University Hospital Jena and Chairman of the German Sepsis Foundation, requests a “National Action Plan against sepsis” from the Federal Government. In the Federal Republic about 180,000 people suffer from sepsis, about 60,000 die every year – more than from heart attack or lung, breast and colon cancer together. Reinhart believes that a combination of better hygiene measures, vaccination against sepsis pathogens, education and further measures can significantly reduce morbidity and mortality.
Sepsis is a complex overreaction of the immune system to bacteria or fungi that is so strong that vital body functions are limited and single or multiple organs fail. It occurs as a consequence of infection or after major surgery. In the case of an infection the defense system of the body produces so-called cytokines that, as messengers, coordinate the entire defense. If the amount of cytokines exceeds a certain value, the defensive actions change: Organs are no longer protected but damaged.
In the past, there have been several attempts to get at the disease by pharmaceutical or medical therapies. However success remained modest or completely non-existent. Only now there is a promising new approach that could save the lives of many patients.
The small US company Cytosorbents from New Jersey has developed a cytokine adsorber which removes the hazardous messengers and other inflammatory mediators from the blood: The blood of an infected person is passed through a 20 cm long cylinder, in which tens of thousands of small beads are contained. They are made of highly biocompatible polymers; each of them is perforated with countless tiny holes on which the unwanted molecules remain hung. Thus life-threatening high cytokine levels are reduced to a level at which the body’s runaway immune response can regain control. “We give doctors an instrument to regain control of these patients and thus save life.“ says Christian Steiner, Managing Director of Cytosorbents Europe.
The cytokine filter is already in use in eleven states. In Germany more than 40 clinics successfully use the cartridge; the therapy is part of the routine in the Munich University Hospital Großhadern and Augustinum for certain patients as well as routine at the University Hospital of Essen, Greifswald and Halle. In more than 20 studies, the effectiveness of the adsorber is currently being evaluated – and the first results are very promising. A crucial factor in the success of the use during long operations seems to be two facts: Inflammatory mediators such as interleukin 6 are effectively reduced, and the effect persists postoperatively, suggesting that the adsorber exerts an influence on the production of interleukins.

Own online medium for new technology
Whether a 60-year-old who suffered a streptococcal infection after a forearm fracture and was saved thanks to the adsorber, or a 37-year-old man who suffered a staphylococcal infection after liver cirrhosis and convalesced – the results of the new form of therapy have been positive.
The knowledge about the cytokine adsorber is so fast growing that Professor Frank Brunkhorst, head of the Center for Clinical Studies at the University Hospital Jena and General Secretary of the German Sepsis Society, has created an own online medium for the new technology in cooperation with the manufacturing company: In the Cytosorb Registry, application centers can together record data on the application which document the safety and efficacy.
Side effects that exist in almost all forms of therapy have so far occurred nowhere. Although it cannot be excluded that the small polymer beads, remove substances from the blood that are desirable – for example, antibiotics administered to fight a bacterial infection. However this could be dealt with by the doctors increasing the dose of the drug. The corresponding data are currently collected in several studies.
Axel Nierhaus, senior physician at the department of Intensive Care in the university hospital Hamburg-Eppendorf sees “enormous potential in combating sepsis”. Professor Karl Träger, head of the cardiac intensive care unit at the University Hospital Ulm, who proved to be one of the first heart specialists to reduce inflammatory mediators through the adsorber, notes, Cytosorb is a “promising new treatment option” and has “greatest benefits”.
How big it is, is hard to identify. When the Eppendorf intensive care physician Nierhaus recently got a suicidal patient at his station, who had swallowed an overdose of the painkiller paracetamol, it was no longer enough to pump the stomach. The active ingredients of the drug had already paralyzed the liver. Nierhaus used the cytokine filter – and rescued the man´s liver and life.