Towards a novel carbon device for the treatment of sepsis

Sepsis is a systemic inflammatory response to infection in which the balance of pro- andanti-inflammatory mediators, which normally isolate and eliminate infection, is disrupted. Gram negative sepsis is initiated by bacterial endotoxin release which activates macrophages and circulating monocytes to release TNF and IL-1β followed by IL-6 and other inflammatory cytokines. As the disease progresses, an unregulated inflammatory response results in, tissue injury, haematological dysfunction and organ dysfunction. Severe sepsis, involving organ hypoperfusion may be further complicated by hypotension that is unresponsive to adequate fluid replacement, resulting in septic shock and finally death.Despite improvements in anti-microbial and supportive therapies, sepsis remains a significant cause of morbidity and mortality in ICUs worldwide. The complexity of processes mediating the progression of sepsis suggests that an extracorporeal device combining blood filtration with adsorption of a wide range of toxins, and inflammatory mediators offers the most comprehensive treatment strategy. However, no such device exists at present. A novel, uncoated, polymer pyrolysed synthetic carbon device is proposed which combines the superior adsorption properties of uncoated activated carbons with the capacity to manipulate porous structure for controlled adsorption of target plasma proteins and polypeptides. Preliminary haemocompatibility and adsorptive capacity was assessed using a carbon matrix prototype.