Elimination of Herpes Simplex Virus-2 and Epstein-Barr Virus With Seraph 100 Microbind Affinity Blood Filter and Therapeutic Plasma Exchange: An Explorative Study in a Patient With Acute Liver Failure

Rea Andermatt; Guido V Bloemberg; Christoph C Ganter; Nicolas J Mueller; Antonia M S Mueller; Beat Muellhaupt; Jan T Kielstein; Sascha David

doi:10.1097/CCE.0000000000000745

Elimination of Herpes Simplex Virus-2 and Epstein-Barr Virus With Seraph 100 Microbind Affinity Blood Filter and Therapeutic Plasma Exchange: An Explorative Study in a Patient With Acute Liver Failure

Crit Care Explor. 2022 Aug 11;4(8):e0745. doi: 10.1097/CCE.0000000000000745. eCollection 2022 Aug.

Authors

Rea Andermatt¹, Guido V Bloemberg², Christoph C Ganter¹, Nicolas J Mueller³, Antonia M S Mueller⁴, Beat Muellhaupt⁵, Jan T Kielstein⁶, Sascha David¹

Affiliations

¹ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
² Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
³ Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
⁴ Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich.
⁵ Department of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland.
⁶ Medical Clinic V, Nephrology Rheumatology Blood Purification, Academic Teaching Hospital Braunschweig, Braunschweig, Germany.

Abstract

Herpes simplex virus (HSV)-2 is a rare cause of hepatitis that can lead to acute liver failure (ALF) and often death. The earlier the initiation of acyclovir treatment the better the survival. With regard to ALF, controlled randomized data support the use of therapeutic plasma exchange (TPE) both as bridge to recovery or transplantation-possibly by modulating the systemic inflammatory response and by replacing coagulation factors. Seraph 100 Microbind Affinity Blood Filter (Seraph; Ex Thera Medical, Martinez, CA), a novel extracorporeal adsorption device, removes living pathogens by binding to a heparin-coated surface was shown to efficiently clear HSV-2 particles in vitro. Here, we tested the combination of Seraph with TPE to reduce a massive HSV-2 viral load to reach a situation in that liver transplantation would be feasible.

Design: Explorative study.

Setting: Academic tertiary care transplant center.

Patient: Single patient with HSV-2-induced ALF.

Interventions: TPE + Seraph 100 Microbind Affinity Blood Filter.

Measurements and main results: We report Seraph clearance data of HSV-2 and of Epstein-Barr virus (EBV) in vivo as well as total viral elimination by TPE. Genome copies/mL of HSV-2 and EBV in EDTA plasma were measured by polymerase chain reaction every 60 minutes over 6 hours after starting Seraph both systemically and post adsorber. Also, HSV-2 and EBV were quantified before and after TPE and in the removed apheresis plasma. We found a total elimination of 1.81 × e¹¹ HSV-2 copies and 2.11 × e⁶ EBV copies with a single TPE (exchange volume of 5L; 1.5× calculated plasma volume). Whole blood clearance of HSV-2 in the first 6 hours of treatment was 6.64 mL/min (4.98-12.92 mL/min). Despite much lower baseline viremia, clearance of EBV was higher 36.62 mL/min (22.67-53.48 mL/min).

Conclusions: TPE was able to remove circulating HSV-2 copies by 25% and EBV copies by 40% from the blood. On the other hand, clearance of HSV-2 by Seraph was clinically irrelevant, but Seraph seemed to be far more effective of removing EBV, implicating a possible use in EBV-associated pathologies, but this requires further study.

Keywords: absorption; acute liver failure; herpes; viral load.