Inflammatory mediators and mid-molecular-weight solutes

Inflammatory mediators and mid-molecular-weight solutes refers to a heterogeneous group of circulating molecules that drive the pathophysiology of systemic inflammatory states and organ failure. This group includes cytokines such as Interleukin-6 and Tumor Necrosis Factor, which are pivotal signaling proteins in the immune response but can lead to a cytokine storm when dysregulated (Fajgenbaum & June, 2020). High mobility group box 1 (HMGB1) is a nuclear protein that functions as a late-acting pro-inflammatory alarmin when released into the extracellular space by damaged cells (Wang et al., 1999). Endotoxins, or lipopolysaccharides, are structural components of Gram-negative bacteria that act as potent triggers for systemic inflammation via Toll-like receptor 4 signaling (Opal, 2010). Mid-molecular-weight solutes, typically ranging from 0.5 to 60 kDa, encompass various uremic toxins and peptides that accumulate during renal or hepatic impairment. These substances are the primary targets of extracorporeal blood purification therapies, such as hemoadsorption and high-flux dialysis, which aim to modulate the inflammatory response by reducing the circulating burden of these mediators to restore immune homeostasis (Ankawi et al., 2019).

Other names

CytokinesHigh mobility group box 1 (HMGB1)EndotoxinLipopolysaccharide (LPS)Mid-molecular-weight solutesUremic toxinsSepsis-associated mediatorsPathogen-associated molecular patterns (PAMPs)Damage-associated molecular patterns (DAMPs)

Extracorporeal adsorption, convective clearance, and pharmacological neutralization of circulating inflammatory and toxic mediators.