Plasma toxins and inflammatory mediators

Plasma toxins and inflammatory mediators represent a heterogeneous group of endogenous and exogenous substances that accumulate in the blood during critical illnesses such as sepsis, liver failure, and renal dysfunction (Monard et al., 2023). This category includes pro-inflammatory cytokines (e.g., IL-6, TNF-alpha), uremic toxins, bilirubin, and bacterial endotoxins, which collectively drive systemic inflammatory response syndrome (SIRS) and multi-organ failure (Ronco et al., 2017). Rather than being targeted by a single pharmacological agent, these substances are typically the focus of extracorporeal blood purification therapies, such as hemoperfusion and continuous renal replacement therapy (CRRT) (Honoré et al., 2019). These therapies aim to restore immunological homeostasis by non-selectively or semi-selectively removing excess mediators from the circulation. Effective management of these toxins is crucial in preventing the cytokine storm and mitigating the damage associated with hyperinflammation. However, a significant challenge remains the unintended removal of beneficial molecules, including antibiotics and nutrients, during the purification process (Monard et al., 2023).

Other names

Circulating inflammatory mediatorsUremic toxinsSeptic toxinsCytokines and chemokinesPathological plasma solutesDAMPs and PAMPs

Extracorporeal removal via adsorption, convection, or diffusion to reduce systemic concentrations of inflammatory and toxic solutes (Ronco et al., 2017). Pharmacological agents may also neutralize specific mediators through monoclonal antibody binding or receptor antagonism (StatPearls, 2023).