EH 6/2014

www.european-hospital.com 15LABORATORY A new filtering device spreads through Europe Terry Gourlay is Professor of Bio- engineering and head of the Department of Biomedical Engineering at Strathclyde University in Glasgow, Scotland. His main research interest is in cardiovascular devices with a specific focus on extra- corporeal systems, life support, ECMO, cardiopulmonary by-pass and implantable devices. The device consists of the Hemosep bag, shaker unit, a blood collection bag to hold the processed blood, and the intra-operative pump, suction and blood reservoir Recycling blood lost during major surgeryReport: Mark Nicholls Sucking up blood spilt during a major surgical procedure, or drained from a heart-lung machine after surgery, the Hemosep cell concentration system has a blood bag that uses a chemical sponge technology and mechanical agitator to filter red and white blood cells and platelets through a plastic membrane so that they can then be returned to the patient by intravenous transfusion. A critical benefit is that a patient receives their own blood back rather than having donated blood. In recent months the system’s inventor Professor Terry Gourlay, from Strathclyde University, Glasgow, has seen significant implementation in hospitals across Europe and the UK. ‘Hemosep is a machine that’s a cell salvage device for use during a whole range of surgery,’ he explained. ‘It was designed for cardiothoracic surgery but now has an application for accident and emergency, vascular and orthopaedic, anywhere there’s likely to be substantive blood loss. ‘There are other technologies that do the same thing, but they are invariably fairly complex centrifuge devices. Hemosep’s USP is in its simplicity and the fact it does not use centrifuge but a powerful high performance super absorber.’ The advanced membrane in Hemosep does not permit the blood cells, including the smallest cells – the platelets responsible for clotting – to pass into the super-absorber. Therefore, Hemosep gives the patient back all their cells – red and white cells and platelets – rather than only red cells returned by other devices.’ Hemosep has been in develop- ment at Strathclyde University since 2007 and on the market since 2012, following successful clinical trials that were led by Professor Serdar Gunaydin, Head of Cardiac Surgery at the University of Kirikkale Hospital in Ankara, Turkey, which saw the sys- tem receive the CE mark for Europe. ‘The primary benefit for patients of this type of technology is that they are getting their own blood back, which reduces the need for donor transfu- sion and risk of transfusion reaction,’ he pointed out. ‘Another advantage is that they are not just getting red blood cells but all cells and that can have a positive impact on reducing bleeding. The early clinical study also demonstrated that Hemosep removed pro-inflammatory molecules.’ For clinicians, the device is simple to use with no specialist expertise required and, for a hospital and health system, it reduces the need for donor blood and associated com- plications. The Hemosep device also occupies a small footprint and is easily port- able. Along with wider use across Europe and Asia, there are plans to introduce the system into Africa and Australasia via Brightwake Ltd, spe- cialist in research and development, engineering, production and global marketing of products. A key factor in the partnership with Brightwake has been the company’s knowledge of textiles and expertise to invent fil- ters with microscopic meshes. These make Hemosep the only machine in the world capable of salvaging the tiny platelets that help blood to clot. The avoidance of post-operative complications and a reduced reli- ance on blood banks mean poten- tially huge savings for the National Health Service (NHS), estimated at over £10m a year. Next generation devices are already being developed as Professor Gourlay’s team works with Brightwake to improve performance. There are also adaptations planned for a military setting, where particular challenges include using it away from main centres, and for the develop- ment of a version that requires no power as well as a version for pae- diatric surgery and also veterinary surgery. Dr Markus Cornberg is managing senior physician at the Centre of Internal medicine as well as senior physician at the Clinic of Gastroenterology, Hepatology and Endocrinology at the Medical University, Hanover. His clinical work focuses on the treatment of patients with liver disease. He was lead physician in several clinical studies, which looked at new drugs for hepatic viral infections. In 2007 and 2010 he served on the organisational committee, which drafted the S3 guidelines for hepatitis B management. His basic research focuses on the role of cellular immune responses with regard to the course of disease and the treatments response of patients with viral hepatitis. at most six months. ‘The major advantage of these drugs is the fact that they have few side effects,’ Cornberg explains. The drawback: They come with a price tag of up to 100,000 euros per course. ‘The drug development costs have to be recovered but the price will drop,’ Cornberg says but underlines that life-long therapies for other diseases are equally expensive. In January 2014 sofosbuvir was introduced, simprevir followed suit in May and in August the third new drug, daclatasvir, was approved. In November, Gilead is expected to present an oral hepatitis medication that combines two of the agents and, for January 2015, AbbVie announced a triple combination. In his presentation Dr Cornberg will also cover other forms of hepa- titis, such as A and E. Both are prevalent in tropical countries, nevertheless Dr Cornberg explains that,hepatitis E pathogens can occur in Europe ‘...for example in food such as uncooked meat, ground pork sausage or wild boar meat.’ Approximately twenty percent of the German population are esti- mated to have been exposed to the hepatitis E virus, Cornberg says, but mostly with genotype 3, a rather benign variant, while in the tropi- cal countries genotype 1 is com- mon: ‘In very rare cases we have patients with jaundice, albeit today we know that transplant patients or immunocompromised patients are particularly at risk.’ They can develop chronic hepatitis, where the virus remains in the body and causes inflammations. ‘Ever since we’ve understood this we detect the hepatitis E virus much more often. Before, we simply didn’t look for it,’ Cornberg explains. In Germany, estimates mention up to one million carriers of hepatitis B and C with the major transmission vector for hepatitis B being sexual intercourse. Also in that coun, preg- nant women are routinely tested for the virus to prevent a transmission from mother to the child. Most hepatitis B carriers do not show symptoms, ‘the virus sleeps in the body and can break out at any time,’ according to Dr Cornberg. Immunosuppressant drugs such as rituximab are used to treat rheuma- tism, lymphoma or multiple sclero- sis. But, Cornberg warns, the phy- sicians should exercise prudence since these drugs weaken the anti- bodies, which in turn can activate the hepatitis B virus. The disease can be extremely severe, even fatal, Cornberg says and emphasises that physicians must be arware of this. Even in healthy patients who carry hepatitis B markers, rituximab can reactivate these markers. Then, a conventional hepatitis B treatment must be initiated. ‘Unfortunately it does happen that patients are not properly tested before receiving medication,’ he says, ‘and then the liver function tests skyrocket and before it occurs to you that your patient might have hepatitis B, he’s almost dead.’ Earlier this year a drug was launched that can cure hepatitis C without severe side effects in most patients. Whilst the treatment is fast, it is very expensive but does avoid liver cancer and thus makes liver transplants superfluous. This is only one of the many promising developments in hepatitis research that Dr Markus Cornberg of the Medical University Hanover has addressed at the Medica Education Conference. Breakthrough in hepatitis C research ‘Hepatitis C is a chronic infectious disease caused by a virus which was identified in 1989,’ says Markus Cornberg, adding: ‘Until recently the treatment consisted of a combina- tion of interferon and ribavirin, two unspecific drugs of which we even to date don’t know why they work.’ However, only about 30 percent of the infected patients received the medication, the expert points out, since ‘in patients hepatitis with advanced liver disease or other severe sequelae we could not use it due to the adverse effects. However, now we have antiviral substances such as protease inhibi- tors, polymerase inhibitors and NS5A inhibitors which for the first time provide a targeted and effective hepatitis C treatment.’ The new drug can cure hepatitis C in more than 90 percent of patients with a course of treatment taking Therapeutic revolution – new drug fights hepatitis C successfully

EH 6/2014

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