Kidney Week

Abstract: SA-PO1056

Seraph 100: A New Tool to Decrease Elevated sFlt-1 in Preeclamptic Plasma? An In Vitro Analysis

Session Information

• Women's Health and Kidney Diseases
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Women's Health and Kidney Diseases

• 2200 Women's Health and Kidney Diseases

Authors

• Gienapp, Amelie, Stadtisches Klinikum Braunschweig gGmbH, Braunschweig, Niedersachsen, Germany

Amelie Gienapp, MD

• Lehmann, Kijanosh, Stadtisches Klinikum Braunschweig gGmbH, Braunschweig, Niedersachsen, Germany

Kijanosh Lehmann, MD

• Meyer, Torsten M., Stadtisches Klinikum Braunschweig gGmbH, Braunschweig, Niedersachsen, Germany

Torsten M. Meyer, MD

• Kielstein, Jan T., Stadtisches Klinikum Braunschweig gGmbH, Braunschweig, Niedersachsen, Germany

Jan T. Kielstein, MD, FASN

Group or Team Name

• Kielstein Lab.

Introduction

There is an unmet need to treat pre-eclampsia. To reverse endothelial dysfunction caused by elevated soluble fms-like tyrosine kinase -1 (sFlt-1) and therefore antagonizing placental growth factor (PIGF), extracorporeal techniques have been tested including unselective therapeutiic plasma exchange (TPE) and specific adsorprive devices. Since sFlt-1 binds to heparin, we hypothesized that the Seraph^® 100, that consists of small polyethylene beads with endpoint attached heparin, lowers sFlT-1.

Case Description

We used the plasma of a 33-year-old woman with severe preeclampsia during her 23^rd week of gestation (blood pressure 190/110 mmHg, sFlT1/PIGF ratio 1433, platlets 36.000/µl, ALT 238 U/l). She and her son survived thanks to prolongation of the pregnancy by TPE.
For the in vitro testing the Seraph^® 100 was used in hemoperfusion mode. The Seraph^® 100 adsorber clearance (CL) of sFlT-1 as calculated based on the plasma perfusion rate and extraction ratio (C_pre - C_post) / C_pre, using the equation CL_sFlT-1 = Q_e * (C_pre - C_post) / C_pre, where Q_e is the effective plasma flow through the adsorber and C_pre and C_post are pre and post adsorber concentrations, respectively [Figure].

Discussion

In vitro the Seraph^® 100 lowered sFlT-1 by roughly 12 % in the plasma of our patient. The median plasma clearance of the Seraph^® 100 for sFlT-1 based on seven pre- and post Seraph^® 100 plasma levels at a pump speed of 200 mL/min was 8.9 (0.4 – 13.5) mL/min. Interestingly the clearance decreased during the treatment, which could reflect saturation. of the device. A total amount of 3.5 µg sFlT-1 had been removed. Further data are needed to clarify whether the Seraph^® 100 decreases sFlT-1 to a clinically relevant degree.

Serum levels of s-FLT-1 in a life size in vitro treatment with 4500 ml pre-eclamptic plasma using the Seraph^® 100 on a Multifiltrate^® Fresenius Medical Care machine in hemoperfusion mode at a pump speed of 200 mL/min for 120 min. "Arterial" levels refer to the plasma before entering the Seraph^® 100 "Venous" levels refer to the plasma leaving the Seraph^® 100.