Research priorities for therapeutic plasma exchange in critically ill patients

Intensive Care Medicine Experimental

Table 2 Circulating factors that might be modulated by therapeutic plasma exchange

Removal
Potential target	Role	Disease	Available data
Cytokines	Inflammation	Sepsis, SIRS	Experimental
Autoantibodies (e.g. ANCA)	Autoimmune	vasculitis, Goodpasture’s syndrome	SOC
Donor-specific antibodies	Rejection	Transplantation	SOC, expert opinion
Immunoglobulins	Hyperviscosity	Hyperviscosity syndrome	SOC
Angiopoietin-2	Permeability	ARDS, sepsis	OBS
vWF antigen	Coagulopathy	Sepsis, DIC	OBS
Heparanase-1	Glycocalyx shedding	Systemic inflammation, Covid-19	OBS
Active viral particles (HSV, EBV)	infectious diseases	Virus-induced acute liver failure	CR
Heparin/PF4 antibody	Coagulation	Heparin-induced thrombocytopenia	CS

Replacement
Potential target	Role	Disease	Available data
ADAMTS13	vWF cleaving protease	TTP	RCT, SOC
Heparanase-2	Glycocalyx stabilisation	Systemic inflammation, Covid-19	OBS
Immunoglobulins	Ig deficiencies	Infection	OBS
Angiopoietin-1	Anti-permeability	Sepsis, systemic inflammation	OBS
Protein C	Coagulation, microcirculation	Sepsis, purpura fulminans	OBS
Coagulation factors	Coagulopathy/DIC	Investigated in acute liver failure	RCT

ANCA anti-neutrophil cytoplasmic antibody, vWF von Willebrand factor, PF4 platelet factor4, SIRS systemic inflammatory response syndrome, ARDS acute respiratory distress syndrome, DIC disseminated intravascular coagulopathy, HSV herpes simplex virus, EBV Epstein–Barr virus, ADAMTS13 A disintegrin and metalloproteinase with a thrombospondin type 1 motif, member13; TTP thrombotic thrombocytopenic purpura, SOC standard of care, OBS observational study, CR case report, CS case series, RCT randomized controlled trial