Novel Treatment of Cryptococcal Meningitis via Neurapheresis Therapy. (17th May 2018)

• Record Type: Journal Article
• Authors: Smilnak, Gordon J; Charalambous, Lefko T; Cutshaw, Drew; Premji, Alykhan M; Giamberardino, Charles D; Ballard, Christi G; Bartuska, Andrew P; Ejikeme, Tiffany U; Sheng, Huaxin; Verbick, Laura Zitella; Hedstrom, Blake A; Pagadala, Promila C; McCabe, Aaron R; Perfect, John R; Lad, Shivanand P
• Is Part Of: Journal of infectious diseases. Volume 218:Number 7(2018)
• Page Start: 1147
• Page End: 1154
• Publication Date: 2018-05-17
• Subjects: Cryptococcus neoformans -- fungal meningitis -- cerebrospinal fluid filtration; Communicable diseases -- Periodicals; Diseases -- Causes and theories of causation -- Periodicals; Medicine -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.9
• DOI: 10.1093/infdis/jiy286
• Languages: English
• ISSNs: 0022-1899

Abstract

Abstract: Cryptococcal meningitis (CM) has emerged as the most common life-threatening fungal meningitis worldwide. Current management involves a sequential, longitudinal regimen of antifungals; despite a significant improvement in survival compared with uniform mortality without treatment, this drug paradigm has not led to a consistent cure. Neurapheresis therapy, extracorporeal filtration of yeasts from cerebrospinal fluid (CSF) in infected hosts, is presented here as a novel, one-time therapy for CM. In vitro filtration of CSF through this platform yielded a 5-log reduction in concentration of the yeast and a 1-log reduction in its polysaccharide antigen over 24 hours. Additionally, an analogous closed-loop system achieved 97% clearance of yeasts from the subarachnoid space in a rabbit model over 4–6 hours. This is the first publication demonstrating the direct ability to rapidly clear, both in vitro and in vivo, the otherwise slowly removed fungal pathogen that directly contributes to the morbidity and mortality seen in CM. Abstract : Neurapheresis therapy, a catheter-based platform for mechanical filtration of infected cerebrospinal fluid, is presented here as a novel, effective potential treatment for both in vitro and in vivo models of cryptococcal meningitis.