A Paradigm of Translational Medicine

Antimicrobial peptides (AMPs) are small, cationic, amphiphilic peptides with broad-spectrum microbicidal activity against both bacteria and fungi. In mammals, AMPs form the first line of host defense against infections and generally play an important role as effector agents of the innate immune system. The AMP era was born more than 6 decades ago when the first cationic cyclic peptide antibiotics, namely polymyxins and tyrothricin, found their way into clinical use. Due to the good clinical experience in the treatment of, for example, infections of mucus membranes as well as the subsequent understanding of mode of action, AMPs are now considered for treatment of inflammatory skin diseases and for improving healing of infected wounds. Based on the preclinical findings, including pathobiochemistry and molecular medicine, targeted therapy strategies are developed and first results indicate that AMPs influence processes of diseased skin. Importantly, in contrast to other antibiotics, AMPs do not seem to propagate the development of antibiotic-resistant micro-organisms. Therefore, AMPs should be tested in clinical trials for their efficacy and tolerability in inflammatory skin diseases and chronic wounds. Apart from possible fields of application, these peptides appear suited as an example of the paradigm of translational medicine for skin diseases which is today seen as a ‘two-way road’ – from bench to bedside and backwards from bedside to bench

Efficacy of a Tyrothricin-Containing Wound Gel in an Abrasive Wound Model for Superficial Wounds

Background: Topical preparations are a common treatment for superficialacute wounds, which at the least do not interfere with healing andideally result in enhanced wound healing irrespective of microbialcolonization. Objective: To examine the effects of a topicalantimicrobial gel and its vehicle on the wound healing of standardized,superficial abrasions. Methods: Thirty-three healthy volunteers wereenrolled in a double-blinded, randomized, intraindividual comparisonstudy. Three standardized, superficial abrasions were induced on theirforearms. A tyrothricin 0.1% gel (Tyrosur (R) gel; EngelhardArzneimittel GmbH & Co. KG, Niederdorfelden, Germany) and its vehiclewere randomly applied to two of the test areas, and one lesion remaineduntreated. Results: A significant improvement of wound healing was seenwith both tyrothricin 0.1% gel and its corresponding vehicle in theclinical assessment. The mean area under the curve (AUC) of woundhealing scores was the same for both preparations and the meanreepithelization scores were comparable at all test points over theentire 12 days. A lower mean AUC representing less reepithelization wasfound for the untreated test fields. Conclusion: The use of tyrothricin0.1% gel and its corresponding vehicle resulted in statisticallysignificant improved wound healing with an earlier onset of healing inparticular. Based on these results obtained using an abrasive woundmodel, it can be concluded that the addition of tyrothricin 0.1% to thegel vehicle did not interfere with the improved wound healing seen withthe vehicle alone

Impact of Hydrophilic Modification of Synthetic Dialysis Membranes on Hemocompatibility and Performance

The dialyzer is the core element in the hemodialysis treatment of patients with end-stage kidney disease (ESKD). During hemodialysis treatment, the dialyzer replaces the function of the kidney by removing small and middle-molecular weight uremic toxins, while retaining essential proteins. Meanwhile, a dialyzer should have the best possible hemocompatibility profile as the perpetuated contact of blood with artificial surfaces triggers complement activation, coagulation and immune cell activation, and even low-level activation repeated chronically over years may lead to undesired effects. During hemodialysis, the adsorption of plasma proteins to the dialyzer membrane leads to a formation of a secondary membrane, which can compromise both the uremic toxin removal and hemocompatibility of the dialyzer. Hydrophilic modifications of novel dialysis membranes have been shown to reduce protein adsorption, leading to better hemocompatibility profile and performance stability during dialysis treatments. This review article focuses on the importance of performance and hemocompatibility of dialysis membranes for the treatment of dialysis patients and summarizes recent studies on the impact of protein adsorption and hydrophilic modifications of membranes on these two core elements of a dialyzer

Hemodiafiltration: Technical and Medical Insights

Despite the significant medical and technical improvements in the field of dialytic renal replacement modalities, morbidity and mortality are excessively high among patients with end-stage kidney disease, and most interventional studies yielded disappointing results. Hemodiafiltration, a dialysis method that was implemented in clinics many years ago and that combines the two main principles of hemodialysis and hemofiltration—diffusion and convection—has had a positive impact on mortality rates, especially when delivered in a high-volume mode as a surrogate for a high convective dose. The achievement of high substitution volumes during dialysis treatments does not only depend on patient characteristics but also on the dialyzer (membrane) and the adequately equipped hemodiafiltration machine. The present review article summarizes the technical aspects of online hemodiafiltration and discusses present and ongoing clinical studies with regards to hard clinical and patient-reported outcomes

Hemodiafiltration: Technical and Medical Insights

Despite the significant medical and technical improvements in the field of dialytic renal replacement modalities, morbidity and mortality are excessively high among patients with end-stage kidney disease, and most interventional studies yielded disappointing results. Hemodiafiltration, a dialysis method that was implemented in clinics many years ago and that combines the two main principles of hemodialysis and hemofiltration—diffusion and convection—has had a positive impact on mortality rates, especially when delivered in a high-volume mode as a surrogate for a high convective dose. The achievement of high substitution volumes during dialysis treatments does not only depend on patient characteristics but also on the dialyzer (membrane) and the adequately equipped hemodiafiltration machine. The present review article summarizes the technical aspects of online hemodiafiltration and discusses present and ongoing clinical studies with regards to hard clinical and patient-reported outcomes