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Extracorporeal Blood Phototherapy to Remove Carbon Monoxide (CO) From the Blood of a CO-poisoned Individual

Use of PECMO (Photo-ECMO Machine) induces photodissociation in CO-bound hemoglobin molecules.


Executive summary

Carbon monoxide (CO) poisoning is the leading cause of poisoning-related deaths and results in more than 50,000 visits to the emergency room in the U.S. every year. Carbon monoxide poisoning occurs when carbon monoxide binds to hemoglobin, consequently blocking oxygen from binding. CO avidly binds to hemoglobin (Hb) to form carboxyhemoglobin (COHb), which cannot transport oxygen. Carbon monoxide also binds to hemoglobin longer than oxygen, lengthening the time before dissociation.

This invention is a novel treatment system for carbon monoxide poisoning. Like dialysis and ECMO machines, this device is an extracorporeal blood treatment device. The technology consists of systems and methods for an extracorporeal phototherapy system that emits light onto opposing sides of an oxygenator to photodissociate CO from Hb.

This device incorporates phototherapy into an ECMO device, resulting in a 30% more effective therapy than existing treatment options for CO poisoning.


Unmet need

Carbon monoxide poisoning is currently treated with either normobaric 100% oxygen (NBO) or hyperbaric oxygen (HBO). These treatment approaches are focused on more oxygen being absorbed in the blood, rather than directly removing CO from the blood.  

This technology actively targets CO bound to hemoglobin, offering a more targeted and effective approach to treating CO poisoning.

Value proposition

This technology offers a more efficient treatment of this serious illness. CO exposure and poisoning have long-term effects, such as memory loss, tremors, vision loss, and hearing loss. A more effective treatment could mitigate these long-term effects and help patients recover quicker.

Team

Richard Rox Anderson, MD

Dr. Anderson is a Harvard Medical School professor in dermatology, the director of the Wellman Center for Photomedicine, and adjunct professor of health sciences and technology at MIT. Dr. Anderson has been awarded more than 60 national and international patents, co-authored over 250 scientific books and papers, and is a member of the National Inventors Hall of Fame. His research focuses on photomedicine, imaging, and novel treatment for dermatological disorders.

 

Warren Zapol, MD 

Dr. Zapol was the emeritus anesthetist-in-chief at Massachusetts General Hospital from 1994–2008 and a professor of anesthesia at Harvard Medical School. He was also the director of the Mass General Anesthesia Center for Critical Care Research until his passing in 2021. Dr. Zapol’s work from his previous laboratory is now continued by Dr. Fumito Ichinose, MD, PhD.

Robert Ng, PhD 

Manager, Business Development & Licensing, Mass General Brigham Innovation 
cng11@partners.org 

Technology

Background and proof of concept

The inventors developed and published a mouse-scale device (Figure 1) in October 2019 that showed the efficacy of phototherapy at removing CO in CO poisoned rats and mice. Compared to ventilation with 100% oxygen, the addition of extracorporeal removal of CO with phototherapy (ECCOR-P) doubled the rate of CO elimination in CO-poisoned rats with normal lungs. In CO-poisoned rats with acute lung injury, treatment with ECCOR-P increased the rate of CO removal by threefold compared to ventilation with 100% oxygen alone and was associated with improved survival. A scaled-up version of the device was developed and tested in vitro in pigs. Six scaled-up oxygenators were assembled and tested in a pig model of CO poisoning. A 30% increase in efficiency of CO removal with red light was achieved compared to standard treatment of CO poisoning (breathing 100% oxygen only). 

Advantages and progress

This technology has been shown in several studies to be more effective than NBO and HBO at treating CO poisoning. This technology’s efficiency in CO removal from the blood allows for fewer devices to be needed for treatment as compared to competitive technologies.

Mechanism

The invention is an ECMO device with light that enters or is created within the volume of the device that can dissociate carbon monoxide from hemoglobin to quickly treat CO poisoning. The modified ECMO device allows light from external LED array sources to expose a sheet of flowing blood-and-gas tubules that are the usual internal components of ECMO. Optical intrusions in the device's interior allow external light to penetrate deep with the device to enable the photodissociation of CO.

The technology is based on the fact that absorption of light by HbCO leads to efficient photodissociation. The probability of dissociation per absorbed photon for HbCO photodissociation is nearly 1. Absorption of light by HbO2 also leads to photodissociation but with much lower efficiency. This helps preserve the HbO2 molecules that deliver oxygen. Therefore, sufficient light exposure at wavelengths absorbed by HbCO can preferentially remove CO from the Hb binding sites, making it possible for O2 to competitively bind to the empty sites.

Competitive advantages

ECMO devices have not been previously modified to allow light delivery deep into the device. The light wavelength and gas exchange properties of this invention differentiates it from other competing technologies. This invention is patent protected and is uniquely designed while also offering more efficient treatment.

The worldwide cumulative incidence and mortality of CO poisoning are estimated at 137 cases and 4.6 deaths per million, respectively. CO intoxication is the leading cause of poisoning-related deaths in the U.S. and results in more than 50,000 visits to emergency departments in the U.S. each year. Nearly 400 Americans die from unintentional carbon monoxide poisoning (not linked to fires), and more than 4,000 are hospitalized in the U.S. each year.

United States Provisional Application 62/693,620 (MGH 25133)

WIPO PCT Application PCT/US2019/040656 (MGH 25133)

United States Application 17/257,217 (MGH 25133)

EPO Application 19830842.1 (MGH 25133)

United States Provisional Application 63/153,410 (MGH 2021-175)

WIPO PCT Application PCT/US2022/017975 (MGH 2021-175)