Selective Glucose-Depleted Perfusion Technique for VHL-Mutated Renal Cell Carcinoma: A Novel Extracorporeal Approach

This preprint describes a novel selective glucose-depleted perfusion technique for VHL-mutated renal cell carcinoma.Background: Clear cell RCC with VHL mutation exhibits obligate glucose and glutamine dependency (Warburg effect). Systemic metabolic therapies fail due to toxicity.Technique: Blood is taken from the abdominal aorta and passed through an extracorporeal filter containing 100 g boronic acid-based glucose-binding resin, achieving glucose <20 mg/dL in a single pass. The filter is changed every 60 minutes. Glucose-depleted blood is supplemented with ketone bodies, fatty acids, and glutamine antagonist 3,4-Dihydroxyphenyl boronic acid (DiPBA), and pumped back to the renal artery via a balloon catheter positioned 1-2 cm inside the ostium at physiological arterial pressure. The aorta is not occluded, thus there is no ischemic risk to lower extremities or other organs. The level of aortic cannulation may be suprarenal or infrarenal depending on anatomical considerations.This is a theoretical conceptual study. No human or animal subjects were involved.Author: Abdurrahman INEN, MDAffiliation: Bitlis Provincial Directorate of Health, Bitlis, TurkeyDOI: 10.5281/zenodo.23664438