Schaefer et al.  Decrease of serum alkaline phosphatase and prognostic relevance in adult cardiopulmonary bypassShort title: Alkaline phosphatase in cardiac surgery. Interactive CardioVascular and Thoracic Surgery (2020) 1–8 ORIGINAL ARTICLE   doi:10.1093/icvts/ivaa103

Presbitero AMancini EBrands RKrzhizhanovskaya VVSloot PMA Supplemented Alkaline Phosphatase Supports the Immune Response in Patients Undergoing Cardiac Surgery: Clinical and Computational Evidence. Front Immunol. 2018 Oct 11;9:2342. doi: 10.3389/fimmu.2018.02342. eCollection 2018 

– Chandrupatla DMSH, Molthoff CFM, Ritsema WIGR, Vos R, Elshof E, Matsuyama T, Low PS, Musters RJP, Hammond A, Windhorst AD, Lammertsma AA, van der Laken CJ, Brands R, Jansen G. Prophylactic and therapeutic activity of alkaline phosphatase in arthritic rats: single-agent effects of alkaline phosphatase and synergistic effects in combination with methotrexate.Transl Res. 2018 Sep;199:24-38. doi: 10.1016/j.trsl.2018.04.001. Epub 2018 May 17.

– Pike AF, Kramer NI, Blaauboer BJ, Seinen W, Brands R.  An Alkaline Phosphatase Transport Mechanism in the Pathogenesis of Alzheimer’s Disease and Neurodegeneration. Chemico-Biological Interactions 226 (2015) 30–39  doi: 10.1016/j.cbi.2014.12.006. Review.

– Pike AF, Kramer NI, Blaauboer BJ, Seinen W, BrandsR. A novel hypothesis for an alkaline phosphatase ‘rescue’ mechanism in the hepatic acute phase immune response.Biochim Biophys Acta. 2013 Dec;1832 (12):2044-56

– Bender, B  et al  Recombinant human tissue non-specific alkaline phosphatase successfully counteracts lipopolysacharide induced sepsis in mice (accepted for publication in Physiological Research 03  2015)

– Huizinga R, Kreft KL, Onderwater S, Boonstra JG, Brands R, Hintzen RQ, Laman JD. Endotoxin- and ATP-neutralizing activity of alkaline phosphatase as a strategy to limit neuroinflammation.J Neuroinflammation. 2012 Dec 11;9:266.

– Kats, S., R. Brands, et al. (2009). “Anti-Inflammatory effects of Alkaline Phosphatase in Coronary Artery Bypass Surgery with Cardiopulmonary Bypass.” Recent Pat Inflamm Allergy Drug Discov. 3,3, 214

– Kats S, Schönberger JP, Brands R, Seinen W, van Oeveren W.Endotoxin release in cardiac surgery with cardiopulmonary bypass: pathophysiology and possible therapeutic strategies. An update. Eur J Cardiothorac Surg. 2011 Apr;39(4):451-8.-

Ongoing APPIRED III clinical study with bRESCAP in cardiothoracic surgery


Demonstrate reduction in acute kidney injury peri- & post-heart surgery in more than 1250 patients


RESCAP works as prophylactic anti-inflammatory protein and systemic anti inflammatory compound, preventing ischemic injury.
It restores/maintains the integrity of microvasculature, thereby maintaining e.g. kidney function.


Singapore, Eindhoven, Kuala Lumpur, Melbourne, Hasselt, Genk, Lisbon, Rome,Vienna, St. Petersburg, Kazan with other centres in pipeline.

Completed APPIRED ll clinical study with bRESCAP in Cardiothoracic surgery

APPIRED ll clinical study showed that treatment with alkaline phosphatase in patients undergoing invasive cardiac surgery is safe, well tolerated and results in reduction of both mortality and morbidity as deduced from reduced serious adverse events and adverse events.

Alkaline Phosphatase application so far has not resulted in complications that are likely to be ascribed to the medication.