Acute Effect of Rheopheresis on Peripheral Endothelial Dysfunction in Patients Suffering From Sudden Hearing Loss

Abstract

Single low density lipoprotein (LDL) fibrinogen apheresis has shown beneficial effects in the treatment of patients with sudden sensorineural hearing loss (SSHL). Pathophysiologically, a microcirculatory disorder of the inner ear, probably caused by disturbed endothelial function, is discussed as a final common pathway of a variety of SSHL etiologies. Thus, we carried out a prospective pilot study on the efficacy of Rheopheresis on vascular function in these patients, embedded into an ongoing randomized controlled multicenter trial investigating the efficacy of Rheopheresis for the treatment of SSHL. Potential modulation of systemic endothelial dysfunction by Rheopheresis was examined by measuring flow-associated vasodilatation of the brachial artery (according to the criteria of the American College of Cardiology) in a small group of patients suffering from SSHL (N=6, 5m/1f, mean age 56+/-11 years) within the last 3 days. At baseline, five of the six patients with acute hearing loss showed endothelial dysfunction as evidenced by diminished flow-mediated vasodilatation (FMD<5%). After a single Rheopheresis treatment, flow-mediated vasodilatation improved significantly (from 3.9+/-3.6% to 7.2+/-2.4%, P=0.05, mean+/-SD, two-sided paired T-test). This was paralleled by a reduction in fibrinogen (364+/-216 mg/dL to 142+/-96 mg/dL, P=0.03), total cholesterol (228+/-23 to 98+/-10, P<0.0001) and LDL cholesterol levels (153+/-8 mg/dL to 83+/-23 mg/dL, P<0.01). Based on this case series we conclude that single Rheopheresis treatment might have an acute beneficial effect on endothelial dysfunction in patients suffering from SSHL.

Treatment with HELP‐apheresis in patients suffering from sudden sensorineural hearing loss: A prospective, randomized, controlled study

“…The amount of heparin used in HELP procedure (100 IU/mL of plasma treated) does not affect the outcomes of SSHL patients because it is completely removed from heparin adsorber as reported above in the Materials and Methods section. For this reason we consider that the positive results obtained in our study are due to the fast and strong improvement of blood viscosity, rheology, and endothelial dysfunction, thanks to the high removal rate of lipoproteins and coagulation factors 9–11…”

“…After a single apheretic treatment, flow‐mediated vasodilatation improved significantly. Studies based on case series conclude that single apheresis might have an acute beneficial effect on endothelial dysfunction in patients suffering from SSHL 10. The circulating adhesion molecules (sE‐selectin, sVCAM‐1, and sICAM‐1), often present in higher than normal concentrations in SSHL, were reduced by the apheretic treatment, in addition to reducing LDL cholesterol and fibrinogen 11…”

Soluble Intercellular Adhesion Molecule 1 and Soluble Vascular Cell Adhesion Molecule 1 in Sudden Hearing Loss

“…In a prospective study, 1 to 3 specific fibrinogen apheresis lowered fibrinogen levels and improved hearing thresholds in 80% of patients (17). An ongoing multicenter clinical trial is evaluating the effect of rheopheresis in patients affected by SSHL; preliminary results show that a single rheopheresis has a beneficial effect on endothelial dysfunction in patients affected by SSHL (11). All these studies show that the reduction of high molecular weight proteins (fibrinogen and lipoproteins) may represent an effective treatment of the hearing loss.…”

“…An endothelial dysfunction has been described in SSHL patients (11), strengthening the vascular pathogenesis of this syndrome. Our group has recently described a patient affected by SSHL with high levels of circulating adhesion molecules (12) that represent one of the first signs of endothelial dysfunction (13).…”

Acute and Subacute Effect of Rheopheresis on Microvascular Endothelial Function in Patients Suffering From Age‐related Macular Degeneration

“…This hypothesis suggests a further rationale for the use of rheopheresis in the treatment of ARMD, based on its hypothetical positive effect on microvascular endothelial dysfunction. In the literature, just one study assessed the effect of rheopheresis on the endothelial function at the level of the brachial artery in patients suffering from sudden hearing loss (2). Another study investigated the effect of rheopheresis treatment on choroidal microcirculation in patients affected by early or late ARMD, using fluorescein angiography (8).…”