Direct Hemoperfusion With a β2‐Microglobulin‐selective Adsorbent Column Eliminates Inflammatory Cytokines and Improves Pulmonary Oxygenation

Abstract

Acute respiratory distress syndrome (ARDS) and acute lung injury (ALI) are characterized by a high mortality rate; therefore, ARDS/ALI in humans is a leading cause of morbidity and mortality in critically ill patients. As previously reported, cytokines play a critical role as signaling molecules that initiate, amplify, and perpetuate inflammatory responses on a local and systemic basis, and the polymyxin-B immobilized direct hemoperfusion system (PMX-DHP) is effective for the treatment of ARDS/ALI. Furthermore, another direct hemoperfusion system using the beta2-microglobulin-selective adsorbent column, Lixelle, the direct hemoperfusion treatment (Lixelle-DHP), has been applied in some cases to patients who are affected with systemic inflammatory response syndrome. The aim of this study is to evaluate the therapeutic efficacy of Lixelle-DHP in the treatment of ARDS/ALI. Four patients, aged 67-79 years old (mean 72 +/- 6.2 years), diagnosed with ARDS/ALI were treated with Lixelle-DHP. The P(a)O(2)/fraction of inspired oxygen (F(i)O(2)) ratio (PF ratio) was 90.0 +/- 22.9 before the treatment, and it increased to 129.9 +/- 5.6 at 72 h afterward the start of treatment. Inflammatory cytokines such as interleukin (IL)-1 beta, IL-6, soluble intercellular adhesion molecule 1 (sICAM-1) decreased significantly after the treatment. All patients were still alive after one month. However, while IL-2 had decreased significantly after the treatment, it had returned by the next treatment. It is possible that Lixelle-DHP might be able to improve the PF ratio and mortality rate as a result of decreased cytokines, and it has been suggested that Lixelle-DHP has a beneficial influence in the treatment of ARDS/ALI.

Sulforaphane exerts anti-inflammatory effects against lipopolysaccharide-induced acute lung injury in mice through the Nrf2/ARE pathway

“…Of the detected three types of PGE2 synthase, microsomal prostaglandin E 2 synthase-1 (mPGES-1), as the only induced enzyme, has been noted to be upregulated in response to various types of inflammation (29). In ventilator-associated lung injury in mice, mPGES-1-derived PGE2 has been shown to play a role in the onset of lung injury and pulmonary edema, and can promote pathological reactions in a variety of effector cells and can activate cytokines and inflammatory reactions (30,31). In the present study, we demonstrated that treatment with sulforaphane significantly decreased PGE2 production in mice with LPS-induced ALI.…”

Effects of Direct Hemoperfusion Using a Cytokine-Adsorbing Column on Endotoxin-Induced Experimental Acute Lung Injury in Rats

“…Tsushima et al [11] and Nakamura et al [12] demonstrated that the treatment of DHP with an endotoxin-adsorbing column improved ARDS and ameliorated increased inflammatory mediators in patients. Kono et al [13] showed that the treatment of DHP with ␤ 2 -microglobulin-adsorbing column eliminated inflammatory cytokines and improved pulmonary oxygenation in 4 patients with ARDS. The present study suggests that the treatment of DHP with CTR as same as two columns may improve ARDS and inhibit inflammatory responses in patients.…”

“…These findings suggest that CTR treatment might be effective for the treatment of patients with ALI. Several studies showed the effects of DHP with an endotoxin-adsorbing column and ␤ 2 -microglobulin-adsorbing column in ARDS patients [11][12][13] . Tsushima et al [11] and Nakamura et al [12] demonstrated that the treatment of DHP with an endotoxin-adsorbing column improved ARDS and ameliorated increased inflammatory mediators in patients.…”

Treatment of AECHB and Severe Hepatitis (Liver Failure)

“…After treatment, inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and soluble intercellular adhesion molecule 1 (sICAM-1) were significantly reduced. However, the IL-2 level had returned to within the normal range by the next treatment [ 252 ].…”