β₂‐Microglobulin‐selective AdsorbentColumn (Lixelle) for the Treatment of Dialysis‐related Amyloidosis

Abstract

Lixelle is a direct hemoperfusion-type adsorbent column developed for selective elimination of beta2-microglobulin (beta2-m) from the circulating blood of patients with dialysis-related amyloidosis (DRA). Lixelle S-35, that has a column volume of 350 mL, efficiently eliminates beta2-m and improves symptoms of DRA such as joint pain and nocturnal awakening. The performance of Lixelle S-15, that has a column volume of 150 mL, is dependent on the dialysis membrane used in combination with the adsorbent column in a hemodialysis circuit. The combination of S-15 and a dialysis membrane with a high beta2-m clearance eliminates an amount of beta2-m that is nearly equal to the amount removed by using S-35. Treatment with S-15 for 6 months improved joint pain with an efficacy similar to that observed when using S-35. The major adverse effects were hypotension and decrease in hematocrit, and these incidences were much less in S-15 compared to S-35.

Cytokine Adsorptive Property of Various Adsorbents in Immunoadsorption Columns and a Newly Developed Adsorbent: An in vitro Study

“…That is, CF-X may also be able to be applied as a cytokine adsorption column. However, there are problems with the use of CF-X for the treatment of sepsis, because it was designed for plasma adsorption, not for DHP and has a strong adsorptive property for normal IgG [17] . To solve these problems, we developed a new adsorbent MPCF-X by coating adsorbent in CF-X with MPC, aiming at decreasing the adsorption rate of IgG with the cytokine adsorptive property of CF-X maintained and developing a new adsorbent that can be used for DHP.…”

“…The adsorbent in Selesorb ® can remove anti-DNA antibodies effi ciently and is used for the treatment of SLE [16] . Adsorbent in Lixelle ® can adsorb ␤ 2 -microglobulin by DHP and is used for the treatment of dialysis-related amyloidosis [17] .…”

“…However, as it also shows a strong affi nity to immunoglobulin G (IgG), it has the disadvantage of adsorbing and removing normal IgG as well [17] . Therefore, we developed a new adsorbent, MPCF-X, by coating the surface of CF-X with 2-methacryloyloxyethyl phosphorylcholine (MPC) copolymer [18] , a coating material used to improve the biocompatibility in various artifi cial devices, and studied its cytokine adsorptive property ( fi g. 1 ).…”

Perfusate adsorption during ex vivo lung perfusion improves early post-transplant lung function

“…It is indicated for selective elimination of β2microglobulin from the circulating blood of patients with dialysis-related amyloidosis. 28 This differs from CytoSorb, where there are no ligands attached to the polymer, but which functions on size selectivity and surface adsorption. Furthermore, the experimental conditions of the two studies were very different.…”

Assessment of the Stability of an Immunoadsorbent for the Extracorporeal Removal of Beta-2-Microglobulin from Blood

“…These techniques not only remove ␤ 2 m from the plasma, but also remove other molecules with similar molecular weight and/or hydrophobicity, which complicate elucidating any symptomatic relief observed in the patients. An adsorbent column, referred to as Lixelle [10,[12][13][14][15] is in use in Japan for the selective elimination of ␤ 2 m from the blood of patients with DRA. The specifi city and/ or affi nity of this matrix for ␤ 2 m is in question since it also removes other middle molecular weight molecules such as infl ammatory cytokines [13,14,26,27] .…”