Direct Hemoperfusion With a beta 2-Microglobulin-selective Adsorbent Column Eliminates Inflammatory Cytokines and Improves Pulmonary Oxygenation

• Published in: Therapeutic apheresis and dialysis 2009-02, Vol.13 (1), p.27-33
• Main Authors: Kono, Keiichi, Toda, Shigeru, Hora, Kazuhiko, Kiyosawa, Kendo
• Format: Article
• Language: English
• ISSN: 1744-9979; 1744-9987
• DOI: 10.1111/j.1744-9987.2009.00652.x

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 beta 2-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 67-79years old (mean 72 plus or minus 6.2years), diagnosed with ARDS/ALI were treated with Lixelle-DHP. The PaO2/fraction of inspired oxygen (FiO2) ratio (PF ratio) was 90.0 plus or minus 22.9 before the treatment, and it increased to 129.9 plus or minus 5.6 at 72h 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.