Effects of selective LDL apheresis on plasma concentrations of ICAM-1, VCAM-1 and P-selectin in diabetic patients with arteriosclerosis obliterans and receiving maintenance hemodialysis.
BACKGROUND
Arteriosclerosis obliterans (ASO) is a serious complication in patients with end-stage renal disease (ESRD) caused by diabetic nephropathy. Adsorption of low-density lipoprotein (LDL) has been performed to treat ASO. While efficacy of this treatment has been reported in limb ischemia, the mechanism underlying the benefit remains unclear. We investigated how LDL adsorption affected soluble adhesion molecules; P-selectin, an endothelial and platelet activation marker; inflammatory cytokines such as interleukin (IL)-1beta, IL-6 and tissue necrosis factor (TNF)-alpha; and lipids in serum.


METHODS
Selective LDL adsorption by dextran sulfate columns (LDL apheresis) was performed weekly for 10 weeks to treat eight hemodialysis patients with ASO, ESRD, and type 2 diabetes mellitus. Serum was sampled before and immediately after apheresis.


RESULTS
LDL apheresis was performed safely. After LDL apheresis lipid concentrations were significantly reduced and clinical findings, such as Fontaine's classification and ankle brachial pressure index values, were improved. Pretreatment concentrations of soluble intercellular and vascular cell adhesion molecules (sICAM-1 and sVCAM-1) and also P-selectin were higher in patients than healthy controls. After apheresis these decreased, especially P-selectin. IL-1beta, IL-6, and TNF-alpha concentrations before apheresis were similar to those in controls and were unaffected by treatment.


CONCLUSIONS
Effectiveness of LDL apheresis against ASO may involve decreased endothelial cell and platelet activation.
Utsumi
Kouichi
K
Department of Internal Medicine (Divisions of Neurology, Nephrology, and Rheumatology) Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan. utsumi@nms.ac.jp
Kawabe
Mitsuhiko
M
Hirama
Akio
A
Ueda
Kae
K
Kamada
Yuko
Y
Arii
Kazumasa
K
Komaba
Yuichi
Y
Katsura
Ken-ichiro
K
Iino
Yasuhiko
Y
Katayama
Yasuo
Y
D000368:Aged; D001162:Arteriosclerosis Obliterans / Q000097:blood* / Q000150:complications* / Q000473:pathology; D008078:Cholesterol, LDL / Q000097:blood*; D003920:Diabetes Mellitus / Q000097:blood* / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood*; D008297:Male; D019007:P-Selectin / Q000097:blood*; D006435:Renal Dialysis; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood*
D008078:Cholesterol, LDL; D019007:P-Selectin; D019010:Vascular Cell Adhesion Molecule-1; D018799:Intercellular Adhesion Molecule-1