New Adsorption Column (Lixelle) to Eliminate (β₂‐Microglobulin for Direct Hemoperfusion

Abstract

The Lixelle column is an adsorbent column used to eliminate beta2-microglobulin (beta2M) selectively from circulating blood of dialysis related amyloidosis (DRA) patients, which is used in combination with a dialyzer in series. The column has such a high capacity for adsorbing beta2M that the most intensive removal of beta2M has been possible. In clinical trials of the column, the obvious improvement of subjective symptoms such as decreases in the frequency of nocturnal awakening, the joint pain severity index, and the joint mobility index were observed. Hypotension has been the most frequent adverse event observed during treatment since the column was put on the market. It is very important to clarify the causes of both the efficacy and the side effects. A controlled prospective study is now in progress to clarify the efficacy more scientifically. The results will be published soon elsewhere.

Effects of Direct Hemoperfusion with a β₂-Microglobulin Adsorption Column on Hypercytokinemia in Rats

“…The BMG adsorption column consists of porous cellulose beads (pores of approximately 460 Ìm in diameter) [6], and has a ligand of the hexadecyl group on the surface and is able to adsorb BMG by hydrophobic interaction [7]. Whereas, the BMG adsorption column appears to adsorb various cytokines since they have hydrophobic amino acids like BMG.…”

“…It is easy to use this column, since it can be connected in series to a dialysis membrane on hemodialysis, and the reduction rate of BMG reaches more than 65-80% [7]. The BMG adsorption column has been reported to adsorb inflammatory cytokines and microorganism components such as endotoxin (ET) and peptidoglycans (PG) based on the adsorptive characteristics [8,9].…”

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] .…”

“…These approaches are based on biologically specifi c and nonspecifi c techniques. Biologically specifi c techniques are primarily based on immunoadsorption columns, which provide a high affi nity and specifi city for the targeted molecule of interest [10][11][12][13][14][15] . Unfortunately, these columns are still in experimental stages and have not been pursued in the clinical setting likely due to cost and stability issues.…”

“…Unfortunately, these columns are still in experimental stages and have not been pursued in the clinical setting likely due to cost and stability issues. Current clinical approaches to target and remove elevated levels of ␤ 2 m from the plasma are based on non-specifi c techniques such as size exclusion (for dialysis membranes used in high-fl ux hemodialysis, hemofi ltration, hemodiafi ltration) [4,[16][17][18][19][20][21] and hydrophobic adsorption in the case of hemoadsorption columns and some synthetic dialysis membranes [10][11][12][13][14][15][22][23][24][25][26][27] . 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.…”