V. Tesar et al., INFLUENCE OF PLASMA-EXCHANGE ON SERUM LEVELS OF CYTOKINES AND ADHESION MOLECULES IN ANCA-POSITIVE RENAL VASCULITIS, Blood purification, 16(2), 1998, pp. 72-80
Background: Increased serum levels of proinflammatory cytokines may co
ntribute to the organ damage in active antineutrophil cytoplasmic anti
gen (ANCA)-positive renal vasculitis. Plasma exchange (PE) may influen
ce the activity of vasculitis not only by removing pathogenic autoanti
bodies, but also by lowering the serum levels of circulating cytokines
. Methods: Serum levels of IL-1 beta, IL-1ra, IL-6, IL-8, ICAM-1 and V
CAM-1 were measured using ELISA in 10 patients with active ANCA-positi
ve renal vasculitis (5 patients with Wegener's granulomatosis, WG, and
5 patients with microscopic polyangiitis, MPA) during the course of t
herapeutic PE. Cytokines and adhesion molecules were measured in sampl
es of serum obtained al the beginning and at the end of the Ist, 3rd a
nd 5th PE and in samples of filtrate obtained during the same PE. Resu
lts: In comparison with controls, patients with ANCA had higher serum
les els of IL-1ra. IL-8, ICAM-1 and VCAM-1 before the ist PE, Serum le
vels of IL-6, IL-8, ICAM-1 and VCAM-1 were increased in patients with
MPA, and the serum levers of all the cytokines and adhesion molecules
measured in patients sith WG were increased. At the end of the PE cour
se there were decreases in the serum levels of IL-lr-a and VCAM-1 in A
NCA patients and IL-Ira and ICAM-1 in WG patients. Single PE in ANCA p
atients led only to a decrease in serum levels of ICAM-1 and VCAM-1. O
n the other hand, there was no change in serum levels of IL-1 beta and
IL-8, and the serum levels of IL-Ira and IL-6 even increased at the e
nd of a single PE, in spite of high levels of all cytokines and adhesi
on molecules in the plasma filtrate. Conclusion: Serum levels of solub
le adhesion molecules decrease after PE, but serum levels of proinflam
matory cytokines are not reduced even by a PE course. Removal of these
substances bu PE is obviously counteracted by their increased product
ion, possibly further stimulated by the contact of blood with the synt
hetic membrane, The insufficient influence of PE on the elimination hi
. proinflammatory cytokines may partially explain its limited effect i
n some patients with ANCA-positive renal vasculitis.