Therapeutic role of low-volume plasma exchange in modulating lipopolysaccharides-binding protein and inflammatory pathways in metabolic syndrome

Introduction Metabolic syndrome (MetSy) is associated with chronic low-grade inflammation and metabolic dysfunction, contributing to increased cardiometabolic risk. Low-volume plasma exchange (LVPE) is an emerging extracorporeal therapy designed to reduce systemic inflammation by removing circulating pro-inflammatory mediators. This study evaluated the effects of LVPE on metabolic endotoxemia, inflammation, and mineral metabolism in individuals with MetSy. Material and methods A total of 48 adults with MetSy were enrolled, including 33 men and 15 women, with an average age of 50 years (men: 51 years; women: 48 years). All participants met established diagnostic criteria for MetSy. Each underwent four LVPE cycles using nanoporous membranes designed to selectively remove pro-inflammatory mediators while preserving essential plasma components. Biomarkers of systemic inflammation (CRP, hsCRP), endotoxemia (LBP, zonulin), and mineral metabolism (zinc, magnesium, iron) were measured before and after treatment. Results LVPE significantly reduced CRP levels (p < 0.020), demonstrating attenuation of systemic inflammation. A downward trend in hsCRP was observed (p < 0.050), though without reaching statistical significance. LVPE did not significantly affect endotoxemia markers (LBP, zonulin) or IL-6 (all p > 0.05). A significant post-treatment increase in zinc levels was detected (p < 0.009), while magnesium and iron remained unchanged (p > 0.05). A significant correlation between LBP and CRP after treatment (p < 0.027) suggests that LVPE may modulate systemic inflammation through immune regulatory pathways rather than by directly influencing endotoxemia. Conclusions Four cycles of LVPE effectively reduced low-grade inflammation, as indicated by decreased CRP levels, supporting its potential role as a therapeutic approach in managing inflammation in MetSy. Its effects on endotoxemia and gut permeability remain inconclusive, underscoring the need for additional research to clarify long-term and mechanistic outcomes.