Baseline-dependent immunometabolic effects of low-volume plasma exchange on inflammation and iron homeostasis in metabolic syndrome.

BACKGROUND

Metabolic syndrome (MetS) is characterized by chronic low-grade inflammation, metabolic endotoxemia, and dysregulation of iron and vitamin D homeostasis. Lipopolysaccharide (LPS) and LPS-binding protein (LBP) play key roles in linking metabolic and immune pathways.

OBJECTIVE

To evaluate the effects of low-volume plasma exchange (LVPE) on inflammatory markers, iron metabolism, and vitamin D status in adults with MetS, and to determine whether these effects depend on baseline biomarker levels.

METHODS

In this prospective interventional study, 48 adults with MetS underwent four LVPE sessions using a nanomembrane-based system. Anthropometric and biochemical parameters were assessed before and after treatment. Baseline-stratified analyses were performed to evaluate individualized responses.

RESULTS

LVPE significantly reduced C-reactive protein and increased transferrin levels, while vitamin D levels decreased. No significant changes were observed in IL-6, ferritin, serum iron, or LBP in the overall cohort. Baseline-stratified analyses revealed bidirectional, homeostatic effects, with normalization of both elevated and reduced biomarker levels. Reductions in inflammatory markers, particularly CRP, hsCRP, and LBP, were more pronounced in participants with higher baseline values, while individuals with low baseline levels remained largely unchanged.

CONCLUSION

LVPE acts as a baseline-dependent immunometabolic modulator in MetS, selectively reducing inflammation and normalizing iron-related parameters while preserving physiological stability. These findings support its potential as a personalized adjunctive therapy in cardiometabolic risk management.