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.