Direct adsorption of lipoproteins from whole blood by DALI apheresis: technique and effects
1Department I of Internal Medicine, University Hospital Munich-Grosshadern, Munich, Germany. bosch@med1.med.uni-muenchen.de
Insights
Low-density lipoprotein (LDL) apheresis using the DALI system effectively removes atherogenic lipoproteins. This hemoperfusion method simplifies treatment and shows good biocompatibility in coronary patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Biomedical Engineering
Background:
- Coronary patients often have high levels of atherogenic lipoproteins, such as low-density lipoprotein (LDL) and lipoprotein (a) (Lp[a]), that are resistant to conservative therapies.
- Effective reduction of these lipoproteins is crucial for managing cardiovascular disease.
- Existing apheresis methods can be complex and time-consuming.
Purpose of the Study:
- To evaluate the efficacy and safety of the DALI (LDL and Lp(a) adsorption by polyacrylate/polyacrylamide) system for LDL apheresis.
- To highlight DALI as a simplified hemoperfusion approach for clinical lipoprotein removal.
Main Methods:
- The DALI system directly adsorbs LDL and Lp(a) from whole blood using a polyacrylate/polyacrylamide filter.
- Citrate is used as an anticoagulant.
- The system was evaluated in terms of efficiency, biocompatibility, and clinical outcomes in a long-term study.
Main Results:
- DALI demonstrates high selectivity and capacity for lipoprotein removal, adsorbing up to 8g of LDL cholesterol per session.
- The procedure is biocompatible, showing no significant cell loss, hemolysis, or complement activation.
- A long-term study reported 93% of sessions were uneventful, with minor side effects like paresthesias (1.3%) and hypotension (0.8%).
Conclusions:
- DALI represents a simplified and effective LDL apheresis technique, directly adsorbing lipoproteins from whole blood.
- The system offers significant advantages in terms of handling, staff time, and treatment duration.
- With over 25,000 sessions performed globally, DALI is a proven and safe option for managing refractory hyperlipidemia in cardiovascular patients.
Abstract:
Low-density lipoprotein (LDL) apheresis can drastically reduce atherogenic lipoproteins in coronary patients in whom LDL and lipoprotein (a) (Lp[a]) cannot be sufficiently reduced by conservative therapy. LDL and Lp(a) adsorption by polyacrylate/polyacrylamide (DALI) is the simplest procedure for clinical LDL apheresis to date. DALI was first applied in patients in 1994 and introduced into clinical routine in 1996. It is the first LDL-hemoperfusion system, i.e., it adsorbs LDL and Lp(a) directly from whole blood. This markedly simplifies the extracorporeal circuit, the handling of the system, and reduces significantly staff time and, especially at higher blood flow rates, treatment time. Its features are high selectivity and capacity of lipoprotein removal (maximum about 8 g low-density lipoprotein cholesterol per session). Using citrate anticoagulation, good biocompatibility is evidenced by the lack of cell losses, hemolysis, thrombotic events, and complement activation. Some clotting factors of the intrinsic system are also adsorbed. There is significant bradykinin activation that, however, does not cause problems in most patients if angiotensin converting enzyme inhibitor medication is avoided. In a first long-term study, 93% of sessions were uneventful. Major side effects were citrate-induced paresthesias (1.3%) and hypotension (0.8%). To date, more than 25,000 DALI sessions have been performed all over the world.
