The effects of three different LDL-apheresis methods on the plasma concentrations of E-selectin, VCAM-1, and ICAM-1
Klaus Empen1, Carsten Otto, Uli C Brödl
1Medical Department II, Ludwig-Maximilians-University, Klinikum Grosshadern, D-81366 Munich, Germany. Klaus.Empen@t-online.de
Insights
Different LDL-apheresis methods impact cardiovascular risk factors by reducing adhesion molecules. Heparin precipitation showed the most significant reduction in E-selectin levels, suggesting method-dependent adsorption effects.
Area of Science:
- Cardiovascular Science
- Biochemistry
- Medical Technology
Background:
- Plasma concentrations of cellular adhesion molecules are linked to atherosclerotic diseases and cardiovascular risk factors.
- Previous studies indicated LDL-apheresis with dextran sulfate reduces E-selectin and ICAM-1 in familial hypercholesterolemia.
- The comparative effects of various LDL-apheresis methods on adhesion molecules remained unstudied.
Purpose of the Study:
- To investigate the impact of different LDL-apheresis methods on plasma levels of adhesion molecules in patients with coronary heart disease and severe hyperlipoproteinemia.
- To compare the efficacy of direct absorption (DA), dextran sulfate adsorption (DS), and heparin precipitation (HP) LDL-apheresis methods in reducing adhesion molecules.
- To determine if adhesion molecule reduction during apheresis is due to adsorption onto the apheresis column.
Main Methods:
- Lipid profiles (cholesterol, triglycerides, LDL, HDL), fibrinogen, and adhesion molecules (E-selectin, VCAM-1, ICAM-1) were measured in 20 patients before and after LDL-apheresis.
- Patients underwent one of three LDL-apheresis methods: DA (n=6), DS (n=7), or HP (n=7).
- Rebound data for adhesion molecule levels were collected from two patients per group.
Main Results:
- All LDL-apheresis methods similarly reduced lipid levels.
- Heparin precipitation (HP) demonstrated the most significant reduction in E-selectin levels (-31%).
- VCAM-1 and E-selectin levels were significantly lower post-apheresis, indicating adsorption to the columns, with the extent varying by method.
Conclusions:
- The reduction in adhesion molecules during LDL-apheresis is partly attributable to adsorption onto the apheresis column, with the principle of LDL elimination influencing the extent of absorption.
- Heparin precipitation is particularly effective in reducing E-selectin levels compared to direct absorption and dextran sulfate methods.
- Adhesion molecule levels returned to pre-apheresis values within 2-4 days post-treatment.
Abstract:
Plasma concentrations of cellular adhesion molecules are associated with atherosclerotic diseases and major cardiovascular risk factors. It was shown that LDL-apheresis with dextran sulfate lowers the levels of E-selectin and ICAM-1 in patients with familial hypercholesterolemia. The effects of different LDL-apheresis methods have not been studied yet. Cholesterol, triglycerides, LDL cholesterol, HDL cholesterol, fibrinogen, and the adhesion molecules E-selectin, VCAM-1, and ICAM-1 were measured in 20 patients with coronary heart disease and severe hyperlipoproteinemia immediately before and after regular LDL-apheresis. Treatment was performed by different apheresis methods (direct absorption, DA, n = 6; dextran sulfate adsorption, DS, n = 7; heparin precipitation, HP, n = 7). Rebound data of adhesion molecule levels were obtained from 2 patients of each group. Lipids were reduced similarly in all groups. The concentrations of all adhesion molecules were lowered during apheresis. The reduction of E-selectin (-31 +/- 7 vs. -6 +/- 5 and -6 +/- 5%, respectively, P < 0.001) was most prominent in the patients treated by heparin precipitation. Depending on the method of LDL-apheresis, the concentrations of VCAM-1 and E-selectin in the outlets of the LDL-apheresis columns were significantly lower compared to the concentration in the inlets. Plasma concentrations of adhesion molecules increased to their pre-apheresis values within 2 to 4 days following LDL-apheresis. The reductions of adhesion molecule levels observed during LDL-apheresis are at least partly due to adsorption to the LDL-apheresis column. The extent of absorption depends on the principle of extracorporeal LDL elimination.
