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Updated: Sep 20, 2026
Isolation and Analysis of Plasma Lipoproteins by Ultracentrifugation
Published on: January 28, 2021
Low-density lipoprotein apheresis: an overview
Rolf Bambauer1, Ralf Schiel, Reinhard Latza
1Institute for Blood Purification Homburg/Saar, Germany. rolf.bambauer-praxis-homburg@t-online.de
Insights
Low-density lipoprotein (LDL) apheresis effectively treats severe familial hypercholesterolemia resistant to other therapies. This safe, long-term treatment significantly reduces cholesterol and improves patient well-being.
Area of Science:
- Cardiovascular Medicine
- Metabolic Disorders
- Medical Technology
Background:
- Atherosclerosis, a leading cause of death, is linked to risk factors including hyperlipidemia.
- Severe hyperlipidemia and elevated lipoprotein (a) (Lpa) in coronary heart disease (CHD) patients resistant to conventional treatment have a poor prognosis.
- Low-density lipoprotein (LDL) apheresis offers a therapeutic option for such patients.
Purpose of the Study:
- To evaluate the efficacy and safety of LDL apheresis in patients with familial hypercholesterolemia refractory to maximal conservative therapy.
- To assess the long-term outcomes and lipid-lowering effects of different LDL apheresis systems.
Main Methods:
- A study involving 45 patients (25 women, 20 men) with familial hypercholesterolemia resistant to diet and lipid-lowering drugs.
- Treatment involved regular LDL apheresis using four different systems (Liposorber, Therasorb, Lipopak, Dali) over an average of 95.6 months.
- Lipid profiles including total cholesterol, LDL, HDL, triglycerides, and Lpa levels were monitored.
Main Results:
- All LDL apheresis methods achieved significant reductions: 57% total cholesterol, 55.9% LDL, 75.8% Lpa, and 45.9% triglycerides.
- High-density lipoprotein (HDL) levels increased by an average of 14.3%.
- Severe side effects were rare (0.3%), and 44 out of 45 patients reported improved well-being and performance.
Conclusions:
- LDL apheresis is a highly effective and safe long-term treatment for familial hypercholesterolemia resistant to maximum conservative therapy.
- The treatment leads to substantial improvements in lipid profiles, including significant reduction in LDL and Lpa.
- Patients experience enhanced quality of life and performance during long-term LDL apheresis therapy.
Abstract:
Atherosclerosis with myocardial infarction, stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial hypertension, diabetes mellitus, and central obesity. Furthermore, there is a strong correlation between hyperlipidemia and atherosclerosis. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lpa) levels, and coronary heart disease (CHD) refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are four different LDL apheresis systems available: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL adsorption and LDL hemoperfusion. Regarding the different LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein (HDL), or triglyceride concentrations. With respect to elevated Lpa levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low-density lipoprotein (LDL) apheresis was performed over 95.6 +/- 44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total cholesterol, 55.9% for LDL, 75.8% for lipoprotein a (Lpa), and 45.9% for triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as shock or allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. The present data demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe even in long-term application.
