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Effect of different LDL-apheresis methods on parameters involved in atherosclerosis
Tiberiu Hershcovici1, Vered Schechner, Jerome Orlin
1Lipid Unit, and Department of Medicine A, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
Insights
Direct LDL apheresis (DSA), direct adsorption of lipoprotein (DALI), and plasma exchange effectively reduce LDL cholesterol in severe hypercholesterolemia. DALI showed the highest LDL removal, while plasma exchange was least effective.
Area of Science:
- Cardiology
- Biochemistry
- Medical Technology
Background:
- Severe hypercholesterolemia requires effective LDL reduction strategies.
- Apheresis methods offer an alternative for patients unresponsive to drug therapy.
Purpose of the Study:
- To compare the effectiveness of three LDL apheresis methods: direct LDL apheresis (DSA), direct adsorption of lipoprotein (DALI), and plasma exchange.
- To evaluate the impact of these procedures on blood parameters linked to atherogenesis.
Main Methods:
- Six patients with severe hypercholesterolemia underwent sequential apheresis treatments.
- Treatments included plasma exchange, DSA, and in some cases, DALI.
- Lipoprotein levels, apoproteins, CRP, homocysteine, fibrinogen, and blood counts were measured pre- and post-treatment.
Main Results:
- All three apheresis methods significantly reduced total cholesterol and ApoB-lipoproteins.
- DALI demonstrated the highest efficacy in LDL removal.
- Significant reductions in triglycerides, HDL, and ApoA1 were observed across all methods.
- DSA and DALI led to a greater reduction in HDL-C than previously reported.
- The LDL/HDL-cholesterol ratio decreased with DSA and DALI, but increased with plasma exchange.
- CRP, fibrinogen, and platelets decreased with all methods; homocysteine decreased with DSA and DALI only.
Conclusions:
- All tested apheresis procedures effectively reduce atherogenic compounds.
- DALI is the most effective LDL apheresis method among those studied.
- Plasma exchange is nonselective and not recommended as the primary apheresis choice for hypercholesterolemia.
Abstract:
LDL-apheresis lowers the LDL level in patients with severe hypercholesterolemia. The present study compared three apheresis methods--DSA, DALI, and plasma exchange--for effectiveness in removal of LDL and effect on various blood parameters involved in atherogenesis. The study group included 6 patients with primary hypercholesterolemia unresponsive to maximal drug therapy. All were treated first with 4 consecutive plasma exchange sessions followed by 4 DSA sessions; in four out of six, an additional 4 sessions of DALI were then performed. Levels of lipoproteins, apoproteins, CRP, homocysteine, fibrinogen, and blood count were determined before and after each session. All 3 procedures yielded a significant reduction in total cholesterol and ApoB-containing lipoproteins, with DALI being the most effective. Also, a significant reduction in triglycerides, HDL, and ApoA1 was observed with all the methods. The reduction in HDL-C with DSA and DALI was greater than previously reported. The LDL/HDL-cholesterol ratio decreased significantly with DSA and DALI and increased with plasma exchange. There was a significant decrease in CRP, fibrinogen, and platelets with all three methods, and a significant decrease in homocysteine only with DSA and DALI. All three procedures effectively reduced the concentration of various compounds involved in atherosclerosis. Plasma exchange is nonselective and cannot be recommended as the procedure of choice.
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