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Long-term experience with extracorporeal low-density lipoprotein cholesterol removal by dextran sulfate cellulose
P Schulzeck1, C J Olbricht, K M Koch
1Abteilung Nephrologie, Medizinische Hochschule Hannover.
Insights
This study shows that LDL apheresis using dextran sulfate cellulose effectively lowers LDL cholesterol in familial hypercholesteremia patients resistant to other treatments. The procedure is safe and offers long-term benefits for managing coronary heart disease risk.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Medical Technology
Background:
- Familial hypercholesterolemia (FH) is characterized by elevated low-density lipoprotein cholesterol (LDL-C), leading to high coronary heart disease (CHD) incidence.
- Patients with FH often exhibit diet- and drug-resistant hypercholesterolemia, necessitating alternative treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of LDL apheresis using dextran sulfate cellulose adsorption for patients with severe, treatment-resistant FH.
- To assess the impact of LDL apheresis on lipid profiles and other blood components.
Main Methods:
- Five patients with FH and LDL-C > 230 mg/dl underwent LDL apheresis via the Liposorber System LA-15.
- The procedure involved plasma separation using a polysulfone hollow fiber filter and LDL adsorption onto dextran sulfate cellulose columns.
- Patients received 360 treatments at 7-day intervals, with treated plasma volume of 4.1 ± 0.4 L per session.
Main Results:
- LDL apheresis significantly reduced LDL-C by 28%, total cholesterol by 40%, and triglycerides by 70%.
- High-density lipoprotein cholesterol (HDL-C) showed a non-significant decrease, while high-density lipoprotein cholesterol (HDL-C) increased in three patients.
- Safety parameters indicated only minor changes, with adverse events occurring in 11 of 360 treatments.
Conclusions:
- Extracorporeal LDL apheresis using dextran sulfate cellulose adsorption is an effective and safe long-term treatment for patients with diet- and drug-resistant familial hypercholesterolemia.
- This therapy can significantly lower LDL-C levels, potentially reducing the risk of coronary heart disease in high-risk individuals.
Abstract:
Patients with familial hypercholesterolemia have a high incidence of coronary heart disease due to diet- and drug-resistant, elevated low-density lipoprotein cholesterol (LDL-C). Five patients with familial hypercholesterolemia and diet- and drug-resistant LDL-C greater than 230 mg/dl were treated by LDL apheresis using dextran sulfate cellulose adsorption (Liposorber System LA-15, Kaneka). Plasma separation was by 0.5-m2 polysulfone hollow fiber filter. Two columns containing 150 ml of dextran sulfate cellulose alternately adsorbed LDL and were regenerated by 4.1% saline. The five patients received a total of 360 treatments at 7-day intervals. The treated plasma volume per session was 4.1 +/- 0.4 l. Postapheresis values compared with preapheresis were: total cholesterol, 40%; LDL-C, 28%; VLDL-C, 65%; HDL-C, 95%; triglycerides, 70%; white blood cells, 116%; platelets, 87%; C3 complement, 79%; fibrinogen, 64%; albumin, 94%. The decrease in HDL-C per treatment was not significant. The safety parameters showed only slight changes. The initial LDL of 436 +/- 172 mg/dl decreased to mean pre-apheresis levels of between 150 and 100 mg/dl. The anti-atherogenic HDL increased in three and remained unchanged in two patients. Adverse events like hypotension, angina pectoris, and technical problems occurred in 11 of the 360 treatments. Long-term treatment of patients with diet- and drug-resistant familial hypercholesterolemia by extracorporeal dextran sulfate cellulose adsorption is effective and safe.