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Effectiveness of cascade filtration plasmapheresis in two patients affected by familial hypercholesterolemia
C M Barbagallo1, M R Averna, T DiMarco
1Department of Internal Medicine and Geriatrics, University of Palermo, Italy.
Insights
Cascade filtration plasmapheresis effectively reduces LDL cholesterol and other risk factors in patients with severe hypercholesterolemia. This non-pharmacological approach offers significant reductions in total cholesterol, triglycerides, Lp(a), and fibrinogen.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Medical Technology
Background:
- Hypercholesterolemia is a major risk factor for coronary heart disease (CHD).
- Lowering plasma total and LDL cholesterol levels can reduce coronary atherosclerosis.
- Plasmapheresis is a non-pharmacological treatment for severe hypercholesterolemias.
Observation:
- Two young males (16 and 26 years) with homozygous familial hypercholesterolemia and severe coronary atherosclerosis underwent cascade filtration plasmapheresis every 7 days.
- Procedures resulted in significant reductions in plasma lipids and proteins.
Findings:
- Mean reduction in total cholesterol: 59.5%
- Mean reduction in LDL cholesterol: 61.6%
- Significant reductions observed in triglycerides (48.1%), HDL-cholesterol (31.1%), apo A-I (30.8%), apo B (57.6%), fibrinogen (49.9%), and Lp(a) (59.9%).
- Approximately 8g of cholesterol removed per procedure.
- Temporary decreases in total proteins and albumin were fully restored within a week.
Implications:
- Cascade filtration plasmapheresis is an effective method for removing LDL cholesterol in severe hypercholesterolemia.
- The system's lack of selectivity is advantageous, as it also reduces other cardiovascular risk factors like Lp(a) and fibrinogen.
- This technique provides comparable results to more selective methods, offering a viable treatment option.
Abstract:
Hypercholesterolemia has been recognised as a primary risk factor for coronary heart disease. Reduction of plasma levels of total and LDL cholesterol has been shown to decrease coronary atherosclerosis. Plasmapheresis represents an useful non-pharmacological tool to treat severe hypercholesterolemias. We have evaluated the effectiveness of a system of plasmapheresis using a cascade filtration method in two young male subjects (aged 16 and 26 years) with homozygous familial hypercholesterolemia. Both showed severe coronary atherosclerosis as determined by angiography. Procedures were performed at intervals of 7 days in each case. We observed a mean reduction of plasma levels of total cholesterol of 59.5% (range 31.0-75.5%); LDL-cholesterol, 61.6% (range 32.6-77.1%); triglycerides, 48.1%; HDL-cholesterol, 31.1%; apo A-I, 30.8%; and apo B, 57.6%. We also noted a reduction of other parameters, such as fibrinogen (49.9%) and Lp(a) (59.9%). At the end of each procedure about 8 g of cholesterol was removed from the total body pool. A decrease of total proteins (26.9%) and albumin (19.6%) was also observed, but this was completely restored before the next apheresis (1 week). These data show the effectiveness of the removal of LDL in a cascade filtration system, which obtains results not very different from other more selective methods. The lack of selectivity is not much of a problem, since it also reduces other risk factors such as Lp(a) and fibrinogen.