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In vitro and in vivo studies with different precipitate filter cartridges for H.E.L.P.-LDL-apheresis. Optimization of
G Morsch1, F Maywald, C Wanner
1B. Braun Melsungen AG, Sparte Medizintechnik, Abt. Extrakorporale Blutbehandlung, Melsungen, Germany.
Insights
Heparin-induced extracorporeal LDL-precipitation (HELP) effectively lowers high cholesterol. Modifying filter design increases plasma treatment volume, benefiting patients with familial hypercholesterolemia and nephrotic syndrome.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Biomedical Engineering
Background:
- Familial hypercholesterolemia causes high cholesterol and coronary heart disease.
- Current treatments aim to improve lipid filtration efficiency.
Purpose of the Study:
- To enhance the filtration capacity of the Heparin-induced extracorporeal LDL-precipitation (HELP) system.
- To optimize filter design for increased plasma treatment volume.
Main Methods:
- Varied nominal filtration area by adjusting pleat count and membrane configuration.
- Tested filters in vitro with healthy donor plasma and in vivo with patients.
- Evaluated filter performance based on pressure drop and treated plasma volume.
Main Results:
- Filter configuration and volume influenced pressure drop.
- Reduced pleat number and filtration area, with thicker membrane supports, increased treatable plasma volume.
- Optimal results achieved with 0.8 +/- 0.1 m2 filters and triple thick supports.
Conclusions:
- Optimized HELP system filters increase plasma treatment capacity.
- Enhanced HELP system effectively treats patients with familial hypercholesterolemia and nephrotic syndrome, even with extreme plasma viscosity.
Abstract:
Heparin-induced extracorporeal LDL-precipitation has successfully been used in lowering high serum cholesterol in patients with coronary heart disease due to familial hypercholesterolemia. In the continuous search to improve treatment facilities we attempted to increase the filtration capacity of low density lipoprotein by the precipitate filter of the H.E.L.P.-system. Therefore, the nominal filtration area was varied by decreasing the pleat count as well as the configuration of the precipitation filter membrane. The device was tested in vitro using fresh frozen plasma from healthy donors as well as in vivo treating 6 patients suffering from familial hypercholesterolemia and 18 patients with the nephrotic syndrome. The data show that the drop in pressure on the filtration side depended on the filtration volume and the filter configuration. Reducing the pleat number and in parallel the nominal filtration area by replacing the standard support on the outside of the membrane by a double or triple thick support results in an increase in plasma volume which can be treated. The optimal results were obtained using filters with a nominal filtration area of 0.8 +/- 0.1 m2 and a triple thick support on the retention side compared to the standard configuration. Therefore, even patients with extreme plasma viscosity such as patients with the nephrotic syndrome can effectively be treated by heparin-induced LDL-precipitation.