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Short- and long-term effects on serum lipoproteins by three different techniques of apheresis
W O Richter1, M G Donner, P Schwandt
1Medical Department II, Klinikum Grosshadern, Ludwig-Maxmilians-University of Munich, Germany.
Insights
Low-density lipoprotein (LDL) apheresis effectively lowers LDL cholesterol in severe hypercholesterolemia. Immunoadsorption, HELP, and dextran sulfate adsorption are powerful tools for managing inherited cholesterol disorders.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Medical Technology
Background:
- Severe inherited hypercholesterolemia poses challenges for conventional treatments.
- Low-density lipoprotein (LDL) apheresis is indicated when drug and dietary therapies fail to reduce LDL cholesterol below 130 mg/dl.
- Lipoprotein apheresis aims to reduce cardiovascular disease risk in specific patient populations.
Purpose of the Study:
- To evaluate the efficacy of different LDL apheresis techniques in lowering lipid levels.
- To compare the impact of immunoadsorption, HELP, and dextran sulfate adsorption on lipoprotein profiles.
- To assess changes in various lipoprotein fractions and related enzyme activities during apheresis.
Main Methods:
- A study involving 19 patients with severe hypercholesterolemia undergoing weekly LDL apheresis.
- Three apheresis methods were employed: immunoadsorption (n=6), Heparin-induced Extracorporeal LDL Precipitation (HELP) (n=5), and dextran sulfate adsorption (n=6).
- Lipoprotein levels, including LDL cholesterol, Lp(a), VLDL, and HDL, were monitored, along with lecithin cholesterol acyltransferase activity.
Main Results:
- All three apheresis methods significantly reduced LDL cholesterol.
- Immunoadsorption decreased LDL cholesterol by 149 mg/dl, HELP by 122 mg/dl, and dextran sulfate by 124 mg/dl.
- Lipoprotein (a) decreased by 52-65%, VLDL by 45-55%, and transient reductions in HDL were observed, with long-term HDL3 cholesterol increasing. Lecithin cholesterol acyltransferase activity decreased during procedures.
Conclusions:
- Immunoadsorption, HELP, and dextran sulfate adsorption are effective in lowering LDL cholesterol in severe inherited hypercholesterolemia.
- Immunoadsorption may be preferable for extremely severe cases due to its ability to process plasma without eliminating other essential constituents.
- Apheresis techniques demonstrate significant impact on lipoprotein metabolism, offering therapeutic options for refractory hypercholesterolemia.
Abstract:
Low-density lipoprotein (LDL) apheresis is applied in patients with coronary heart disease because of severe inherited forms of hypercholesterolemia, for which dietary and combined drug treatment cannot lower LDL cholesterol concentrations less than 130 mg/dl. The following article describes the changes in lipoprotein levels in a total of 19 patients undergoing weekly LDL apheresis. Immunoadsorption, operating with polyclonal antibodies against apolipoprotein B-100, was used in 6 patients. Five patients were put on heparin-induced extracorporeal LDL precipitation (HELP) therapy; 6 received dextran sulfate adsorption treatments. Under steady-state conditions a single treatment reduced LDL cholesterol by 149 + or - 3 mg/dl with immunoadsorption, 122 + or - 2 mg/dl with HELP, and 124 + or - 18 mg/dl with dextran sulfate adsorption. Lipoprotein (a) (Lp[a]) declined by 52 to 65%. Very low density lipoprotein (VLDL) cholesterol and VLDL triglycerides declined by 45 to 55% because of the activation of lipoprotein lipase and precipitation during the HELP procedure. In all procedures, there was a small reduction in the different high-density lipoprotein fractions, which had returned to normal after 24 h. The long-term HDL3 cholesterol levels increased significantly. During all procedures there was a decrease in the molar esterification rate of lecithin cholesterol acyltransferase activity. All changes in lipid fractions were paralleled by changes in the corresponding apolipoprotein levels. It is concluded that all three techniques described are powerful tools capable of lowering LDL cholesterol in severe hereditary forms of hypercholesterolemia. In HELP and dextran sulfate adsorption, the amount of plasma is limited by the elimination of other plasma constituents. Immunoadsorption may thus be preferred in very severe forms of hypercholesterolemia.