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Extracorporeal removal of lipids by dextran sulfate cellulose adsorption
1Department of Nephrology, Medical School Hannover, Germany.
Insights
Dextran sulfate adsorption effectively removes low-density lipoprotein (LDL) cholesterol and lipoprotein (a) (Lp[a]) in patients with severe hypercholesterolemia. This extracorporeal treatment helps prevent or regress coronary heart disease with minimal side effects.
Area of Science:
- Cardiovascular Medicine
- Biochemistry
- Medical Technology
Background:
- Hypercholesterolemia, particularly diet and drug-resistant forms, poses a significant risk for coronary heart disease (CHD).
- Low-density lipoprotein (LDL) cholesterol and lipoprotein (a) (Lp[a]) are key atherogenic lipoproteins implicated in CHD pathogenesis.
Purpose of the Study:
- To evaluate the efficacy and safety of extracorporeal LDL apheresis using dextran sulfate adsorption.
- To assess the impact of this therapy on LDL cholesterol and Lp(a) levels in patients with resistant hypercholesterolemia.
Main Methods:
- Plasma separation followed by adsorption of LDL cholesterol and Lp(a) onto dextran sulfate-coated cellulose beads.
- Weekly apheresis treatments to achieve target LDL cholesterol levels.
Main Results:
- Achieved 65-75% reduction in LDL cholesterol and 40-60% reduction in Lp(a) per treatment.
- Mean LDL reduction to 100-150 mg/dl with typically one weekly treatment.
- Minor side effects in 2-6% of treatments; major side effects were rare.
Conclusions:
- Dextran sulfate LDL apheresis is an effective and safe treatment for resistant hypercholesterolemia, aiding in CHD prevention and regression.
- Potential benefits observed in improving tissue perfusion and treating nephrotic syndrome with hypercholesterolemia.
Abstract:
Extracorporeal removal of low-density lipoprotein (LDL) cholesterol by dextran sulfate adsorption is indicated in patients with diet and drug resistant hyper-cholesterolemia to prevent or to regress coronary heart disease. Plasma separation is the first step in the process, followed by adsorption of LDL cholesterol and lipoprotein (a) (Lp[a]) to negatively charged dextran sulfate covalently bound to cellulose beads. The reduction per treatment in LDL cholesterol is 65-75% and in Lp(a) 40-60%. In most patients one treatment per week is sufficient to reduce mean LDL to 100-150 mg/dl. Minor side effects occur in 2-6% of treatments. Major side effects are rare. In uncontrolled studies long-term treatment was associated with inhibition of progression and induction of regression of coronary artery disease. LDL apheresis by dextran sulfate may increase blood perfusion of some tissues, and preliminary results indicate a beneficial effect on therapy resistant nephrotic syndrome with hypercholesterolemia.