Acute and long-term effects of low-density lipoprotein apheresis on the serum concentrations of vitamins E and A

Abstract

Serum alpha-tocopherol and retinol concentrations were followed in four heterozygous adults and one homozygous child with familial hypercholesterolemia being treated by regular low-density lipoprotein (LDL) apheresis. Approximately 50% of plasma alpha-tocopherol was eliminated during a single apheresis procedure in the heterozygous adults, while a complete elimination of this vitamin along with LDLs was observed in the homozygous child. Absolute losses of alpha-tocopherol amounted to 13.4-22.5 mg/apheresis and are equivalent to the recommended dietary intake for 1.5 to 2 days. Despite these losses, no changes were observed either in serum alpha-tocopherol levels or in the ratio of alpha-tocopherol/total serum lipids after 12 months regular apheresis treatment. Serum retinol concentrations only showed a small decrease on apheresis, there being apparently no specific elimination of this vitamin. The absolute losses ranged from 42-422 micrograms/apheresis and were, therefore, much lower than the recommended dietary intake of the equivalent of 1500 micrograms retinol/day. It is concluded that no extra supplementation of these vitamins is required during LDL-apheresis therapy, although it may be advisable to monitor vitamin E status in patients on long-term, intensive therapy.

Review: The Oxidant/Antioxidant Balance During Regular Low Density Lipoprotein Apheresis

“…unpublished observation). This result is surprising because, from the known elimination of lipophilic antioxidants due to the HELP procedure (44), the opposite, a shorter lag time, could be anticipated. Even though the precise mechanism of this observation is not clear, it is shared with Leitinger et al.…”

Effects of LDL‐immunoapheresis on plasma concentrations of vitamin E and carotenoids in patients with familial hypercholesterolemia

“…A number of studies have looked at atocopherol, b-carotene, and retinol in patients treated by LDL apheresis. Even though a-tocopherol, bcarotene, and retinol are partially removed by LDL apheresis, vitamin E deficiencies and impaired carotenoid status are rarely seen in patients treated with LDL apheresis, possibly also due to the fact that in many centers patients are routinely supplemented with vitamin E and occasionally perhaps also b-carotene [4,5]. Other carotenoids in plasma include canthaxanthin, which has been shown to be a more potent antioxidant than b-carotene [6], and lycopene, which has been described to be the most efficient biological oxygen quencher [7].…”

LDL-Apheresis: Technical and Clinical Aspects

“…Serious complications have never been observed [20], and the technology of the equipment has been improved over time. Many authors have shown that there is clear clinical evidence that a drastic lowering of LDL concentrations by HELP reduces significantly the rate of total and coronary mortality as well as the incidence of cardiovascular events in high-risk hypercholesterolemic patients [20, 23, 144, 146, 147]. Wang suggested that simultaneous reduction of proinflammatory and prothrombotic factors with atherogenic lipoproteins by HELP apheresis may contribute to improvement of endothelial dysfunction and thereby inhibit progression of atherosclerotic lesions and stabilize the existing plague [28].…”

“…Elimination of fibrinogen and other substances also has an influence on blood viscosity, rheology, and erythrocyte aggregation; thus, the microcirculatory situation as a whole can be significantly improved. Numerous reports on clinical results with the HELP technique have been published in recent years [18, 146, 152]. A selection of literature and LDL elimination has been compiled in Table 5.…”