Application of a new LDL apheresis system using two dextran sulfate cellulose columns in combination with an automatic column‐regenerating unit and a blood cell separator

Abstract

Extracorporeal procedures for selective removal of low-density lipoproteins have become a promising new approach for treatment of severe familial hypercholesterolemia. We tested efficacy and safety of a new LDL apheresis system by using two dextran sulfate cellulose adsorbents (Liposorber LA 15TM from Kanegafuchi) under the control of an automatic column-regenerating unit for continuous alternate adsorption and desorption. Plasma was taken from a continuous-flow blood cell separator (model IBM/Cobe 2997) allowing an extracorporeal circuit from one cubital vein to another. A 57-year-old male with drug-resistant heterozygous familial hypercholesterolemia accompanied by moderate hypertriglyceridemia and severe coronary artery disease has been treated every 2 weeks for 3 months so far. Treatment of 4-5 liters of plasma resulted in a mean decrease of total cholesterol from 355 to 111 mg/dl (9.20 to 2.88 mmol/l), of LDL cholesterol from 272 to 49 mg/dl (7.05 to 1.53 mmol/l), and of apolipoprotein B from 175 to 44 mg/dl. HDL cholesterol, apolipoprotein A-I, and other plasma proteins did not substantially change apart from hemodilution. No side effects were seen. This new technique of LDL apheresis represents a very effective and safe method for treatment of drug-resistant familial hypercholesterolemia without or with concomitant hypertriglyceridemia.

Adverse Events in Therapeutic Apheresis: A Single Center Survey of Various Therapies

“…All patients who underwent therapeutic apheresis at the Osaka Red Cross Hospital from October 2004 to October 2008 were included in the study. A total of 854 apheresis sessions were performed for 171 patients using 10 different apheresis therapies: leukocytapheresis (LCAP) (3), LDL adsorption (LDL‐A) (4,5), simple plasma exchange (SPE), granulocyte and monocyte adsorptive apheresis (GMA) (6), double‐filtration plasmapheresis (DFPP) (7), ascitic extracorporeal ultrafiltration method (A‐ECUM), immunoadsorption (IA) (8–10), bilirubin adsorption (BA) (11,12), endotoxin adsorption (EA) (13), and activated charcoal adsorption (ACA) (14). These therapies were performed by doctors, clinical engineers, and nurses with wide experience in extracorporeal circulation treatment.…”

Charge selectivity of the glomerular filtration barrier in healthy and nephrotic humans.

“…Adsorbent columns containing dextran sulfate have recently been shown by Knisel et al (20) to remove a variety of serum proteins during the extracorporeal circulation of human plasma. To estimate the extent of protein binding by DS we performed in vitro experiments using both equilibrium dialysis (Spectrum Medical Industries, Los Angeles, CA) and a stirred cell ultrafiltration apparatus (Amicon Corp., Beverly, MA).…”

Assessment of Currently Available Low‐Density Lipoprotein Apheresis Systems

“…1, 1994 Total number of patients, 11; total number of procedures, 54. of atherosclerosis, an adsorbent system that does not remove fibrinogen has some disadvantages. However, in the clinical setting, approximately a 20-30% reduction of fibrinogen takes place due to the removal of the patient's plasma during the washing cycle of the cartridge for regeneration of adsorbents (17). Figures 5 , 6, and 7 give data for protein removal by these systems.…”