Comparative long-term experience with immunoadsorption and dextran sulfate cellulose adsorption for extracorporeal elimination of low-density lipoproteins

Abstract

Two low-density lipoprotein (LDL) apheresis methods allowing a specific extracorporeal removal of atherogenic lipoproteins from plasma were compared concerning their efficacy and safety in the long-term therapy of severe familial hypercholesterolemia. Five patients were treated with immunoadsorption (IMA) at weekly intervals over 3 years each, and three patients received weekly therapy with dextran sulfate cellulose adsorption (DSA) for up to 2 years. The mean plasma volume processed per session to decrease total cholesterol to a target level of 100-150 mg/dl at the end of LDL apheresis was significantly lower in DSA than in IMA: 143% vs. 180% of the individual plasma volume. Both LDL apheresis procedures achieved a mean acute reduction of plasma LDL cholesterol by more than 70%. The average interval concentrations of plasma LDL cholesterol obtained without concomitant lipid-lowering medication were 151 +/- 26 mg/dl compared to 351 +/- 65 mg/dl at baseline in the IMA-treated patients and 139 +/- 18 mg/dl compared to 359 +/- 48 mg/dl at baseline in the DSA-treated patients. Two patients from the DSA group died after 2 years of study participation due to a stroke and a sudden cardiac death several days after the last plasma therapy. Treatment-related side effects were infrequent. Long-term therapy with IMA and DSA was associated with symptomatic improvement of coronary artery disease and mobilization of tissue cholesterol deposits. Analysis of coronary angiograms after 3 years of weekly LDL apheresis with IMA revealed in five patients nearly identical atherosclerotic lesions without definite regression or progression.

Current management of severe homozygous hypercholesterolaemias

“…Subsequently, attempts were made to remove LDL selectively [46,47] and several techniques for selective removal of LDL, termed LDL apheresis, are in current use: immunoadsorption, dextran sulphate-cellulose adsorption (DSA), heparin extracorporeal LDL precipitation system (HELP) and direct adsorption of lipoprotein using haemoperfusion (DALI). Comparison of these methods [48][49][50][51][52] In addition to, or perhaps because of, the profound cholesterol-lowering effects of LDL apheresis, several other potentially beneficial phenomena have been documented: decreased oxidability of LDL [57], improved vascular endothelial function and haemorheology [58,59], reduction in lipoprotein (a) and procoagulatory status [48,60,61], decrease in adhesion molecules [62,63] and C-reactive protein [64 . ]. The extent of changes in these non-LDL cholesterol parameters depends on the method used for extracorporeal LDL elimination.…”

Adsorption of lipoproteins with the aid of carboxymethylchitosan mircrospheres crosslinked with poly(ethylene glycol) bisglycidyl ether

“…The use of LDL apheresis in the treatment of patients with homozygous familial hypercholesterolemia (FH) and severe heterozygous FH provides an effective means of reducing LDL in plasma and has gained broad clinical acceptance during recent years (Bosch et al, 2006;Dräger et al, 1998;Knisel et al, 1994;Moriarty, Gibson, Shih, & Matias, 2001;Richter et al, 1993). But there are limitations to extending the application of the techniques.…”