Dextran‐sulfate‐adsorption of atherosclerotic lipoproteins from whole blood or separated plasma for lipid‐apheresis—Comparison of performance characteristics with DALI and lipidfiltration

Abstract

For many years dextran sulfate adsorption (DSA) treatment of separated plasma has been an established technology for low-density lipoprotein (LDL)-elimination. Recently a system for the treatment of whole blood based on DSA was introduced into clinical practice. To further characterize DSA treatment of whole blood, the performance characteristics of both DSA modalities were compared at two investigational sites with two alternative LDL apheresis systems being already in routine clinical use. In prospective cross-over design, DSA whole blood treatment was compared with a whole blood polyacrylate LDL adsorption system (DALI) in one study group. DSA for plasma treatment was compared with Lipidfiltration in cross-over design in a second study group. In total, 12 patients on chronic LDL apheresis received 169 treatments. Six patients were treated twice with whole blood polyacrylate adsorption and twice with whole blood DSA. LDL-cholesterol (74.9-78.0%) and lipoprotein (a) (72.1-73.3%) were reduced by both with equal efficacy. DSA achieved a significantly higher reduction rate of fibrinogen. Another six patients were treated eight times with DSA plasma adsorption followed by 16 Lipidfiltration treatments. LDL-cholesterol (67.0-70.2%) and lipoprotein (a) (69.2-73.7%) were reduced by both with equal efficacy. Fibrinogen was eliminated more efficiently by Lipidfiltration (50.2 vs. 38.5%). DSA proved to be a safe and effective in both treatment modes, for plasma as well as for whole blood. At the discretion of the apheresis specialist, depending upon the status of national approval, DSA of whole blood complements the armamentarium of powerful modalities for extracorporeal elimination of atherosclerotic lipoproteins to meet specific individual, medical, or logistic needs.

Comparison of different LDL apheresis methods

“…In a recent study comparing LS-DL100 adsorbers and the DALI system, the ability to reduce LDL-C was rather similar with both methods [6]. This is in accordance with another comparison [7].…”

“…In another study the LS DL-100 and the DALI systems were compared in six patients (two treatments with each method) [6]. The effect on fibrinogen concentrations was different between these methods (FIGURE 8A).…”

Long-term therapeutic efficacy of lipoprotein apheresis on circulating oxidative stress parameters – A comparison of two different apheresis techniques

“…Their substantial reduction by different apheresis techniques may constitute an additional beneficial mechanism of apheresis beyond lowering apoBcontaining lipoproteins [11]. The two lipoprotein apheresis techniques LF and DSA are safe and efficient therapeutic options for lipoprotein elimination and prevention of cardiovascular disease [12]. In contrast to LF, which implicates separation of plasma from blood cells, DSA does not require prior plasma separation procedure.…”

Different inflammatory responses induced by three LDL‐lowering apheresis columns

“…HDL-cholesterol is typically reduced from 10% to 20% [1] as we also noted. There are few studies comparing columns head-to-head, but Julius et al found a more pronounced decrease in LDL cholesterol in whole blood apheresis than in LDL plasma apheresis, however stating that both methods are clinically effective and that LDL reduction partly is a function of treated volume [32]. Poli and Busnach compared two different whole blood apheresis systems (direct adsorption with a polyacrylic acid column vs. adsorption with a modified dextran sulfate column) and found LDL reductions of 62% and 59%, respectively, in accordance with our findings [33].…”