Different inflammatory responses induced by three LDL‐lowering apheresis columns

Hovland, Anders; Hardersen, Randolf; Sexton, Joe; Mollnes, Tom Eirik; Lappegård, Knut Tore

doi:10.1002/jca.20223

Cited by 36 publications

(37 citation statements)

References 34 publications

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“…In contrast to wholeblood devices, reductions in systolic BP using the PSDS-device were less profound (approximately 10-20 mmHg in most cases) and immediately improved with saline administration and reducing blood flow rates. Whether this attenuation can be attributed to differential effects on cytokine/chemokine activation by different apheresis columns 30 will require further study.…”

Section: Discussionmentioning

confidence: 99%

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Thadhani¹,

Hagmann²,

Schaarschmidt³

et al. 2016

Journal of the American Society of Nephrology

219

145

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Preeclampsia is a devastating complication of pregnancy. Soluble Fms-like tyrosine kinase-1 (sFlt-1) is an antiangiogenic protein believed to mediate the signs and symptoms of preeclampsia. We conducted an open pilot study to evaluate the safety and potential efficacy of therapeutic apheresis with a plasmaspecific dextran sulfate column to remove circulating sFlt-1 in 11 pregnant women (20-38 years of age) with very preterm preeclampsia (23-32 weeks of gestation, systolic BP $140 mmHg or diastolic BP $90 mmHg, new onset protein/creatinine ratio .0.30 g/g, and sFlt-1/placental growth factor ratio .85). We evaluated the extent of sFlt-1 removal, proteinuria reduction, pregnancy continuation, and neonatal and fetal safety of apheresis after one (n=6), two (n=4), or three (n=1) apheresis treatments. Mean sFlt-1 levels were reduced by 18% (range 7%-28%) with concomitant reductions of 44% in protein/creatinine ratios. Pregnancy continued for 8 days (range 2-11) and 15 days (range 11-21) in women treated once and multiple times, respectively, compared with 3 days (range 0-14) in untreated contemporaneous preeclampsia controls (n=22). Transient maternal BP reduction during apheresis was managed by withholding pre-apheresis antihypertensive therapy, saline prehydration, and reducing blood flow through the apheresis column. Compared with infants born prematurely to untreated women with and without preeclampsia (n=22 per group), no adverse effects of apheresis were observed. In conclusion, therapeutic apheresis reduced circulating sFlt-1 and proteinuria in women with very preterm preeclampsia and appeared to prolong pregnancy without major adverse maternal or fetal consequences. A controlled trial is warranted to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Thadhani¹,

Hagmann²,

Schaarschmidt³

et al. 2016

Journal of the American Society of Nephrology

219

145

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“…Although all columns lowered LDL-C to the same extent [12], hematological and hemostatic parameters, as well as homocysteine, were differently affected by the three apheresis columns DL-75, LA-15, and EC-50W. To our knowledge, this is the first time these three columns have been compared in a systematic manner with respect to these clinically relevant biomarkers.…”

Section: Discussionmentioning

confidence: 80%

“…The study design including treatment regimen, columns and patients has been described in detail previously [12]. It was a cross-over study in which three patients already established in long term LDL apheresis treatment underwent six consecutive treatments with three different LDL apheresis columns.…”

Section: Methodsmentioning

confidence: 99%

“…We have recently demonstrated how three LDL apheresis columns induced different inflammatory responses [12]. The hemostatic factors are inevitably altered by mandatory use of anticoagulants during treatment, furthermore the level of fibrinogen, which is important for red blood cell aggregation in LDL apheresis, is also reduced during LDL apheresis [13,14] and possibly also in acute cardiovascular syndromes [15].…”

Section: Introductionmentioning

confidence: 99%

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Hematologic and hemostatic changes induced by different columns during LDL apheresis

Hovland

Hardersen

Mollnes

et al. 2010

J of Clinical Apheresis

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Low density lipoprotein (LDL) apheresis is a long-term treatment and its impact on risk factors other than lipoproteins could be of importance. Three patients with familial hypercholesterolemia participated in six consecutive treatments with three different LDL apheresis columns in random order: DL-75, LA-15, and EC-50W. We compared treatment effects on hemoglobin, leukocytes, platelets, fibrinogen, thrombin-antithrombin complexes (TAT), plasminogen activator inhibitor-1 (PAI-1), and homocysteine. Hemoglobin, leukocytes and platelets decreased significantly with DL-75 (P < 0.05). Hemoglobin and leukocytes increased significantly with LA-15 and EC-50W (P < 0.05). Platelets were unchanged. The DL-75 column was statistically different from LA-15 and EC-50W regarding these parameters. With the columns DL-75, LA-15, and EC-50W fibrinogen decreased significantly by 28%, 32%, and 42%, PAI-1 decreased significantly by 72%, 58%, and 30% while TAT increased significantly by 138%, 3%, and 251%, respectively (P < 0.05 for all). When comparing the columns there were significant differences between all of them regarding fibrinogen, no differences regarding TAT and a difference between DL-75 and EC-50W regarding PAI-1. With the columns DL-75, LA-15 and EC-50W homocysteine decreased 22%, 9%, and 13%, respectively, but there were no inter column differences. In conclusion, the three LDL apheresis columns affected important hematological and hemostatic risk factors differently.

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“…As of today, no therapeutic option to specifically lower the CRP amount in humans in an acute care situation as encountered in AMI is available. Only unspecific apheresis like lipid apheresis, cascade filtration [17,18] and fibrinogen apheresis [19] has been shown to remove CRP and other serum proteins in humans in addition to their intended use. A renowned model for AMI is the closed chest infarction model in the pig.…”

Section: Discussionmentioning

confidence: 99%

Specific Removal of C-Reactive Protein by Apheresis in a Porcine Cardiac Infarction Model

Slagman¹,

Bock²,

Abdel-Aty

et al. 2010

Blood Purif

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it is possible to conduct apheresis at the following 2 days after acute myocardial infarction in a porcine infarction model and to analyze the infarct by cardiovascular magnetic resonance imaging at day 1 and 14. Copyright © 2010 S. Karger AG, Basel C-reactive protein (CRP), a classical acute phase protein, has been extensively studied as a systemic marker of inflammatory processes. During acute myocardial infarction (AMI), the circulating CRP concentration increases and its level predicts the outcome of AMI [1][2][3] . However, there is still a controversy whether CRP is only a marker or a risk factor, contributing causative to myocardial damage after AMI.In rats, administration of human CRP after ligation of the coronary artery reproducibly enhanced infarct size by up to 40% [4,5] . They received 40 mg/kg of isolated pure human CRP by intraperitoneal injection 1 h after coro- Key WordsAcute myocardial infarction ؒ Acute phase protein ؒ Adsorber ؒ Apheresis ؒ C-reactive protein Abstract Background: C-reactive protein (CRP) is a possible causative factor of the destructive processes observed during the weeks after myocardial infarction. Methods: We developed a clinically relevant animal model including the removal of CRP from blood plasma utilizing a specific CRP adsorber and the visualization of the infarct scar in the living animal by cardiovascular magnetic resonance imaging as a tool to investigate the impact of CRP after acute myocardial infarction. Results: We describe the facets of this model system and kinetics of clinical blood parameters like CRP and troponin. In addition, we demonstrate the potency of CRP apheresis reducing CRP levels by ϳ 70% in the established treatment system. Conclusion: We showed for the first time that

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Different inflammatory responses induced by three LDL‐lowering apheresis columns

Cited by 36 publications

References 34 publications

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Removal of Soluble Fms-Like Tyrosine Kinase-1 by Dextran Sulfate Apheresis in Preeclampsia

Hematologic and hemostatic changes induced by different columns during LDL apheresis

Specific Removal of C-Reactive Protein by Apheresis in a Porcine Cardiac Infarction Model

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