Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Walzl, B.; Walzl, Manfred; Valetitsch, H.; Lechner, H

doi:10.1159/000217153

Cited by 14 publications

(13 citation statements)

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“…Clinical reports have demonstrated that HELP and DELP systems can effectively remove TC, TG, LDL, LP(a), and fibrinogen from plasma; reduce blood viscosity; and increase local regional blood flow (6,14) to produce an increase in regional cerebral blood flow by 19.9% (16). In the present animal study, DELP apheresis significantly reduced TC and FIG.…”

Section: Discussionsupporting

confidence: 55%

Improved Neuronal Survival of Focal Ischemia After Delipid Extracorporeal Lipoprotein Treatment in Hyperlipidemic Rabbits

et al. 2011

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A delipid extracorporeal lipoprotein filter (DELP) system has been used to treat patients with stroke and has shown favorable prognosis. However, the mechanism for the neuronal functional recovery remains unclear. This study aimed to investigate the neuronal histological assessment, and the levels of C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), and oxidized low-density lipoprotein (oxLDL) after ischemic stroke following DELP treatment. Hyperlipidemic rabbits underwent middle cerebral artery occlusion. After 30 min, the animals received an extracorporeal apheresis treatment with a DELP filter. Total cholesterol (TC), triglyceride, and low-density lipoprotein (LDL) of the plasma were measured. The levels of CRP, TNF-α, and oxLDL in brain tissue were also measured by enzyme-linked immunosorbent assay. Hematoxylin and eosin staining, cresyl violet staining, neuron-specific enolase (NSE) and glial fibrillary acidic protein immunohistochemistry, and terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) assay were performed. DELP apheresis reduced TC and LDL by >30%. The number of neurons at day 7 (P < 0.01) and the integrated optical density of NSE at day 1 (P < 0.05) and day 7 (P < 0.01) were significantly increased in the DELP group. TUNEL-positive cells were significantly decreased (P < 0.05). Astrocytes were moderately activated, and this activation persisted up to 7 days. Gliosis was not found in the DELP group. After treatment, the level of CRP declined at day 1 (P < 0.05); TNF-α and oxLDL declined at day 7 (P < 0.05). DELP apheresis decreased neuronal apoptosis, reduced inflammatory markers and oxidative stress in cerebral ischemia, and improved neuronal survival.

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Section: Discussionsupporting

confidence: 55%

Improved Neuronal Survival of Focal Ischemia After Delipid Extracorporeal Lipoprotein Treatment in Hyperlipidemic Rabbits

et al. 2011

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“…It could be shown that arteriosclerosis of the carotid artery is associated with an increased fibrinogen plasma level [18]. A decreased red cell transit time results in a decrease in microcirculation [19]. The HELP system (Braun Melsungen) is designated for extracorporeal elimination of fibrinogen, total cholesterol, LDL cholesterol and triglycerides.…”

Section: Ooooooooooooooooomentioning

confidence: 99%

“…In this connection, wholeblood plasma viscosity will be lowered and red cell transit time will be increased. The HELP application is followed by an increase in CBF, thus improving microcirculation [19]. In comparison to HELP application, the effect of PTX administration is rather modest.…”

Section: Ooooooooooooooooomentioning

confidence: 99%

Status of Treatment of Vascular Dementia

Lechner¹

1998

Neuroepidemiology

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The therapeutic goal in treating vascular dementia has been based on its presumed association with cerebral arteriosclerosis. Therefore, it is necessary to control risk factors for arteriosclerosis. In this connection, application of platelet-aggregating substances has been used extensively. Promising results have also been observed by altering the hemorheologic profile because hemorheologically active substances may be able to ameliorate the course of vascular dementia. Further improvement could be achieved by application of the HELP system to enhance the effect of hemorheologically active drugs. Using the HELP system, LDL, cholesterol, triglycerides and fibrinogen can be lowered considerably and may result in clinical improvement or slowing of the progression of vascular dementia.

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“…The HELP system can effectively improve the parameters of hemorheology and the oxygentransfer properties of red blood cells in order to increase the cerebral blood flow. The study of Walzl et al showed that one HELP treatment can lead to the maximum increase in the regional cerebral blood flow by 19.9% (11).…”

Section: Discussionmentioning

confidence: 99%

“…The study of Walzl et al. showed that one HELP treatment can lead to the maximum increase in the regional cerebral blood flow by 19.9% (11).…”

Section: Discussionmentioning

confidence: 99%

Effects of HELP Therapy on Acute Ischemic Stroke and Vascular Endothelial Cell Function

et al. 2007

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To evaluate the therapeutic effects of the HELP system (heparin-induced extracorporeal low-density lipoprotein-apolipoprotein(a)-fibrinogen precipitation) in patients with acute ischemic stroke and probe into its possible mechanism, 10 patients with acute ischemic stroke were included in this study and received the HELP therapy in addition to low molecular weight dextran, salvia miltiorrhiza and aspirin. Matched with gender, age, European Stroke Scale (ESS) and fibrinogen, 20 patients with cerebral infarction treated with low molecular heparin were chosen as controls during the same period. We compared the efficacy and prognosis between the two groups. In order to clarify the effects of HELP treatment on endothelial function, human umbilical vein endothelial cells (HUVEC) were cultured with the serum of pre- and post-HELP therapy and control patients, then endothelial permeability and biomarkers of endothelial dysfunction or activation in the supernatant of incubated HUVEC, such as soluble thrombomodulin (sTM), soluble intracellular adhesion molecule-1 (sICAM-1) and monocyte chemoattractant protein-1 (MCP-1), were tested. Twenty-one days after treatment, ESS scores in the HELP group (70.4 +/- 23.06) were higher than those in control group (60.7 +/- 18.94), but there was no statistical significance (P > 0.05). In the HELP group, total efficacy rate reached 60% with ESS score (6 cases of recovery and efficacy, 4 cases of inefficacy), while it was 40% in control group (8 cases of recovery and efficacy, 12 cases of inefficacy), but unfortunately there was no significant difference between both groups using the chi(2)-test (P > 0.05). Interestingly, with the activities of daily living (ADL) score, the efficacy rate in the HELP group (60%) was markedly higher than that in the control group (20%) (P < 0.05). Furthermore, Pearson correlation analysis showed that the therapeutic window (the time from the patient's onset to receiving the therapy) was correlated to final ADL scores (P = 0.044) and the mean therapeutic window was 14.08 +/- 3.41 h in patients who achieved efficacy criteria. After therapy, no difference was found in hemorheology, fibrinogen, blood lipid, oxidized low-density lipoprotein (oxLDL) or C-reactive protein (CRP) in the control group, while there was a significant decrease in the HELP group immediately after treatment (P < 0.01). But the hospital stay time was similar between the HELP group and the controls (23.11 +/- 10.65 vs. 21.53 +/- 8.73 days; P > 0.05) and 21 days later, the dimension of the largest cross-sectioned infarction area by CT scan did not significantly change for the two groups' of patients (P > 0.05). When cultured with the patient's serum after HELP therapy, the concentration of sTM, sICAM-1, and MCP-1 in the supernatant of cultured HUVEC remained unchanged at 24 h (P > 0.05), while it was remarkably higher when HUVEC was cultured with the serum of the controls and patients before HELP therapy (P < 0.01), except for sTM. The endothelial permeability was also improved after the HELP ...

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Increased Cerebral Perfusion following Reduction of Fibrinogen and Lipid Fractions

Cited by 14 publications

References 11 publications

Improved Neuronal Survival of Focal Ischemia After Delipid Extracorporeal Lipoprotein Treatment in Hyperlipidemic Rabbits

Improved Neuronal Survival of Focal Ischemia After Delipid Extracorporeal Lipoprotein Treatment in Hyperlipidemic Rabbits

Status of Treatment of Vascular Dementia

Effects of HELP Therapy on Acute Ischemic Stroke and Vascular Endothelial Cell Function

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