LDL-Apheresis: Technical and Clinical Aspects

Abstract

<jats:p>The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) levels, and coronary heart disease refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are five different LDL-apheresis systems available: cascade filtration or lipid filtration, immunoadsorption, heparin-induced LDL precipitation, dextran sulfate LDL adsorption, and the LDL hemoperfusion. There is a strong correlation between hyperlipidemia and atherosclerosis. Besides the elimination of other risk factors, in severe hyperlipidemia therapeutic strategies should focus on a drastic reduction of serum lipoproteins. Despite maximum conventional therapy with a combination of different kinds of lipid-lowering drugs, sometimes the goal of therapy cannot be reached. Hence, in such patients, treatment with LDL-apheresis is indicated. Technical and clinical aspects of these five different LDL-apheresis methods are shown here. There were no significant differences with respect to or concerning all cholesterols, or triglycerides observed. With respect to elevated lipoprotein (a) levels, however, the immunoadsorption method seems to be most effective. The different published data clearly demonstrate that treatment with LDL-apheresis in patients suffering from severe hyperlipidemia refractory to maximum conservative therapy is effective and safe in long-term application.</jats:p>

Lomitapide: a novel drug for homozygous familial hypercholesterolemia

“…Different apheresis techniques have been developed over the years, including dextran sulphate cellulose adsorption, heparin-induced extracorporeal LDL-C precipitation, immunoadsorption and double filtration plasmapheresis [18,19,103]. The two approved methods by the FDA are the LiposorberVR system and the heparin-induced extracorporeal LDL-C precipitation system [14].…”

Therapeutic apheresis: Technical modalities and therapeutic applications

“…This means that the treatment is generally shorter in time. There are 2 companies which produce whole blood apheresis technology: Kaneka which manufactures the DX21 device ASAHI KASE and the Fresenius Medical Care which produces the DALI device [12].…”

LDL apheresis or PCSK9 inhibition? Sometimes we have to combine them

“…The constant reduction of cholesterol is meant, above all, to prevent the progression or the development of atherosclerosis. [7] Human monoclonal antibodies against PCSK9: alirocumab and evolocumab have recently been approved by the Food and Drug Administration. These agents target and inactivate PCSK9, a hepatic protease that attaches and internalizes LDL receptors into lysosomes hence promoting their destruction.…”