Lipid‐apheresis improves microcirculation of the upper limbs

Abstract

Lipid-apheresis (LA) is thought to improve microcirculation. However, limited data are available on the effects on peripheral microcirculation. We investigated upper limb microcirculation of 22 patients undergoing regular LA on a weekly basis before and after LA. Using standardized semiquantitative scales, we analyzed blood flow, vasomotor function, and erythrocyte aggregation by capillary microscopy. In addition, capillary blood flow in quiescence and under heat and cryo-stress was evaluated by photoplethysmographic and laser Doppler anemometry. Moreover, levels of vasoactive mediators adrenalin, noradrenalin, endothelin-1 (ET-1), atrial natriuretic peptide (ANP), asymmetrical dimethyl-arginine (ADMA), as well as total protein and fibrinogen were measured. We found a significant increase in blood flow, the number of perfused capillaries and an improvement of erythrocyte aggregation by capillary microscopy. Using laser Doppler anemometry, we were able to show that this increase was predominantly located in the superficial layer capillaries (Δ44.53 ± 135.81%, n.s.) and less so in deeper layer arterioles (Δ2.75 ± 24.84%, n.s.). Vascular response to heat and cryo stress was also improved after LA but failed to reach significance. LA significantly reduced levels of epinephrin (-33 ± 39.2%), ANP (-28.8 ± 20.2%), ADMA (-74.1 ± 23%), and fibrinogen (-45.4 ± 19.7%) when comparing before LA and after LA values. In summary, we found an improvement in the microcirculation of the upper limbs under LA, which may result from a decrease of vasoconstrictors, improvement of vasomotor function, and a decrease in blood viscosity or erythrocyte aggregation.

Evaluation of endothelial function and platelet activation in dyslipidemic children

“…Many diseases such as hypercholesterolemia, hypertension, diabetes, cardiovascular disease, and insulin resistance have been noted to be correlated with increased levels of ADMA. Our results were in line with those found by Rossenbach et al, who reported a decrease in ADMA levels (-74.1±23%) via LDL-apheresis (15) . We found significantly lower ADMA levels in post-LDLapheresis homozygous patients when compared with heterozygous hyperlipidemic patients and healthy subjects.…”

Lipoprotein apheresis reduces biomarkers of plaque destabilization and cardiovascular risk

“…In accordance to the already shown and here also observed LA associated decrease of ADMA serum level by approximately 70%, for ADMA the mean plasma half-life is suggested to be 15 min, but is certainly longer in the present cohort suffering from hypercholesterolemia by which ADMA degradation is strongly impaired [12,29]. The previously determined serum half-lifes of the investigated biomarkers are even longer and therefore contribute to the plausibility of the LA induced reduction in the current study (CRP 19h, PAPP-A 53h, VCAM 4h, MMP-9 7-150h) [30][31][32][33].…”

“…ADMA is suggested to play a pivotal role in plaque destabilization and is considered as a cardiovascular risk factor [21]. In the current study there was a reduction of 69.7 6 18.4% (P < 0.01), with the highest value in DALI (88.6 6 1.6%), followed by DFPP (68.6 6 17.3%) and HELP (52.56 6 10.18%) (Data already shown in Rossenbach et al [12]) whereby reduction rates in DALI-treated patients differed significantly from those treated with DFPP (P 5 0.002) or HELP (P 5 0.0039). Intergroup comparison made no significant difference between group A before LA, group B and C, whereas EP ADMA-levels were significant lower compared with the control groups (P < 0.01) (Fig.…”

Lipoprotein apheresis: an update

“…Another group showed an improvement in the micro circulation of the upper limbs under lipoprotein apheresis [49]. After lipoprotein apheresis sessions, the parasympathetic response to cardiovascular stimulation improved and sympathetic outflow to peripheral vasculature was reduced [50].…”