Lipid apheresis, indications, and principles

Abstract

Low-density lipoprotein apheresis (LDL apheresis) is a term that describes a group of apheresis techniques and devices that selectively remove apolipoprotein B containing lipoproteins. A number of different devices are available worldwide, which all effectively remove low-density lipoprotein cholesterol while sparing other important plasma components. LDL apheresis is used to treat familial hypercholesterolemia (FH), an inherited condition of accelerated atherosclerosis and severe coronary artery disease resulting in premature death. It has also been used to treat other disorders, although the evidence for its use is limited. This review describes the underlying pathophysiology of FH, the mechanism of action of the various LDL apheresis devices available, and how LDL apheresis is used to treat this uncommon metabolic condition.

The impact of citrate concentration on adhesion of platelets and leukocytes to adsorbents in whole blood lipoprotein apheresis

“…Two systems for whole blood lipoprotein apheresis are currently in clinical application . They are based on dextran sulfate or polyacrylate, respectively, and the polyacrylate‐based system was chosen for this study.…”

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].…”

Changes in serum afamin and vitamin E levels after selective LDL apheresis

“…The prevalence of heterozygous FH has been reported to be 1/217 in a recent Danish study and 1/250 in an American study using Dutch criteria for diagnosis . An accepted tool for retarding or arresting the atherosclerotic process in FH patients refractory to maximally tolerated pharmacotherapy is LDL apheresis . Beyond its lipid lowering efficacy, LDL apheresis affects several pro‐ and anti‐inflammatory factors involved in the pathophysiology of human atherosclerosis including the complement cascade, the cytokine network and several other inflammatory mediators.…”

“…3 An accepted tool for retarding or arresting the atherosclerotic process in FH patients refractory to maximally tolerated pharmacotherapy is LDL apheresis. 4 Beyond its lipid lowering efficacy, LDL apheresis affects several pro-and anti-inflammatory factors involved in the pathophysiology of human atherosclerosis including the complement cascade, the cytokine network and several other inflammatory mediators. Several studies demonstrated the benefits of LDL apheresis on these factors, most likely due to adsorption of the mediators to the columns.…”