Treatment of Severe Hyperlipidemia: Six Years' Experience with Low–Density Lipoprotein Apheresis

Abstract

In total, 30 patients suffering from familial hypercholesterolemia, resistant to diet and lipid-lowering drugs, were treated for up to 6 years (3.6 + or - 1.6; range, 0.2-6.8 years) with low-density lipoprotein (LDL) apheresis. Three different systems were used; the dextran sulfate adsorption system (Kaneka) for 27 of 30 patients, the immunoadsorption system from Baxter for 2 of 30 patients, and the immunoadsorption system with special lipoprotein(a) (Lp[a]) columns from Lipopak for one patient. Prior to the LDL apheresis, 23 of 30 patients suffered from coronary heart disease. Twenty of 23 patients suffered intermittently from symptoms of angina, excertional dyspnea, and claudication. With LDL apheresis, reductions of 47% for total cholesterol, 49% for LDL, 26% for Lp(a), and 40% for triglycerides were reached. Severe side effects such as shock or allergic reactions were very rare (0.55%). In the course of treatment with LDL apheresis, an improvement in general well-being and increased performance were experienced in 27 of 30 patients. A reduction of nitrate medication between 60 and 100% was observed in 17 of 23 patients. The present data clearly demonstrate that treatment with LDL apheresis in patients suffering from severe familial hyperlipidemia, resistant to maximum conservative therapy, is very effective and safe even over long periods of time.

Lowering Low-Density Lipoprotein Particles in Plasma Using Dextran Sulphate Co-Precipitates Procoagulant Extracellular Vesicles

“…Given the content and procoagulant activity of (V)LDL co-precipitated EVs, one may postulate that concomitant removal of those EVs during apheresis may contribute to the clinical benefits of apheresis beyond lipid lowering [ 8 ]. Apheresis, however, is only used in a small group of patients with severe hypercholesterolemia [ 11 , 12 , 13 , 14 , 15 ]. Statins, a class of drugs that reduce (V)LDL by inhibiting the production of cholesterol, are now also considered as antithrombotic drugs [ 38 ].…”

“…For most hypercholesterolemic patients, a standard diet and lipid-lowering drug therapy are recommended. However, patients with severe hypercholesterolemia, such as homozygous familial hypercholesterolemia, may require additional treatment, such as LDL apheresis, a procedure that eliminates LDL and VLDL from the blood [ 11 , 12 , 13 , 14 , 15 ]. One of the most commonly used methods, dextran sulphate adsorption (DSA), has been reported to deplete blood coagulation factors [ 16 , 17 , 18 , 19 ].…”

Removal of Immunoglobulins by a Protein A Versus an Antihuman Immunoglobulin G‐Based System: Evaluation of 602 Sessions of Extracorporeal Immunoadsorption

“…Reusable double column immunoadsorption systems are currently available in all European countries and also in the United States. Adsorbents are on a sepharose basis and are used, depending on the ligand, for elimination of IgG (7,9–11) and for low density lipoprotein (13). One of the advantages of these systems is their virtually unlimited adsorption capacity due to simultaneous regeneration and adsorption during 1 therapeutic session.…”

Therapeutic Apheresis and Human Monoclonal Antibodies in Non-Immunologic Diseases. TA, HMA in non-immunologic diseases

“…Vasoactive substances released by blood cells are sensed by endothelial cells which are formed by changes in hemodynamic forces such as pressure and shear stress. These endothelial cells synthetize and release biological active substances such as nitride oxide (NO), prostacyclin, endothelium-derived hyperpolarization factor, endothelin, prostaglandin H2, thromboxane A2, heparin sulfate, transforming growth factor, vascular endothelial growth factor, basic fibroblast activator, plasminogen activator inhibitor-1, oxygen free radicals, and others [41][42][43][44]. These substances together form the vascular tone through their relaxing and contracting actions as well as vascular structure through production of growth promoting and growth-inhibiting substances.…”