Intraindividual Comparison of two Extracorporeal LDL Apheresis Methods: Lipidfiltration and HELP

Abstract

Low density lipoprotein (LDL) apheresis is an effective treatment option for patients with severe hypercholesterolemia not adequately responding to diet and drug therapy. Membrane differential filtration (MDF), synonymous with double filtration plasmapheresis (DFPP), here named Lipidfiltration, and heparin-induced extracorporeal LDL-precipitation (HELP) are two of the five methods available for extracorporeal LDL apheresis. In this prospective investigation 6 patients with severe LDL-hypercholesterolemia and CAD were treated in a cross-over design with Lipidfiltration at two stages of technical development and HELP to compare the efficacy of these two LDL apheresis methods with respect to lowering and modifying plasma lipids and rheologically relevant plasma proteins, especially fibrinogen. In total, 44 LDL apheresis sessions were investigated. In weekly intervals, patients were treated with consecutive LDL apheresis sessions with either Lipidfiltration and HELP, treating identical plasma volumes. In one part of the investigation Lipidfiltration was performed with the novel Lipidfilter EC-50, combined with a newly developed blood and plasma therapy machine allowing optimized plasma heating. The results showed that the reduction rates of LDL-cholesterol, lipoprotein(a) and triglycerides were essentially identical for both methods. Also pretreatment levels of total cholesterol, triglycerides, LDL-cholesterol and HDL-cholesterol were not significantly different in both treatment groups. Both methods lead to a significant reduction of serum lipoproteins, especially for LDL-cholesterol, which was decreased by 61.4% with Lipidfiltration (treated plasma volume: 2998 ml) and 61.3% with HELP (treated plasma volume: 3013 ml). With respect to Lipidfiltration LDL-cholesterol reduction was more efficient with the novel Lipidfilter EC-50. Mean pretreatment HDL cholesterol concentrations remained unchanged. Comparing Cascadeflo AC-1770 with the novel Lipidfilter EC-50 reduction rates of HDL-cholesterol (17.4% versus 6.4%) and total protein (17.9% versus 7.8%) were significantly reduced. Lipidfiltration and HELP both resulted in a reduction of plasma viscosity and hemorheologically relevant plasma proteins, like fibrinogen.

Dextran‐sulfate‐adsorption of atherosclerotic lipoproteins from whole blood or separated plasma for lipid‐apheresis—Comparison of performance characteristics with DALI and lipidfiltration

“…Lipidfiltration, also reported as safe and efficient previously [23,33,34], showed an identical elimination of atherogenic lipoproteins, but eliminates fibrinogen with higher efficacy. It has been shown, that Lipidfiltration can be used with either heparin or ACD-A as anticoagulant without differences in efficacy.…”

“…Liposorber DL-100 revealed a significantly higher reduction of fibrinogen than DALI 1000, but still lower compared with plasma treatment with Liposorber LA-15. However, because of the significantly greater fibrinogen elimination in this comparison, Lipidfiltration or HELP-apheresis might be advantageous for patients with elevated fibrinogen levels representing an independent cardiovascular risk factor [23]. The simultaneous reduction of fibrinogen and LDL-cholesterol has previously been shown to improve rheological blood properties.…”

“…Lipidfiltration, a method of LDL-apheresis established in clinical practice for many years, was compared with DSA using the Lipidfilter EC-50, a synthetic polyethylene membrane with an effective surface area of 2.0 m 2 (Asahi Kasei Medical, Tokyo, Japan) together with the Octo Nova (software version 4.27) using tubing systems AV-210, MF-230, and H-300 [23,27]. Plasma was separated from cellular blood components using a polyethylene plasma separator OP-05 (Asahi Kasei Medical, Tokyo, Japan).…”

“…With lipidfiltration, macromolecules like lipoproteins can be eliminated from plasma dependent on their particle size and threedimensional properties. Plasma and proteins with a diameter smaller than 15 nm are filtered through the pores in its outer space and then returned to the patient together with blood cells previously separated from whole blood [15,23].…”

Different inflammatory responses induced by three LDL‐lowering apheresis columns

“…Chemokines (chemotactic cytokines) are important in many diseases including atherosclerotic coronary heart disease [10] and several chemokines correlate with cardiovascular risk [11]. Some studies have compared different apheresis columns regarding immunoglobulins, coagulation, and some inflammatory markers [12][13][14][15][16], but a systematic investigation of how three different columns affect a whole range of biomarkers such as chemokines and complement activation products has not previously been performed. Different column effects could be of great importance for patients facing many years of LDL apheresis and possible column dependent effects on the immune system.…”